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. 2021 Jan 11;12(1):267.
doi: 10.1038/s41467-020-20568-4.

Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19)

Jeroen J A van Kampen  1 , David A M C van de Vijver  2 , Pieter L A Fraaij  2   3 , Bart L Haagmans  2 , Mart M Lamers  2 , Nisreen Okba  2 , Johannes P C van den Akker  4 , Henrik Endeman  4 , Diederik A M P J Gommers  4 , Jan J Cornelissen  5 , Rogier A S Hoek  6   7 , Menno M van der Eerden  6 , Dennis A Hesselink  7   8 , Herold J Metselaar  7   9 , Annelies Verbon  10 , Jurriaan E M de Steenwinkel  10 , Georgina I Aron  2 , Eric C M van Gorp  2 , Sander van Boheemen  2 , Jolanda C Voermans  2 , Charles A B Boucher  2 , Richard Molenkamp  2 , Marion P G Koopmans  2 , Corine Geurtsvankessel  2 , Annemiek A van der Eijk  2
Affiliations

Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19)

Jeroen J A van Kampen et al. Nat Commun. .

Abstract

Key questions in COVID-19 are the duration and determinants of infectious virus shedding. Here, we report that infectious virus shedding is detected by virus cultures in 23 of the 129 patients (17.8%) hospitalized with COVID-19. The median duration of shedding infectious virus is 8 days post onset of symptoms (IQR 5-11) and drops below 5% after 15.2 days post onset of symptoms (95% confidence interval (CI) 13.4-17.2). Multivariate analyses identify viral loads above 7 log10 RNA copies/mL (odds ratio [OR] of 14.7 (CI 3.57-58.1; p < 0.001) as independently associated with isolation of infectious SARS-CoV-2 from the respiratory tract. A serum neutralizing antibody titre of at least 1:20 (OR of 0.01 (CI 0.003-0.08; p < 0.001) is independently associated with non-infectious SARS-CoV-2. We conclude that quantitative viral RNA load assays and serological assays could be used in test-based strategies to discontinue or de-escalate infection prevention and control precautions.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Viral loads and duration of symptoms for infectious virus shedding.
Viral RNA loads (Log10 RNA copies/mL) in the respiratory samples versus the duration of symptoms (days). Black boxes represent virus culture positive samples and open red circles represent the virus culture negative samples.
Fig. 2
Fig. 2. Probabilities of infectious virus shedding.
Probit analyses of the detection of infectious virus in respiratory samples with cell culture for duration of symptoms in days (A) (n = 690 samples), viral RNA load in Log10 copies per mL (B) (n = 688 samples), and serum neutralizing antibody titer (C) (n = 112 samples). Blue line represent the probit curve and the dotted red lines represent the 95% confidence interval. Serum neutralizing antibody titers are expressed as plaque-reduction neutralization titers 50% as described previously.
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