Persistent SARS-CoV-2 RNA Shedding Without Evidence of Infectiousness: A Cohort Study of Individuals With COVID-19
Daniel Owusu, Mary Pomeroy, Nathaniel M. Lewis, Ashutosh Wadhwa, Anna R. Yousaf, Brett Whitaker, Elizabeth A. Dietrich, Aron J. Hall, Victoria Chu, Natalie J. Thornburg, Kimberly Christensen, Tair Kiphibane, Sarah Willardson, Ryan P. Westergaard, Trivikram Dasu, Ian W. Pray, Sanjib Bhattacharyya, Angela Dunn, Jacqueline E. Tate, Hannah L. Kirking, Almea Matanock, Household Transmission Study Team, Lindsey M. Duca, Elizabeth M. Rabold, Radhika Gharpure, Henry Njuguna, Patrick Dawson, Erin E. Conners, Victoria L. Fields, Phillip P. Salvatore, Perrine Marcenac, Hannah E. Reses, Mark Fajans, Rebecca L. Laws, Sherry Yin, Dongni Ye, Eric Pevzner, Katherine Battey, Cuc H. Tran, Michelle O’Hegarty, Jeni Vuong, Rebecca J. Chancey, Christopher J. Gregory, Michelle Banks, Jared R. Rispens, Sandra Lester, Lisa Mills, Alicia M. Fry, Scott A. Nabity, Brandi Freeman, Sean Buono
Abstract
BACKGROUND: To better understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding and infectivity, we estimated SARS-CoV-2 RNA shedding duration, described participant characteristics associated with the first negative rRT-PCR test (resolution), and determined if replication-competent viruses was recoverable ≥10 days after symptom onset. METHODS: We collected serial nasopharyngeal specimens from 109 individuals with rRT-PCR-confirmed COVID-19 in Utah and Wisconsin. We calculated viral RNA shedding resolution probability using the Kaplan-Meier estimator and evaluated characteristics associated with shedding resolution using Cox proportional hazards regression. We attempted viral culture for 35 rRT-PCR-positive nasopharyngeal specimens collected ≥10 days after symptom onset. RESULTS: The likelihood of viral RNA shedding resolution at 10 days after symptom onset was approximately 3%. Time to shedding resolution was shorter among participants aged <18 years (adjusted hazards ratio [aHR], 3.01; 95% confidence interval [CI], 1.6-5.6) and longer among those aged ≥50 years (aHR, 0.50; 95% CI, .3-.9) compared to participants aged 18-49 years. No replication-competent viruses were recovered. CONCLUSIONS: Although most patients were positive for SARS-CoV-2 for ≥10 days after symptom onset, our findings suggest that individuals with mild to moderate COVID-19 are unlikely to be infectious ≥10 days after symptom onset.