Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19)
Jeroen J. A. van Kampen, David van de Vijver, Pieter L. A. Fraaij, Bart L. Haagmans, Mart M. Lamers, Nisreen M.A. Okba, Johannes P. C. van den Akker, Henrik Endeman, Diederik Gommers, Jan J. Cornelissen, Rogier A.S. Hoek, Menno M. van der Eerden, Dennis A. Hesselink, Herold J. Metselaar, Annelies Verbon, Jurriaan E.M. de Steenwinkel, Georgina I. Aron, Eric C. M. Van Gorp, Sander van Boheemen, Jolanda J.C. Voermans, Charles A. Boucher, Richard Molenkamp, Marion Koopmans, Corine H. GeurtsvanKessel, Annemiek A. van der Eijk
Abstract
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 log 10 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.