Coronavirus disease 2019 (COVID -19) is an acute infection of the respiratory tract that emerged in late 2019 1,2 . Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses 3 . This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung 2,4 ; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 2003 5 . However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre-or oligosymptomatic transmission 6-8 . There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the

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Coronavirus disease 2019 (COVID-19) is an acute respiratory tract infection thatemerged in late 2019 1,2 . Initial outbreaks in China involved 13.8% cases with severe-, and 6.1% with critical courses 3 . This severe presentation corresponds to the usage of a virus receptor that is expressed predominantly in the lung 2,4 . By causing an early onset of severe symptoms, this same receptor tropism is thought to have determined pathogenicity but also aided the control of severe acute respiratory syndrome (SARS) in 2003 5 . However, there are reports of COVID-19 cases with mild upper respiratory tract symptoms, suggesting a potential for pre-or oligosymptomatic transmission 6-8 .There is an urgent need for information on body site -specific virus replication, immunity, and infectivity. Here we provide a detailed virological analysis of nine All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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