Persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19: a hospital-based longitudinal study

Abstract

Background The persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmission. There is still uncertainty on whether the recommended quarantine duration is sufficient to reduce the risk of transmission. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19. Methods In this hospital-based longitudinal study, 100 confirmed cases of COVID-19 were recruited between March 2020 and August 2020 in Guilan Province, north of Iran. Nasopharyngeal, blood, urine, and stool samples were obtained from each participant at the time of hospital admission, upon discharge, 1 week after discharge, and every 2 weeks until all samples were negative for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) assay. A survival analysis was also performed to identify the duration of viral persistence. Results The median duration of viral RNA persistence in the nasopharyngeal samples was 8 days from the first positive RT-PCR result upon admission (95% CI 6.91–9.09); the maximum duration of viral shedding was 25 days from admission. Positive blood, urine, and stool RT-PCR results were detected in 24%, 7%, and 6% of the patients, respectively. The median duration of viral persistence in the blood, urine, and stool samples was 7 days (95% CI 6.07–7.93), 6 days (95% CI 4.16–8.41), and 13 days (95% CI 6.96–19.4), respectively. Also, the maximum duration of viral persistence in the blood, urine, and stool samples was 17, 11, and 42 days from admission, respectively. Conclusion According to the present results, immediately after the hospitalized patients were discharged, no evidence of viral genetic materials was found. Therefore, appropriate treatments were selected for the patients at this hospital. However, we recommend further investigations on a larger sample size in multi-center and prospective randomized controlled trials (RCTs) to evaluate the effects of different drugs on the shedding of the virus through body secretions.

Persistent viral RNA shedding of SARS-CoV-2 is associated with delirium incidence and six-month mortality in hospitalized COVID-19 patients

“…Persistent viral shedding is a known marker of initial disease severity and varies extensively based on viral infection type, corticosteroid/antiretroviral treatment, and host immunity [ 8 , 30 ]. However, SARS-CoV-2 viral load has not necessarily correlated with disease severity, though current literature remains conflicting [ 31 , 32 ].…”

“…Evaluation for persistent viral RNA shedding is one method to track recovery and long-term response to severe viral infections. Detection of persistent viral shedding is influenced by initial disease severity, viral load, and sample source [ 8 – 10 ]. The phenomenon of persistent viral shedding is well-studied and demonstrated in numerous other viruses with broad public health impact, including avian influenza A [ 11 ], Zika [ 12 ], and Ebola [ 13 ].…”

Persistence of SARS-CoV-2 in COVID-19 patients during the second wave of the pandemic in India

“…Our study found no significant association between the persistence of SARS-CoV-2 positivity till the 6 th week with underlying comorbid conditions or demographic variables in the patients. This finding could be supported by the study by Joukaret al who stated that no significant associations were found between clinical and demographic characteristics of patients and duration of SARS-CoV-2 RNA persistence [20]. On the contrary, Shu et al reported that prolonged SARS-CoV-2 RNA positivity was significantly associated and underlying comorbid conditions (p = 0.029) [5].…”

Disorders of gut-brain interaction in post-acute COVID-19 syndrome

“…14 Through a longitudinal study, Joukar et al showed persistence of the virus for a mean duration of 13 days compared with lower duration in blood and urine samples. 15…”