Virological assessment of hospitalized patients with COVID-2019

Wölfel, Roman; Corman, Victor M.; Guggemos, Wolfgang; Seilmaier, Michael; Zange, Sabine; Müller, Marcel A.; Niemeyer, Daniela; Jones, Terry C.; Vollmar, Patrick; Rothe, Camilla; Höelscher, Michael; Bleicker, Tobias; Brünink, Sebastian; Schneider, Julia; Ehmann, Rosina; Zwirglmaier, Katrin; Drosten, Christian; Wendtner, Clemens

doi:10.1038/s41586-020-2196-x

Cited by 6,592 publications

(7,754 citation statements)

References 28 publications

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“…Both provide insights of the transmissibility of COVID19, but from two different aspects. Our findings are largely consistent with the currently available data of viral shedding studies in the close contacts and the confirmed cases[10][11]. However, a difference should be noticed that the infection time distribution is more likely to be affected by the sociological factors and non-pharmaceutical interventions performed by local public health authorities.Our findings should be interpreted with caution.…”

supporting

confidence: 91%

Estimating the presymptomatic transmission of COVID19 using incubation period and serial interval data

Zhang

2020

Preprint

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We estimated the fraction and timing of presymptomatic transmissions of COVID19 with mathematical models combining the available data of the incubation period and serial interval. We found that up to 79.7% transmissions could be presymptomatic among the imported cases in China outside Wuhan. The average timing of presymptomatic transmissions is 3.8 days (SD = 6.1) before the symptom onset, which is much earlier than previously assumed.

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supporting

confidence: 91%

Estimating the presymptomatic transmission of COVID19 using incubation period and serial interval data

Zhang

2020

Preprint

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“…The SARS-CoV-2 load to municipal wastewater was estimated using excretion rates in human stool recently reported by Zhang et al, (2020e) and Wölfel et al (2020), and assuming a fecal load in the range of 100 -400 g feces/day/person, and a fecal density of 1.06 g/mL (Brown and Butler, 1996).…”

Section: Estimation Of Initial Sars-cov-2 Loads In Wastewatermentioning

confidence: 99%

“…This mass load translates into concentrations of 0.15 to 141.5 million viral genomes per liter of wastewater generated in North America and Europe. This is based on the presence of between a reported 600,000 (Zhang et al, 2020e) to 30,000,000 (Wölfel et al, 2020) viral genomes of SARS-CoV-2 per mL of fecal material, and assuming a fecal load of 100 -400 g feces/day/person with a density of 1.06 g/mL (Brown and Butler, 1996). A further refinement of the lower and upper bounds estimate is desirable and will be informed by future studies providing more comprehensive information on virus shedding by symptomatic and asymptomatic infected individuals.…”

Section: Virus Occurrence and Detectability In Wastewatermentioning

confidence: 99%

“…When first proposed for tracking of SARS-CoV-2, the prevailing scientific opinion was that the virus may be shed into wastewater at insufficiently high rates, and that both the virus itself and its RNA may be too labile to facilitate detection in wastewater. Recent reports of coronavirus shedding in human stool (Gao et al, 2020;Holshue et al, 2020;Jiehao et al, 2020;Tang et al, 2020;Wölfel et al, 2020;Zhang et al, 2020a;2020c;2020d;2020e) and three preliminary reports of successful SARS-CoV-2 detection in municipal wastewater from the Netherlands the United States and Australia have dispelled some of these concerns (Ahmed 2020, Lodder 2020, Medema et al 2020, Wu et al 2020). Yet, considerable uncertainty remains as to what information may be gleaned from monitoring for SARS-CoV-2 RNA in wastewater and whether a WBE assay, once perfected and shown to be Journal Pre-proof J o u r n a l P r e -p r o o f 5 reproducible across different laboratories, will be sensitive enough to inform public health responses.…”

Section: Introductionmentioning

confidence: 99%

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Computational analysis of SARS-CoV-2/COVID-19 surveillance by wastewater-based epidemiology locally and globally: Feasibility, economy, opportunities and challenges

Hart

Halden

2020

Science of The Total Environment

510

520

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Journal Pre-proof J o u r n a l P r e -p r o o f 2 Abstract:With the economic and practical limits of medical screening for SARS-CoV-2/COVID-19 coming sharply into focus worldwide, scientists are turning now to wastewater-based epidemiology (WBE) as a potential tool for assessing and managing the pandemic. We employed computational analysis and modeling to examine the feasibility, economy, opportunities and challenges of enumerating active coronavirus infections locally and globally using WBE.Depending on local conditions, detection in community wastewater of one symptomatic/asymptomatic infected case per 100 to 2,000,000 non-infected people is theoretically feasible, with some practical successes now being reported from around the world. Computer simulations for past, present and emerging epidemic hotspots (e.g., Wuhan, Milan, Madrid, New York City, Teheran, Seattle, Detroit and New Orleans) identified temperature, average in-sewer travel time and per-capita water use as key variables. WBE surveillance of populations is shown to be orders of magnitude cheaper and faster than clinical screening, yet cannot fully replace it. Cost savings worldwide for one-time national surveillance campaigns are estimated to be in the million to billion US dollar range (US$), depending on a nation's population size and number of testing rounds conducted. For resource poor regions and nations, WBE may represent the only viable means of effective surveillance. Important limitations of WBE rest with its inability to identify individuals and to pinpoint their specific locations. Not compensating for temperature effects renders WBE data vulnerable to severe under-/overestimation of infected cases. Effective surveillance may be envisioned as a two-step process in which WBE serves to identify and enumerate infected cases, where after clinical testing then serves to identify infected individuals in WBE-revealed hotspots. Data provided here demonstrate this approach to save money, be broadly applicable worldwide, and potentially aid Journal Pre-proof J o u r n a l P r e -p r o o f 3 in precision management of the pandemic, thereby helping to accelerate the global economic recovery that billions of people rely upon for their livelihoods.

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“…Although these particular studies relate to longitudinal studies of infected patients, the data is not disaggregated per patient. Some authors have however presented sequential test data from individual patients [5,6,10] . Here we use the latter type of data to characterise how the probability of a false-negative test result depends on the number of days between the onset of symptoms and the performance of the test and how this is affected by the site from which swabs are taken.…”

Section: Introductionmentioning

confidence: 99%

Estimating false-negative detection rate of SARS-CoV-2 by RT-PCR

Wikramaratna

Paton

Ghafari

2020

Preprint

152

167

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Reverse transcription-polymerase chain reaction (RT-PCR) assays are used to test patients and key workers for infection with the causative SARS-CoV-2 virus. RT-PCR tests are highly specific and the probability of false positives is low, but false negatives can occur if the sample contains insufficient quantities of the virus to be successfully amplified and detected. The amount of virus in a swab is likely to vary between patients, sample location (nasal, throat or sputum) and through time as infection progresses. Here, we analyse publicly available data from patients who received multiple RT-PCR tests and were identified as SARS-CoV-2 positive at least once. We identify that the probability of a positive test decreases with time after symptom onset, with throat samples less likely to yield a positive result relative to nasal samples. Empirically derived distributions of the time between symptom onset and hospitalisation allowed us to comment on the likely false negative rates in cohorts of patients who present for testing at different clinical stages. We further estimate the expected numbers of false negative tests in a group of tested individuals and show how this is affected by the timing of the tests. Finally, we assessed the robustness of these estimates of false negative rates to the probability of false positive tests. This work has implications both for the identification of infected patients and for the discharge of convalescing patients who are potentially still infectious.

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Virological assessment of hospitalized patients with COVID-2019

Cited by 6,592 publications

References 28 publications

Estimating the presymptomatic transmission of COVID19 using incubation period and serial interval data

Estimating the presymptomatic transmission of COVID19 using incubation period and serial interval data

Computational analysis of SARS-CoV-2/COVID-19 surveillance by wastewater-based epidemiology locally and globally: Feasibility, economy, opportunities and challenges

Estimating false-negative detection rate of SARS-CoV-2 by RT-PCR

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