Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)

Clin Infect Dis. 2020 Jul 28;71(15):799-806. doi: 10.1093/cid/ciaa351.

Abstract

Background: An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the duration and host factors related to viral shedding.

Methods: In this retrospective study, risk factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding were evaluated in a cohort of 113 symptomatic patients from 2 hospitals outside Wuhan.

Results: The median (interquartile range) duration of SARS-CoV-2 RNA detection was 17 (13-22) days as measured from illness onset. When comparing patients with early (<15 days) and late (≥15 days after illness onset) viral RNA clearance, prolonged SARS-CoV-2 RNA shedding was associated with male sex (P = .009), old age (P = .033), concomitant hypertension (P = .009), delayed admission to hospital after illness onset (P = .001), severe illness at admission (P = .049), invasive mechanical ventilation (P = .006), and corticosteroid treatment (P = .025). Patients with longer SARS-CoV-2 RNA shedding duration had slower recovery of body temperature (P < .001) and focal absorption on radiograph images (P < .001) than patients with early SARS-CoV-2 RNA clearance. Male sex (OR, 3.24; 95% CI, 1.31-8.02), delayed hospital admission (OR, 1.30; 95% CI, 1.10-1.54), and invasive mechanical ventilation (OR, 9.88; 95% CI, 1.11-88.02) were independent risk factors for prolonged SARS-CoV-2 RNA shedding.

Conclusions: Male sex, delayed admission to hospital after illness onset, and invasive mechanical ventilation were associated with prolonged SARS-CoV-2 RNA shedding. Hospital admission and general treatments should be started as soon as possible in symptomatic COVID-19 patients, especially male patients.

Keywords: COVID-19; SARS-COV-2; coronavirus; risk factors; viral shedding.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Betacoronavirus / isolation & purification*
  • Betacoronavirus / pathogenicity
  • COVID-19
  • China / epidemiology
  • Cohort Studies
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / virology*
  • Disease Progression
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / virology*
  • RNA, Viral / isolation & purification*
  • Respiration, Artificial / adverse effects
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Sex Factors
  • Time Factors
  • Time-to-Treatment
  • Virus Shedding*

Substances

  • RNA, Viral