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Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 270-274, 2020 May 25.
Article in Chinese | MEDLINE | ID: covidwho-238993


OBJECTIVE: To investigate the clinical outcome of patients with moderate type of coronavirus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid. METHODS: Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantined in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the quarantined period, the symptoms and signs were documented, and sputum or nasal swab and feces samples were collected to test SARS-CoV-2 nucleic acid by RT-PCR method. RESULTS: There was no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-CoV-2 nucleic acid at 5 to 7 days after they met the discharge criteria. CONCLUSIONS: There is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.

Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , RNA, Viral , Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Feces/chemistry , Feces/virology , Follow-Up Studies , Humans , Patient Discharge/statistics & numerical data , Pneumonia, Viral/diagnosis , Quarantine/statistics & numerical data , RNA, Viral/analysis , Reverse Transcriptase Polymerase Chain Reaction , Time Factors
Nature ; 581(7809): 465-469, 2020 05.
Article in English | MEDLINE | ID: covidwho-23868


Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. 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 transmission6-8. 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 upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.

Betacoronavirus/immunology , Betacoronavirus/isolation & purification , Coronavirus Infections/immunology , Coronavirus Infections/virology , Hospitalization , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Seroconversion , Virus Replication , Antibodies, Viral/analysis , Antibodies, Viral/immunology , Base Sequence , Betacoronavirus/genetics , Betacoronavirus/pathogenicity , Blood/virology , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Feces/chemistry , Feces/virology , Humans , Immunoglobulin G/analysis , Immunoglobulin G/immunology , Immunoglobulin M/analysis , Immunoglobulin M/immunology , Lung/virology , Pandemics , Pharynx/virology , Pneumonia, Viral/diagnosis , Polymorphism, Single Nucleotide/genetics , RNA, Viral/analysis , Sputum/virology , Urine/virology , Viral Envelope Proteins/genetics , Viral Load/immunology , Virus Shedding