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Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Virus in Symptomatic Coronavirus Disease 2019 (COVID-19) Outpatients: Host, Disease, and Viral Correlates.
Mollan, Katie R; Eron, Joseph J; Krajewski, Taylor J; Painter, Wendy; Duke, Elizabeth R; Morse, Caryn G; Goecker, Erin A; Premkumar, Lakshmanane; Wolfe, Cameron R; Szewczyk, Laura J; Alabanza, Paul L; Loftis, Amy James; Degli-Angeli, Emily J; Brown, Ariane J; Dragavon, Joan A; Won, John J; Keys, Jessica; Hudgens, Michael G; Fang, Lei; Wohl, David A; Cohen, Myron S; Baric, Ralph S; Coombs, Robert W; Sheahan, Timothy P; Fischer, William A.
  • Mollan KR; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Eron JJ; School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Krajewski TJ; Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Painter W; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Duke ER; School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Morse CG; Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Goecker EA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Premkumar L; Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Wolfe CR; Ridgeback Biotherapeutics LP, Miami, Florida, USA.
  • Szewczyk LJ; Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
  • Alabanza PL; Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  • Loftis AJ; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
  • Degli-Angeli EJ; School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Brown AJ; Duke University Medical Center, Durham, North Carolina, USA.
  • Dragavon JA; Ridgeback Biotherapeutics LP, Miami, Florida, USA.
  • Won JJ; Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Keys J; School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Hudgens MG; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
  • Fang L; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Wohl DA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
  • Cohen MS; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Baric RS; Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Coombs RW; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Sheahan TP; Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States.
  • Fischer WA; Pharstat Inc., Raleigh, North Carolina, USA.
Clin Infect Dis ; 75(1): e1028-e1036, 2022 Aug 24.
Article in English | MEDLINE | ID: covidwho-1621585
ABSTRACT

BACKGROUND:

Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectious virus isolation in outpatients with coronavirus disease 2019 (COVID-19) has been associated with viral RNA levels and symptom duration, little is known about the host, disease, and viral determinants of infectious virus detection.

METHODS:

COVID-19 adult outpatients were enrolled within 7 days of symptom onset. Clinical symptoms were recorded via patient diary. Nasopharyngeal swabs were collected to quantitate SARS-CoV-2 RNA by reverse transcriptase polymerase chain reaction and for infectious virus isolation in Vero E6-cells. SARS-CoV-2 antibodies were measured in serum using a validated ELISA assay.

RESULTS:

Among 204 participants with mild-to-moderate symptomatic COVID-19, the median nasopharyngeal viral RNA was 6.5 (interquartile range [IQR] 4.7-7.6 log10 copies/mL), and 26% had detectable SARS-CoV-2 antibodies (immunoglobulin (Ig)A, IgM, IgG, and/or total Ig) at baseline. Infectious virus was recovered in 7% of participants with SARS-CoV-2 antibodies compared to 58% of participants without antibodies (prevalence ratio [PR] = 0.12, 95% confidence interval [CI] .04, .36; P = .00016). Infectious virus isolation was also associated with higher levels of viral RNA (mean RNA difference +2.6 log10, 95% CI 2.2, 3.0; P < .0001) and fewer days since symptom onset (PR = 0.79, 95% CI .71, .88 per day; P < .0001).

CONCLUSIONS:

The presence of SARS-CoV-2 antibodies is strongly associated with clearance of infectious virus. Seropositivity and viral RNA levels are likely more reliable markers of infectious virus clearance than subjective measure of COVID-19 symptom duration. Virus-targeted treatment and prevention strategies should be administered as early as possible and ideally before seroconversion. CLINICAL TRIALS REGISTRATION NCT04405570.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Communicable Diseases / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adult / Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Communicable Diseases / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adult / Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid