Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Virus in Symptomatic Coronavirus Disease 2019 (COVID-19) Outpatients: Host, Disease, and Viral Correlates.

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.

• Authors: Katie R Mollan, Joseph J Eron, Taylor J Krajewski, Wendy Painter, Elizabeth R Duke, Caryn G Morse, Erin A Goecker, Lakshmanane Premkumar, Cameron R Wolfe, Laura J Szewczyk, Paul L Alabanza, Amy James Loftis, Emily J Degli-Angeli, Ariane J Brown, Joan A Dragavon, John J Won, Jessica Keys, Michael G Hudgens, Lei Fang, David A Wohl, Myron S Cohen, Ralph S Baric, Robert W Coombs, Timothy P Sheahan, William A Fischer
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 75 Issue 1 Pg. e1028-e1036 (08 24 2022) ISSN: 1537-6591 [Electronic] United States
• PMID: 35022711 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Antibodies, Viral
• Immunoglobulin A
• RNA, Viral

Topics

• Adult
• Antibodies, Viral
• COVID-19
• COVID-19 Testing
• Communicable Diseases
• Humans
• Immunoglobulin A
• Outpatients
• RNA, Viral
• SARS-CoV-2