April 13, 2021

COVID-19 Patient Shed SARS-CoV-2 Up to 70 Days

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Long-term SARS-CoV-2 shedding was observed from the upper respiratory tract of a female immunocompromised patient with chronic lymphocytic leukemia and acquired hypogammaglobulinemia.

Long-term SARS-CoV-2 shedding was observed from the upper respiratory tract of a female immunocompromised patient with chronic lymphocytic leukemia and acquired hypogammaglobulinemia, according to a Case Study: Prolonged infectious SARS-CoV-2 shedding from an asymptomatic immunocompromised cancer patient.

A COVID-19 patient whose immune system had been weakened by treatment for leukemia shed SARS-CoV-2 for up to 70 days, much longer than typical COVID-19 patients, NIAID scientists and colleagues report in Cell. SARS-CoV-2 is the virus that causes COVID-19. The finding could help inform treatment and testing considerations for COVID-19 patients with weakened immune systems

the report says shedding of infectious SARS-CoV-2 was observed up to 70 days, and genomic and subgenomic RNA up to 105 days past initial diagnosis.

The infection was not cleared after a first treatment with convalescent plasma, suggesting limited impact on SARS-CoV-2 in the upper respiratory tract within this patient. Several weeks after a second convalescent plasma transfusion, SARS-CoV-2 RNA was no longer detected.

We observed marked within-host genomic evolution of SARS-CoV-2, with continuous turnover of dominant viral variants. However, replication kinetics in Vero E6 cells and primary human alveolar epithelial tissues were not affected.

Our data indicate that certain immunocompromised patients may shed infectious virus for longer durations than previously recognized. Detection of subgenomic RNA is recommended in persistently SARS-CoV-2 positive individuals as a proxy for shedding of infectious virus.


credit: National Institute of Allergy and Infectious Diseases (NIAID)

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