SEX AND PROLONGED VIRUS SHEDDING

Several factors, including male sex, are independently associated with prolonged SARS-CoV-2 RNA shedding in patients with COVID-19, researchers in China report.

Data on viral shedding of SARS-CoV-2 is important for optimizing treatment and preventing transmission of COVID-19, but so far little is known about the pattern of SARS-CoV-2 RNA shedding during the course of the infection.

Dr. Lanjuan Li of Zhejiang University's College of Medicine and First Affiliated Hospital, in Hangzhou City, and colleagues used data from 113 patients with confirmed COVID-19 to evaluate the occurrence of viral RNA clearance in the first 21 days after illness onset.

Among these patients, 69 were cured and discharged in 21 days, 13 remained hospitalized but had viral RNA clearance within 21 days, 29 had viral RNA detectable beyond day 21, and two patients died with viral RNA clearance within 21 days.

Most of the patients had mild symptoms, with only 28.3% diagnosed as having severe illness at admission.

Overall, 74.3% of patients had viral RNA clearance within 21 days after illness onset, with a median duration of viral shedding among these 84 patients of 15 days, the researchers report in Clinical Infectious Diseases.

In multivariable and stepwise analyses, the odds of shedding SARS-CoV-2 RNA beyond day 15 were 3.24-fold higher among male patients, 9.88-fold higher among patients who had invasive mechanical ventilation during hospitalization, and 30% higher among patients whose time from illness onset to hospitalization was more than five days. All of the results were statistically significant.

"These results reinforce guidance that hospital admission and treatments should be started as soon as possible in patients with COVID-19," the authors conclude. "Male patients need particular attention for their prolonged viral RNA shedding, which might be associated with poor treatment outcomes. Understanding the virological dynamics during the process of illness should be helpful in the clinical management of patients with COVID-19."

Dr. Mei Zeng of Children's Hospital of Fudan University, in Shanghai, China, previously reported prolonged virus shedding in the respiratory tract and feces at the convalescent stage of COVID-19 in children. She told Reuters Health by email, "Critically severe patients requiring invasive mechanical ventilation therapy usually shed virus for longer time, and the virus load may be higher and virus replicates more actively. In the future, if effective antiviral drugs are available for treating SARS-CoV-2 infection, severe/critically severe patients will benefit from antiviral treatment."

"To my surprise, the authors found male and delayed admission to the hospital are also associated with longer virus shedding," she said, referring to the new study. "I am not sure these two factors are certain to be associated with longer virus shedding; they need to be further assessed."

Dr. Li did not respond to a request for comments.

SOURCE: https://bit.ly/3bl7V4g Clinical Infectious Diseases, online April 9, 2020.