학술논문
Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Virus in Symptomatic Coronavirus Disease 2019 (COVID-19) Outpatients: Host, Disease, and Viral Correlates.
Document Type
Article
Author
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
Source
Subject
*REVERSE transcriptase polymerase chain reaction
*SARS-CoV-2
*COVID-19
*IMMUNOGLOBULINS
*CONFIDENCE intervals
*RISK assessment
*COMPARATIVE studies
*ENZYME-linked immunosorbent assay
*OUTPATIENT services in hospitals
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Language
ISSN
1058-4838
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. [ABSTRACT FROM AUTHOR]