Virological assessment of hospitalized patients with COVID-2019
- PMID:32235945
- DOI: 10.1038/s41586-020-2196-x
Virological assessment of hospitalized patients with COVID-2019
Erratum in
- Author Correction: Virological assessment of hospitalized patients with COVID-2019.Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, Niemeyer D, Jones TC, Vollmar P, Rothe C, Hoelscher M, Bleicker T, Brünink S, Schneider J, Ehmann R, Zwirglmaier K, Drosten C, Wendtner C.Wölfel R, et al.Nature. 2020 Dec;588(7839):E35. doi: 10.1038/s41586-020-2984-3.Nature. 2020.PMID:33303961No abstract available.
Abstract
Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
Comment in
- Just one more hygiene practice in COVID-19.Gui D, Pepe G, Magalini S.Gui D, et al.Eur Rev Med Pharmacol Sci. 2020 Apr;24(7):3438-3439. doi: 10.26355/eurrev_202004_20796.Eur Rev Med Pharmacol Sci. 2020.PMID:32329812No abstract available.
- New challenges from Covid-19 pandemic: an unexpected opportunity to enlighten the link between viral infections and brain disorders?Gialluisi A, de Gaetano G, Iacoviello L.Gialluisi A, et al.Neurol Sci. 2020 Jun;41(6):1349-1350. doi: 10.1007/s10072-020-04444-z. Epub 2020 May 6.Neurol Sci. 2020.PMID:32372197Free PMC article.No abstract available.
- It's in our hands: a rapid, international initiative to translate a hand hygiene song during the COVID-19 pandemic.Thampi N, Longtin Y, Peters A, Pittet D, Overy K.Thampi N, et al.J Hosp Infect. 2020 Jul;105(3):574-576. doi: 10.1016/j.jhin.2020.05.003. Epub 2020 May 6.J Hosp Infect. 2020.PMID:32387744Free PMC article.No abstract available.
- Return to work for healthcare workers with confirmed COVID-19 infection.Zhang JC, Findlater A, Cram P, Adisesh A.Zhang JC, et al.Occup Med (Lond). 2020 Jul 17;70(5):345-346. doi: 10.1093/occmed/kqaa092.Occup Med (Lond). 2020.PMID:32432325Free PMC article.No abstract available.
References
- Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat. Microbiol. 5, 536–544 (2020).
- WHO. Report of the WHO–China Joint Mission on Coronavirus Disease 2019 (COVID-19)https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mis... (WHO, 2020).
- Hoffmann, M. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 181, 271–280 (2020).
- Leung, G. M. et al. The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients. Ann. Intern. Med. 141, 662–673 (2004). - DOI
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