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Differences of Severe Acute Respiratory Syndrome Coronavirus 2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With Coronavirus Disease 2019.
Chest. 2020 11; 158(5):1876-1884.Chest

Abstract

BACKGROUND

The viral shedding duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been fully defined. Consecutive detection of SARS-CoV-2 RNA from respiratory tract specimens is essential for determining duration of virus shedding and providing evidence to optimize the clinical management of coronavirus disease 2019 (COVID-19).

RESEARCH QUESTION

What are the shedding durations of SARS-CoV-2 RNA in the upper and lower respiratory tract specimens? What are their associated risk factors?

STUDY DESIGN AND METHODS

A total of 68 patients with COVID-19 admitted to Wuhan Taikang Tongji Hospital and Huoshenshan Hospital from February 10, 2020, to March 20, 2020, were recruited. Consecutive SARS-CoV-2 RNA detection from paired specimens of nasopharyngeal swab (NPS) and sputum were carried out. The clinical characteristics of patients were recorded for further analysis.

RESULTS

SARS-CoV-2 RNA was detected from NPSs in 48 patients (70.6%), and from sputum specimens in 30 patients (44.1%). The median duration of viral shedding from sputum specimens (34 days; interquartile range [IQR], 24-40) was significantly longer than from NPSs (19 days; IQR, 14-25; P < .001). Elderly age was an independent factor associated with prolonged virus shedding time of SARS-CoV-2 (hazard ratio, 1.71; 95% CI, 1.01-2.93). It was noteworthy that in 9 patients, the viral RNA was detected in sputum after NPS turned negative. Chronic lung disease and steroids were associated with virus detection in sputum, and diabetes mellitus was associated with virus detection in both NPS and sputum.

INTERPRETATION

These findings may impact a test based clearance discharge criteria given patients with COVID-19 may shed virus longer in their lower respiratory tracts, with potential implication for prolonged transmission risk. In addition, more attention should be given to elderly patients who might have prolonged viral shedding duration.

Authors+Show Affiliations

Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China; Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.Department of Pulmonary and Critical Care Medicine, People's Liberation Army Joint Logistic Support Force 920th Hospital, Yunnan, China.Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.Department of Respiratory and Critical Care Medicine, People's Liberation Army Joint Logistic Support Force 900th Hospital, Fuzhou, China.Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Scotland.Centre for Global Health, Usher, University of Edinburgh, Scotland.Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China. Electronic address: dongwx_med@hotmail.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32569635

Citation

Wang, Kun, et al. "Differences of Severe Acute Respiratory Syndrome Coronavirus 2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With Coronavirus Disease 2019." Chest, vol. 158, no. 5, 2020, pp. 1876-1884.
Wang K, Zhang X, Sun J, et al. Differences of Severe Acute Respiratory Syndrome Coronavirus 2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With Coronavirus Disease 2019. Chest. 2020;158(5):1876-1884.
Wang, K., Zhang, X., Sun, J., Ye, J., Wang, F., Hua, J., Zhang, H., Shi, T., Li, Q., & Wu, X. (2020). Differences of Severe Acute Respiratory Syndrome Coronavirus 2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With Coronavirus Disease 2019. Chest, 158(5), 1876-1884. https://doi.org/10.1016/j.chest.2020.06.015
Wang K, et al. Differences of Severe Acute Respiratory Syndrome Coronavirus 2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With Coronavirus Disease 2019. Chest. 2020;158(5):1876-1884. PubMed PMID: 32569635.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differences of Severe Acute Respiratory Syndrome Coronavirus 2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With Coronavirus Disease 2019. AU - Wang,Kun, AU - Zhang,Xin, AU - Sun,Jiaxing, AU - Ye,Jia, AU - Wang,Feilong, AU - Hua,Jing, AU - Zhang,Huayu, AU - Shi,Ting, AU - Li,Qiang, AU - Wu,Xiaodong, Y1 - 2020/06/20/ PY - 2020/03/24/received PY - 2020/06/10/revised PY - 2020/06/12/accepted PY - 2020/6/23/pubmed PY - 2020/11/27/medline PY - 2020/6/23/entrez KW - COVID-19 KW - SARS-CoV-2 KW - nasopharyngeal swab KW - sputum KW - virus shedding SP - 1876 EP - 1884 JF - Chest JO - Chest VL - 158 IS - 5 N2 - BACKGROUND: The viral shedding duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been fully defined. Consecutive detection of SARS-CoV-2 RNA from respiratory tract specimens is essential for determining duration of virus shedding and providing evidence to optimize the clinical management of coronavirus disease 2019 (COVID-19). RESEARCH QUESTION: What are the shedding durations of SARS-CoV-2 RNA in the upper and lower respiratory tract specimens? What are their associated risk factors? STUDY DESIGN AND METHODS: A total of 68 patients with COVID-19 admitted to Wuhan Taikang Tongji Hospital and Huoshenshan Hospital from February 10, 2020, to March 20, 2020, were recruited. Consecutive SARS-CoV-2 RNA detection from paired specimens of nasopharyngeal swab (NPS) and sputum were carried out. The clinical characteristics of patients were recorded for further analysis. RESULTS: SARS-CoV-2 RNA was detected from NPSs in 48 patients (70.6%), and from sputum specimens in 30 patients (44.1%). The median duration of viral shedding from sputum specimens (34 days; interquartile range [IQR], 24-40) was significantly longer than from NPSs (19 days; IQR, 14-25; P < .001). Elderly age was an independent factor associated with prolonged virus shedding time of SARS-CoV-2 (hazard ratio, 1.71; 95% CI, 1.01-2.93). It was noteworthy that in 9 patients, the viral RNA was detected in sputum after NPS turned negative. Chronic lung disease and steroids were associated with virus detection in sputum, and diabetes mellitus was associated with virus detection in both NPS and sputum. INTERPRETATION: These findings may impact a test based clearance discharge criteria given patients with COVID-19 may shed virus longer in their lower respiratory tracts, with potential implication for prolonged transmission risk. In addition, more attention should be given to elderly patients who might have prolonged viral shedding duration. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/32569635/Differences_of_Severe_Acute_Respiratory_Syndrome_Coronavirus_2_Shedding_Duration_in_Sputum_and_Nasopharyngeal_Swab_Specimens_Among_Adult_Inpatients_With_Coronavirus_Disease_2019_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(20)31718-9 DB - PRIME DP - Unbound Medicine ER -