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Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients: A systematic review and meta-analysis.
EBioMedicine. 2020 Aug; 58:102916.E

Abstract

BACKGROUND

The spatial and temporal dynamics of SARS-CoV-2 have been described in case series and retrospective studies. In this study, we provide a coherent overview of the duration of viral detection and viral RNA load in COVID-19 patients, stratified by specimen type, clinical severity, and age.

METHOD

We systematically searched PubMed/MEDLINE and Cochrane review database for studies published between 1.11.2019 and 23.04.2020. We pooled the data of selected studies (22/7226 (650 patients) for meta-analysis) to estimate duration of viral detection and visualized viral load over time.

FINDINGS

Our analysis showed consistent viral detection from specimen from the upper respiratory tract (URT), the lower respiratory tract (LRT), and faeces, irrespective of the clinical severity of COVID-19. Our analysis suggests that SARS-CoV-2 persists for a longer duration in the LRT compared to the URT in adult patients (5•7 days in mild; 5•9 days in moderate-severe patients). The differences in the duration of viral detection between mild and moderate-severe patients is limited in the LRT, but an indication of longer duration of viral detection for moderate-severe patients was observed in feces (15 days in mild vs. 21 days in moderate-severe patients) and the URT (12 days in mild vs. 16 days in moderate-severe patients). Further, viral load was demonstrated to peak in earlier stages of infection in the URT compared to LRT.

INTERPRETATION

This review may aid mathematical modelling and help in defining appropriate endpoints for clinical trails with antivirals in COVID-19.

FUNDING

The project has received funding support from Innovation Fund Denmark.

Authors+Show Affiliations

UNION therapeutics, Tuborg Havnevej 18, 2900 Hellerup, Denmark.UNION therapeutics, Tuborg Havnevej 18, 2900 Hellerup, Denmark.UNION therapeutics, Tuborg Havnevej 18, 2900 Hellerup, Denmark; Novo Nordisk Foundation Center for Biosustainability, Technical University Denmark, Kemitorvet 220, 2800 Lyngby, Denmark. Electronic address: morten.sommer@uniontherapeutics.com.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32711256

Citation

Weiss, Anne, et al. "Spatial and Temporal Dynamics of SARS-CoV-2 in COVID-19 Patients: a Systematic Review and Meta-analysis." EBioMedicine, vol. 58, 2020, p. 102916.
Weiss A, Jellingsø M, Sommer MOA. Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients: A systematic review and meta-analysis. EBioMedicine. 2020;58:102916.
Weiss, A., Jellingsø, M., & Sommer, M. O. A. (2020). Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients: A systematic review and meta-analysis. EBioMedicine, 58, 102916. https://doi.org/10.1016/j.ebiom.2020.102916
Weiss A, Jellingsø M, Sommer MOA. Spatial and Temporal Dynamics of SARS-CoV-2 in COVID-19 Patients: a Systematic Review and Meta-analysis. EBioMedicine. 2020;58:102916. PubMed PMID: 32711256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients: A systematic review and meta-analysis. AU - Weiss,Anne, AU - Jellingsø,Mads, AU - Sommer,Morten Otto Alexander, Y1 - 2020/07/22/ PY - 2020/05/28/received PY - 2020/07/02/revised PY - 2020/07/10/accepted PY - 2020/7/28/pubmed PY - 2020/9/4/medline PY - 2020/7/26/entrez KW - COVID-19 KW - SARS-CoV-2 KW - Systematic review KW - Viral dynamics SP - 102916 EP - 102916 JF - EBioMedicine JO - EBioMedicine VL - 58 N2 - BACKGROUND: The spatial and temporal dynamics of SARS-CoV-2 have been described in case series and retrospective studies. In this study, we provide a coherent overview of the duration of viral detection and viral RNA load in COVID-19 patients, stratified by specimen type, clinical severity, and age. METHOD: We systematically searched PubMed/MEDLINE and Cochrane review database for studies published between 1.11.2019 and 23.04.2020. We pooled the data of selected studies (22/7226 (650 patients) for meta-analysis) to estimate duration of viral detection and visualized viral load over time. FINDINGS: Our analysis showed consistent viral detection from specimen from the upper respiratory tract (URT), the lower respiratory tract (LRT), and faeces, irrespective of the clinical severity of COVID-19. Our analysis suggests that SARS-CoV-2 persists for a longer duration in the LRT compared to the URT in adult patients (5•7 days in mild; 5•9 days in moderate-severe patients). The differences in the duration of viral detection between mild and moderate-severe patients is limited in the LRT, but an indication of longer duration of viral detection for moderate-severe patients was observed in feces (15 days in mild vs. 21 days in moderate-severe patients) and the URT (12 days in mild vs. 16 days in moderate-severe patients). Further, viral load was demonstrated to peak in earlier stages of infection in the URT compared to LRT. INTERPRETATION: This review may aid mathematical modelling and help in defining appropriate endpoints for clinical trails with antivirals in COVID-19. FUNDING: The project has received funding support from Innovation Fund Denmark. SN - 2352-3964 UR - https://www.unboundmedicine.com/medline/citation/32711256/Spatial_and_temporal_dynamics_of_SARS_CoV_2_in_COVID_19_patients:_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-3964(20)30291-7 DB - PRIME DP - Unbound Medicine ER -