Virological assessment of hospitalized patients with COVID-2019
Abstract
Coronavirus disease 2019 (COVID-19) is an acute respiratory tract infection that emerged in late 20191,2. Initial outbreaks in China involved 13.8% cases with severe, and 6.1% with critical courses3. This severe presentation corresponds to the usage of a virus receptor that is expressed predominantly in the lung2,4.
By causing an early onset of severe symptoms, this same receptor
tropism is thought to have determined pathogenicity, but also aided the
control, of severe acute respiratory syndrome (SARS) in 20035.
However, there are reports of COVID-19 cases with mild upper
respiratory tract symptoms, suggesting the potential for pre- or
oligosymptomatic transmission6–8. There is an urgent need for
information on body site-specific virus replication, immunity, and
infectivity. Here we provide a detailed virological analysis of nine
cases, providing proof of active virus replication in upper respiratory
tract tissues. Pharyngeal virus shedding was very high during the first
week of symptoms (peak at 7.11 × 108 RNA copies per throat
swab, day 4). Infectious virus was readily isolated from throat- and
lung-derived samples, but not from stool samples, in spite of high virus
RNA concentration. Blood and urine never yielded virus. Active
replication in the throat was confirmed by viral replicative RNA
intermediates in throat samples. Sequence-distinct virus populations
were consistently detected in throat and lung samples from the same
patient, proving independent replication. Shedding of viral RNA from
sputum outlasted the end of symptoms. Seroconversion occurred after 7
days in 50% of patients (14 days in all), but was not followed by a
rapid decline in viral load. COVID-19 can present as a mild upper
respiratory tract illness. Active virus replication in the upper
respiratory tract puts the prospects of COVID-19 containment in
perspective.
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Supplementary Information
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file contains Supplementary Methods, which include a description of RNA
extraction and RT-PCR methods, a description of cell culture and
antibody detection methods and Supplementary References.
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Wölfel, R., Corman, V.M., Guggemos, W. et al. Virological assessment of hospitalized patients with COVID-2019.
Nature (2020). https://doi.org/10.1038/s41586-020-2196-x
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