Novel coronavirus can live in body for 37 days, remains detectable until death

Adult inpatients with the 2019 coronavirus disease (COVID-19) are at an increased risk of mortality if they are older, have high Sequential Organ Failure Assessment (SOFA) score and d-dimer >1 μg/mL, according to a China study. Viral shedding can last for up to 37 days among survivors, while the virus appears to be detectable until death among nonsurvivors.

“The potential risk factors of older age, high SOFA score and d-dimer >1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage,” the researchers said. “Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.”

In total, 191 adult inpatients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital; aged ≥18 years) with laboratory-confirmed COVID-19 who had been discharged or had died by 31 January 2020 were included in this retrospective, multicentre cohort study.

The researchers extracted demographic, clinical, treatment and laboratory data, including serial samples for viral RNA detection, from electronic medical records and compared these between survivors and nonsurvivors. They used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.

Of the patients, 137 were discharged and 54 died in hospital. Ninety-one (48 percent) patients had a comorbidity, with hypertension being the most common (30 percent), followed by diabetes (19 percent) and coronary heart disease (8 percent). [Lancet 2020;doi:10.1016/S0140-6736(20)30566-3]

In a multivariate regression model, a higher risk of in-hospital death was associated with older age (odds ratio [OR] per year increase, 1.10, 95 percent confidence interval [CI], 1.03–1.17; p=0.0043), higher SOFA score (OR, 5.65, 95 percent CI, 2.61–12.23; p<0.0001) and d-dimer >1 μg/mL (OR, 18.42, 95 percent CI, 2.64–128.55; p=0.0033) on admission.

Viral shedding had a median duration of 20.0 days (interquartile range, 17.0–24.0) in survivors. Notably, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, remained detectable until death in nonsurvivors. The longest observed duration of viral shedding in survivors was almost 5 weeks (37 days).

“[W]e found that the detectable SARS-CoV-2 RNA persisted for a median of 20 days in survivors and that it was sustained until death in nonsurvivors,” the researchers said. “This has important implications for both patient isolation decision making and guidance around the length of antiviral treatment.”

Prolonged viral shedding in severe influenza virus infection could lead to fatal outcome, while delayed antiviral treatment correlated with prolonged virus detection. [J Infect Dis 2018;217:1708-1717]

“Similarly, effective antiviral treatment might improve outcomes in COVID-19, although we did not observe shortening of viral shedding duration after lopinavir/ritonavir treatment in the current study,” the researchers said.

Randomized clinical trials are still ongoing for lopinavir/ritonavir (ChiCTR2000029308) and intravenous remdesivir (NCT04257656, NCT04252664) in the treatment of COVID-19, they added.

SARS-CoV-2 was first detected in Wuhan City, China, in December 2019. As of 19 March 2020, there are close to 200,000 cases of COVID-19 across the globe, with nearly 8,000 deaths recorded.