Associations of clinical characteristics and treatment regimens with the duration of viral RNA shedding in patients with COVID-19

Abstract

ObjectiveThe novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, but the factors influencing viral RNA shedding, which would help inform optimal control strategies, remain unclear. MethodsThe clinical course and viral RNA shedding pattern of 267 consecutive symptomatic COVID-19 patients admitted to the hospital from January 20, 2020 to March 15, 2020 were evaluated retrospectively. ResultsThe median duration of viral RNA shedding was 12 days (interquartile range 8–16 days) after the onset of illness. Of the 267 patients included in this study, 65.2% had viral RNA clearance within 14 days, 88.8% within 21 days, and 94.4% within 28 days. Older age (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.98–1.00; p = 0.04), time lag from illness onset to hospital admission (HR 0.91, 95% CI 0.88–0.94; p < 0.001), diarrhea (HR 0.59, 95% CI 0.36–0.96; p = 0.036), corticosteroid treatment (HR 0.60, 95% CI 0.39–0.94; p = 0.024), and lopinavir/ritonavir use (HR 0.70, 95% CI 0.52–0.94; p = 0.014) were significantly and independently associated with prolonged viral RNA shedding. ConclusionsEarly detection and timely hospital admission may be warranted for symptomatic COVID-19 patients, especially for older patients and patients with diarrhea. Corticosteroid treatment is associated with prolonged viral RNA shedding and should be used with caution. Lopinavir/ritonavir use may be associated with prolonged viral RNA shedding in non-severe patients; further randomized controlled trials are needed to confirm this finding.