Abstract
Data on the clinical course and duration of viral RNA detection in patients with mild or asymptomatic coronavirus disease 2019 are limited. In this retrospective analysis, clinical characteristics and serial real-time reverse transcriptase-polymerase chain reaction (RT-PCR) results were reviewed in a cohort of 1186 asymptomatic and mildly symptomatic coronavirus disease 2019 patients in South Korea. Factors associated with prolonged duration of RT-PCR positivity for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) were also evaluated. Patients with two consecutive negative RT-PCR tests ≥ 24 hours apart were considered to be in virologic remission and discharged. The average virologic remission period, defined as the number of days from diagnosis to virologic remission, was 22.0 ± 9.7 days; patients with longer than 30 days accounted for 21.2% (251/1186) of the population. Patients who took longer than 30 days to achieve virologic remission had a higher frequency of overall symptoms (p < 0.001) and respiratory symptoms (p < 0.001). In multivariate analysis using Cox-proportional hazard regression, it was confirmed that respiratory symptoms (hazard ratio [HR], 0.7372; 95% confidence interval [CI], 0.6540-0.8311) and gastrointestinal symptoms (HR, 0.8213; 95% CI, 0.6970-0.9679) were independent factors associated with prolonged virologic remission. Age and co-morbidity such as diabetes and hypertension were not associated with the prolonged RT-PCR positivity. A considerable percentage of asymptomatic and mildly symptomatic patients with coronavirus disease 2019 showed prolonged RT-PCR positivity for SARS-CoV-2; which was independently associated with the presence of symptoms, but not with age and co-morbidity.
Highlights
Data on the clinical course and duration of viral RNA detection in patients with mild or asymptomatic coronavirus disease 2019 are limited
We retrospectively identified 1242 asymptomatic and mildly symptomatic patients who had tested positive for SARS-CoV-2 by RT-PCR and had been admitted to one of three community treatment centers (CTCs) or a regional center hospital dedicated for COVID-19 in the DaeguGyeongbuk providence of South Korea between Feb 21 to Apr 29, 2020: Daegu 1 CTC, Daegu 2 CTC, Gyeongbuk-Daegu 7, and Daegu Dongsan hospital
Comparison of clinical characteristics The clinical characteristics of the study patients were compared by dividing the period from diagnosis to discharge into two Gender Male Female Age Mean ± SD < 50 ≥ 50 Comorbidity None Any comorbidity Hypertension Diabetes Dyslipidemia Respiratory disease Other Symptom None Any symptoms Fever Respiratory Gastrointestinal Headache Other
Summary
Data on the clinical course and duration of viral RNA detection in patients with mild or asymptomatic coronavirus disease 2019 are limited. Conclusions: A considerable percentage of asymptomatic and mildly symptomatic patients with coronavirus disease 2019 showed prolonged RT-PCR positivity for SARS-CoV-2; which was independently associated with the presence of symptoms, but not with age and co-morbidity. While the largest proportion of cases are mild, the clinical spectrum of severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) can vary from asymptomatic to the most serious conditions that lead to hospitalization and death [4,5]. The proportion of those infected with COVID-19 who are undiagnosed or have minimal symptoms, but can still actively transmit the disease, propels the expansion of the pandemic [6]. It is crucial to properly isolate and monitor the asymptomatic and mildly symptomatic patients
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