Abstract
BackgroundThe persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmission. There is still uncertainty on whether the recommended quarantine duration is sufficient to reduce the risk of transmission. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19.MethodsIn this hospital-based longitudinal study, 100 confirmed cases of COVID-19 were recruited between March 2020 and August 2020 in Guilan Province, north of Iran. Nasopharyngeal, blood, urine, and stool samples were obtained from each participant at the time of hospital admission, upon discharge, 1 week after discharge, and every 2 weeks until all samples were negative for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) assay. A survival analysis was also performed to identify the duration of viral persistence.ResultsThe median duration of viral RNA persistence in the nasopharyngeal samples was 8 days from the first positive RT-PCR result upon admission (95% CI 6.91–9.09); the maximum duration of viral shedding was 25 days from admission. Positive blood, urine, and stool RT-PCR results were detected in 24%, 7%, and 6% of the patients, respectively. The median duration of viral persistence in the blood, urine, and stool samples was 7 days (95% CI 6.07–7.93), 6 days (95% CI 4.16–8.41), and 13 days (95% CI 6.96–19.4), respectively. Also, the maximum duration of viral persistence in the blood, urine, and stool samples was 17, 11, and 42 days from admission, respectively.ConclusionAccording to the present results, immediately after the hospitalized patients were discharged, no evidence of viral genetic materials was found. Therefore, appropriate treatments were selected for the patients at this hospital. However, we recommend further investigations on a larger sample size in multi-center and prospective randomized controlled trials (RCTs) to evaluate the effects of different drugs on the shedding of the virus through body secretions.
Highlights
Coronavirus disease 2019 (COVID-19) was declared as a global pandemic by the World Health Organization (WHO) in December 2020 [1]
24% of blood reverse transcriptionpolymerase chain reaction (RT-PCR) samples were positive upon admission; one sample remained positive upon discharge and became negative after 1 week
The RT-PCR result was positive in the stool samples of four patients upon admission, and two samples remained positive at discharge
Summary
Coronavirus disease 2019 (COVID-19) was declared as a global pandemic by the World Health Organization (WHO) in December 2020 [1]. There were 1,189,203 confirmed cases of COVID19 and 54,440 deaths in Iran from February 15, 2019, until December 25, 2020 [3]. The main route of COVID-19 transmission seems to be direct or indirect exposure to respiratory droplets [4, 5]. Other routes of transmission, such as motherto-fetus, fecal–oral, and airborne transmission, are currently controversial and subject to future investigations [5,6,7,8], epidemiological studies have shown that COVID19 patients have had close contact with an infected individual or have been in close proximity to a patient [9]. The persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmis‐ sion. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19
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