Median Duration Of Viral Shedding Research Articles

Prolonged Viral Shedding in Cancer Patients with Asymptomatic or Mild Omicron Infection: A Retrospective Study.

This study aimed to investigate the risk factors for persistent viral shedding in cancer patients after Omicron infection. Patients with asymptomatic or mild Omicron infection (≥18 years) who were treated in a makeshift hospital in Shanghai were enrolled from 9 Apr to 11 May, 2022. Deidentified information of all patients were collected retrospectively. Logistic regression model was used to identify risk factors associated with prolonged duration of viral shedding (defined as the time from the day of first positive SARS-CoV-2 RNA test to the first day of two consecutive negative SARS-CoV-2 RNA tests). A total of 1442 Omicron-infected patients were enrolled, including 129 cancer patients and 1313 non-cancer patients. The baseline clinical characteristics of cancer and non-cancer patients were balanced by propensity score matching (1:4). Compared with non-cancer patients, a higher odds ratio ([OR] 1.84, 95% CI 1.24-2.76, P = 0.003) of lasting viral shedding for ≥7 days was found in cancer patients. Further subgroup analyses found that cancer patients were at higher risk for prolonged viral shedding in a subgroup of patients without hypertension (OR 1.89), diabetes (OR 1.80), or other chronic disease (OR 2.13), unvaccinated (OR 1.97), and asymptomatic (OR 2.36). In addition, 29 patients with active cancer and 19 patients with inactive cancer were identified. The median duration of viral shedding in the active cancer group was longer than that in the inactive cancer group (10 vs 6 days, P = 0.002). The risk of persistent viral shedding ≥7 days was also increased in the active cancer group (OR 5.33, 95% CI 1.49-21.51, P = 0.013). Cancer disease is an independent risk factor for prolonged viral shedding in Omicron infected patients, especially in patients with active cancer.

Outcomes and Management of Sars-CoV2 Omicron Variant in Recipients of Hematopoietic Cell Transplantation (HCT) and CAR-T Therapy

HCT or CAR-T therapy recipients who develop COVID-19 have decreased overall survival (68% Sharma et al. Lancet Haematol. 2021), likely due to disease-inherent and therapy-related immunodeficiency. The development of specific COVID therapies and vaccination during the pandemic has changed the prevention and management of COVID-19 infection. Nevertheless, with the appearance of new SARS-CoV2 variants and omicron, in particular, questions about the severity of disease in high-risk patients are yet to be defined. Methods We included retrospectively 218 adult HCT/CAR-T recipients diagnosed with presumed COVID-19 omicron variant at Memorial Sloan Kettering Cancer Center (MSK), New York, between December 2021 and February 2022. Data were analyzed using SPSS version 26 (IBM, Armonk, NY). Results Among 218 patients, 107 received an autologous HCT, 92 allogeneic HCT, and 19 CAR-T. The median age was 58 years (range, 21 to 87), and 56% were male. The median time from HCT/CAR-T to SARS-CoV2 infection was 44 months (range, 0.1 to 272 months), and 27 patients (12%) acquired SARS-CoV2 within the first 100 days post-HCT/CAR-T. The primary hematologic diagnoses were plasma cell (37%), myeloid (37%), and lymphoid (26%) malignancies. Myeloablative conditioning was performed in 90 patients (41%). In the alloHCT recipients, 17 donors (18%) were matched related, 51 (55%) matched unrelated, 19 (21%) umbilical cord blood, and 5 (6%) haploidentical. 31% patients had 2 or more comorbidities and 9% received IVIG for hypogammaglobulinemia within the prior month. Of note, 40% of the patients were on active cancer therapy (maintenance or treatment) at the time of COVID-19 infection, and 47% of the alloHCT recipients were on GVHD immunosuppressive treatment. Characteristics of COVID-19 omicron variant infection are shown in Table1. Specific COVID-19 treatment was administered in 111 patients (51%) and included MoAbs in 63 patients (56.7%), sotrovimab being the most frequently used (n=55, 87 %), remdesivir (n= 23, 21%), and other antivirals (n= 15, 14%). Risk factors for admission were presence of > 3 comorbidities (HR, 6.2; 95% CI 2.3-16.3, p= 0.000), progression of disease (POD) (HR, 3.8; 95% CI 1.6-8.9, p= 0.002,) and CAR-T therapy (HR 4.5; 95% CI 1.4-14.1p= 0.008). Regarding vaccination status, 84% (n= 183) of the cohort was vaccinated with mRNA Covid-19 vaccines, with 42% of patients having 1 booster before COVID19 infection. Interestingly, only 15/35 (42%) of the booster patients with measured serologic response showed SARS-CoV-19 Antibodies value> 2500 BAU/I. Nineteen patients showed low titer COVID-19 antibodies (<2500 BAU/I) testing after COVID-19 infection: 3 patients died (2 for POD, 1 for COVID), 3 were not vaccinated, 1 patient had to be revaccinated after HCT, and 6 patients were administered tixagevimab/cilgavimab for future prophylaxis. Persistent/Long COVID were present in 8 (3.5%) patients, showing fatigue and URI symptoms 5/8 (62%) had a previous admission for COVID-19 infection and 5/8 (62%) had a negative spike antibody titer before infection. The median duration of viral shedding (positive SARS-CoV-2 PCR) was 11 weeks (range, 3.2 to 19.1 weeks). After a median follow up of 4 months (range, 0 to 8 months), 21 patients (9.6%) had recurrent COVID infection, and two of them died. The overall mortality rate was 10% in all patients (22/218 patients), with 2.5% (6/22) attributable to COVID. Other causes of death were progressive disease (n=13), sepsis (n=1), and hepatic VOD (n=1). Comparing our omicron cohort with the initial 77 HCT & CAR-T patients infected with first wave COVID-19 in March 2020 at our institution, overall survival at 30 days was 94% vs 78% (p=0.010) (Figure 1). Conclusions In our cohort, mortality attributable to the COVID-19 omicron variant was low (2.5%), and only 19% required admission. Risk factors for admission were presence of 3 or more comorbidities, POD at time of COVID infection, and CAR-T therapy. Altogether our date confirms enhanced overall survival (94%) in HCT, and CART recipients infected with the omicron variant of SARS-CoV2 as compared to prior waves of the COVID-19 pandemic. Access to SARS-COV-2 specific treatments and the higher incidence of vaccination in this cohort appear to be key factors to successfully managing patients in order to reduce COVID-19 mortality. Pre-exposure prophylaxis became available later and is also likely important. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Lessons Learned from COVID-19 Pandemic: Outcomes after Sars-Cov-2 Infection in Hematopoietic Cell Transplant and Cell Therapy Recipients

Background: Coronavirus disease 2019 (COVID-19), a respiratory illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic in March 2020. Over 500 million cases of SARS-CoV-2 have been reported worldwide, with over 90 million being in the US. More than 6 million lives, with over 1 million only from the US, have been claimed by the pandemic. Hematopoietic cell transplant (HCT) or chimeric antigen receptor-T (CART) cell therapy recipients have a higher risk of mortality with COVID-19. In this updated analysis, we investigated the outcomes after SARS-CoV-2 infection in HCT/CART recipients. Methods: We conducted a single-center prospective study, including all (n=196) adult HCT/CART recipients who were diagnosed with COVID-19 at the University of Kansas Medical Center from March 2020 to March 2022. Baseline and disease-related characteristics were ascertained from medical records. Data were analyzed using SPSS version 21 (SPSS Inc, Chicago, IL). Bivariate analyses, using the chi-square and t-test, were performed. Kaplan-Meier and cox regression analyses were conducted. Results: The study included 196 HCT/CART recipients who acquired SARS-CoV-2 infection, including allogeneic HCT (n=91, 46%), autologous HCT (n=89, 46%), and CART (n=16, 8%) recipients. The median age was 59.8 (21.9-79.5) years; 76.5% were Caucasians and 58% were males. The median time since HCT/CART to SARS-CoV-2 infection was 25.4 (0.2-201.9) months, and 12% of patients acquired SARS-CoV-2 within the first 100 days post-HCT/CAR-T. Plasma cell (37%), myeloid (34%), lymphoid (28%) or solid (1%) malignancies were primary diagnoses. Myeloablative conditioning was performed in 64% of patients. Donors were autologous (53%), matched sibling (12%), matched unrelated (21%), and haploidentical (14%). Prior acute graft-versus-host disease (GVHD), prior chronic GVHD, active GVHD, and current immunosuppressive therapy (IST) were noted in 20%, 26.5%, 23.5%, and 25.5% of patients respectively. Concurrent infections were observed in 12% of patients. COVID-19 severity was mild (n=136, 70%), moderate (n=24, 12%), severe (n=20, 10%) or critical/fatal (n=16, 8%). Clinical findings included pneumonia or abnormal chest imaging (31%), hypoxia (19%), intensive care unit admission (9%), and mechanical ventilation (6%). Therapies included remdesivir (31%), convalescent plasma (11%), dexamethasone (15%), monoclonal antibodies (32%), and tocilizumab/baricitinib (5%). At least one dose of SARS-CoV-2 vaccine was reported in 70% of patients (45% pre-COVID, 25% post-COVID) while 3% of patients had received pre-exposure prophylaxis. The median duration of viral shedding (positive SARS-CoV-2 PCR) was 6.5 (0.3-23.4) weeks. After a median follow-up of 5.4 (0.3-24.8) months, the mortality rate was 12% with COVID-specific mortality of 8%. Of allogeneic HCT patients, 18% (n=16) developed subsequent GVHD after COVID-19 requiring systemic steroids and additional immunosuppression. Eighty-four (43%) patients were diagnosed with COVID after Sep 2021 and had the lowest COVID-specific mortality (2% compared to 12.5% in preceding months of the pandemic). Significant predictors of COVID-19 mortality included allogeneic HCT (HR 3.7, 95% CI 1.2-11.6, p=0.023), COVID-19 within 100 days of HCT/CART (HR 4.8, 95% CI 1.7-13.2, p=0.002), COVID-19 diagnosis earlier in the pandemic (HR 5.2, 95% CI 1.1-24.4, p=0.037), prior acute GVHD (HR 3.2, 95% CI 1.2-8.5, p=0.022), active GVHD (HR 3.5, 95% CI 1.3-9.2, p=0.013), and concurrent IST (OR 7.0, 95% CI 2.4-20.1, p<0.001) while prior SARS-CoV-2 vaccination significantly reduced the COVID-19 mortality (HR 0.19, 95% CO 0.05-0.68, p=0.010). In 15 patients with available data, vaccination induced protective anti-spike protein antibody response (>100 U/mL) in 67% of patients with a median titer of 656 (9-688,000) U/mL after completion of the primary vaccination series. Conclusion: Hematopoietic stem cell transplant and CART cell therapy recipients have a higher risk of morbidity and mortality with SARS-CoV-2 infection. Our findings highlight factors associated with COVID-19 mortality in HCT/CAR-T recipients. In HCT/CART recipients, strict vigilance, infection prevention measures, vaccination prioritization, close monitoring, and early aggressive treatment interventions are suggested for COVID-19 and future emerging infectious diseases. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinical characteristics of patients with confirmed and asymptomatic SARS-CoV-2 infection in China.

To examine the clinical characteristics of patients with asymptomatic novel coronavirus disease 2019 (COVID-19) and compare them with those of patients with mild disease. A retrospective cohort study. Multiple medical centers in Wuhan, Hubei, China. A total of 3,263 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between February 4, 2020, and April 15, 2020. Patient demographic characteristics, medical history, vital signs, and laboratory and chest computed tomography (CT) findings. A total of 3,173 and 90 patients with mild and moderate, and asymptomatic COVID-19, respectively, were included. A total of 575 (18.2%) symptomatic patients and 4 (4.4%) asymptomatic patients developed the severe illness. All asymptomatic patients recovered; no deaths were observed in this group. The median duration of viral shedding in asymptomatic patients was 17 (interquartile range, 9.25-25) days. Patients with higher levels of ultrasensitive C-reactive protein (odds ratio [OR] = 1.025, 95% confidence interval [CI], 1.01-1.04), lower red blood cell volume distribution width (OR = 0.68, 95% CI 0.51-0.88), lower creatine kinase Isoenzyme(0.94, 0.89-0.98) levels, or lower lesion ratio (OR = 0.01, 95% CI 0.00-0.33) at admission were more likely than their counterparts to have asymptomatic disease. Patients with younger ages and fewer comorbidities are more likely to be asymptomatic. Asymptomatic patients had similar laboratory characteristics and longer virus shedding time than symptomatic patients; screen and isolation during their infection were helpful to reduce the risk of SARS-CoV-2 transmission.

Duration of viral shedding in patients with COVID-19 and the redetectable positive cases with SARS-CoV-2: A hospital experience.

ABSTRACTBackground:The study aimed to estimate the duration of viral shedding (DVS) in patients with confirmed coronavirus disease 2019 (COVID-19), investigated the factors affecting that duration, and identified the redetectable positive (RP) cases in the recovered COVID-19 patients in Prince Sultan Military Medical City (PSMMC).Methods:The study was a retrospective record base design in the PSMMC that included 171 confirmed COVID-19 patients from 15 March to 31 May 2020. Their clinical characteristics and laboratory findings were retrieved and reviewed based on the PSMMC COVID-19 database and the Ministry of Health (MOH) Health Electronic Surveillance Network. Data analysis used the SPSS software package to measure the DVS, explore its potential factors, and identify the RP cases. The data presented as frequency distribution tables, medians, and interquartile range (IQR). Mann–Whitney U and Kruskal–Wallis tests compared the medians to explore the significant variables that affect DVS.Results:The median DVS was 11 days, IQR was 7 to 15 days, and statistically significant longer the patient presented with fever (P = 0.025), among health care workers (HCWs) (P = 0.020), and the age group above 65 (P = 0.039). Overall, 13 patients (7.6%) were RP, statistically significantly higher among the contacts to confirmed COVID-19 cases.Conclusions:The DVS in PSMMC COVID-19 patients is comparable to the isolation period approved by MOH. Fever was a risk factor for a prolonged DVS, advised an extended follow-up period for these patients. RP cases were significantly higher among the contacts to COVID-19 cases than non-contacts. The study suggests future comprehensive research on the RP characteristics.

Prolonged Viral Shedding in Vertically Acquired SARS-CoV-2 Infection in Preterm Infants–Shedding Versus Infectivity

The reported median duration of viral shedding after infection with SARS-CoV2 is between 12 and 20 days. It is now established that infected individuals can continue to shed viral ribonucleic acid (RNA) without shedding live virus. This has implications for quarantine and infection control practices. COVID in the acute phase seems to be milder in children, and the duration of viral RNA shedding is shorter in children compared to adults. SARS-CoV-2 infections in the newborn period is rare. Little is known about the duration of viral shedding in preterm infants with vertically acquired SARS-CoV-2. 3 of the 4 preterm infants cared for at our center had prolonged shedding up to 34 days with live viral shedding not seen beyond the second week when tested in 3 of them.

Administration of HeberFERON in Patients with Persistent Oropharyngeal SARS-CoV-2 Wuhan/D614G Strain Viral Shedding

Study background: HeberFERON accelerates SARS-CoV-2 clearance in COVID-19 cases. Considering this we evaluated the employment of HeberFERON in patients with more than 14 days of viral shedding. Methods: This is a case series study of mild or moderate ill patients with laboratory-confirmed SARS-CoV-2 from one hospital in Havana, Cuba. We evaluated the effect and safety of HeberFERON in patients previously treated with Heberon Apha R that resulted with prolonged viral shedding. All patients received lopinavir-ritonavir 200/50 mg every 12 h and chloroquine 250 mg every 12 h. The primary endpoint was the time to negativization of viral RNA in patients with persistent viral shedding. The protocol was approved by the Ethics Committee of the Luis Diaz Soto Hospital. Results: The characteristics of the individuals included the age ranged from 19-87 years with a mean of 40 years, (Study and Control I groups), while in the Control group II the mean age was 43.8 years. Leukocytes, platelets, neutrophils, and eosinophils, show a significantly lower counts in the groups with viral persistence. Under IFN treatment the median viral shedding duration from diagnosis were 21 days and 19 days in Study group and Control group II, respectively. The Control group I showed a median viral shedding of 11 days (log-rank p = 0.000). Significant longer median viral negativization time (19 days) of symptomatic than asymptomatic patients (11 days, Long-rank p = 0.004), was observed. In patients under Heberon Alpha R treatment that resulted persistent for viral presence, the median time to viral negativization was 7 days for the period of administration of HeberFERON. Being symptomatic at diagnosis was significantly associated with viral persistence. The HeberFERON showed an adequate safety profile. Conclusion: HeberFERON showed a safe and rapid negativization of patients with viral persistence, achieving negativization in more than 50% of patients in 7 days.

Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients

Coronavirus disease 2019 (COVID-19), a respiratory illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic in March 2020, and has caused more than 600,000 deaths in the United States at the time of this report. Hematopoietic stem cell transplantation (HCT) or chimeric antigen receptor T cell (CAR-T) therapy recipients have a higher risk of mortality with COVID-19 owing to profound immune dysregulation. In this study, we investigated the impact of SARS-CoV-2 in HCT/CAR-T therapy recipients. This single-center prospective study included all (n = 58) adult HCT/CAR-T recipients who were diagnosed with COVID-19 at the University of Kansas Medical Center between March 2020 and May 2021. Baseline and disease-related characteristics were ascertained from medical records. Data were analyzed using SPSS version 21 (IBM, Armonk, NY). Bivariate analyses, using the chi-square and t-test, and logistic regression analyses were conducted. The study included 58 HCT/CAR-T patients who acquired SARS-CoV-2 infection, including recipients of allogeneic HCT (n = 32), autologous HCT (n = 23), and CAR-T therapy (n = 3). The median patient age was 58 years (range, 24 to 77 years), and 64% were males. The median time from HCT/CAR-T therapy to SARS-CoV-2 infection was 17.7 months (range, 0.2 to 201.9 months), and 22% of the patients acquired SARS-CoV-2 within the first 100 days post-HCT/CAR-T therapy. The primary hematologic disorders were plasma cell (36%), myeloid (38%), and lymphoid (26%) malignancies. Myeloablative conditioning was performed in 62% of patients. Donors were autologous (45%), matched sibling (15%), matched unrelated (21%), and haploidentical (19%). Prior history of grade II-IV acute graft-versus-host disease (GVHD), active GVHD, and current immunosuppressive therapy (IST) was noted in 22%, 31%, and 36% of patients, respectively. Concurrent infections were observed in 19%. Lymphopenia (P = .049) and high serum ferritin concentration (P = .020) were associated with mortality. COVID-19 severity was mild in 50% of the patients, moderate in 22%, and severe in 28%. Clinical findings included pneumonia or abnormal chest imaging (in 50%), hypoxia (28%), intensive care unit admission (19%), and mechanical ventilation (10%). Therapies included remdesivir (in 41%), convalescent plasma (35%), dexamethasone (22%), monoclonal antibodies (19%), and tocilizumab (3%). The median duration of viral shedding (positive SARS-CoV-2 PCR) was 7.7 weeks (range, 2 to 18.7 weeks), and 2 patients had a persistent infection for >5 months post-CAR-T therapy. After a median follow-up of 6.1 months (range, 0.5-13.6 months), the mortality rate was 16% in all patients and 28% in allogeneic HCT recipients. Among 9 patients who died, the median survival after SARS-CoV-2 infection was 23 days (range, 14 to 140 days). In survivors with moderate-severe COVID-19, the median time to recovery was 4.2 weeks (range, 1.1 to 24.7 weeks). Among allogeneic HCT recipients, 5 (16%) developed subsequent pulmonary chronic GVHD necessitating systemic steroids and additional IST. Significant predictors of COVID-19 severity included allogeneic HCT (odds ratio [OR], 3.6, 95% confidence interval [CI], 1.2 to 10.8; P = .020), history of grade II-IV acute GVHD (OR, 4.6; 95% CI, 1.10 to 18.86; P = .036) and concurrent IST (OR, 5.9; 95% CI, 1.8 to 19.8; P = .004). HCT and CAR-T cell therapy recipients are at an increased risk of moderate-severe COVID-19 pneumonia and higher mortality with SARS-CoV-2 infection. Our findings confirm the need for continuing vigilance with social distancing and masks, vaccination prioritization, close monitoring, and aggressive treatment of HCT/CAR-T therapy recipients.

Detectable antibodies against SARS-CoV-2 in newborns from mothers infected with COVID-19 at different gestational ages

Detectable antibodies against SARS-CoV-2 in newborns from mothers infected with COVID-19 at different gestational ages

Clinical characteristics and potential factors for recurrence of positive SARS-CoV-2 RNA in convalescent patients: a retrospective cohort study.

BackgroundThe recurrence of positive SARS-CoV-2 RT-PCR is frequently found in discharged COVID-19 patients but its clinical significance remains unclear. The potential cause, clinical characteristics and infectiousness of the recurrent positive RT-PCR patients need to be answered.MethodsA single-centered, retrospective study of 51 discharged COVID-19 patients was carried out at a designated hospital for COVID-19. The demographic data, clinical records and laboratory findings of 25 patients with recurrent positive RT-PCR from hospitalization to follow-up were collected and compared to 26 patients with negative RT-PCR discharged regularly during the same period. Discharged patients’ family members and close contacts were also interviewed by telephone to evaluate patients’ potential infectiousness.ResultsThe titer of both IgG and IgM antibodies was significantly lower (p = 0.027, p = 0.011) in patients with recurrent positive RT-PCR. Median duration of viral shedding significantly prolonged in patients with recurrent positive RT-PCR (36.0 days vs 9.0 days, p = 0.000). There was no significant difference in demographic features, clinical features, lymphocyte subsets count and inflammatory cytokines levels between the two groups of patients. No fatal case was noted in two groups. As of the last day of follow-up, none of the discharged patients’ family members or close contact developed any symptoms of COVID-19.ConclusionsPatients with low levels of IgG and IgM are more likely to have recurrent positive SARS-CoV-2 RT-PCR results and lead to a prolonged viral shedding. The recurrent positive of SARS-CoV-2 RT-PCR may not indicate the recurrence or aggravation of COVID-19. The detection of SARS-CoV-2 by RT-PCR in the patients recovered from COVID-19 is not necessarily correlated with the ability of transmission.

Characteristics of Viral Shedding in Respiratory Samples and Specific Antibodies Production in 564 COVID-19 Patients.

SummaryPositive nucleic acid (NA) results have been found in recovered and discharged COVID-19 patients, but the proportion is unclear. This study was designed to analyze the recurrent positive rate of NA results after consecutively negative results, and the relationship between the specific antibody production and positive NA rate. According to Strengthening the Reporting of Observational Studies in Epidemiology guidelines, data of inpatients in Sino-French New City Branch of Tongji Hospital between Jan. 28 and Mar. 6, 2020 were collected. A total of 564 COVID-19 patients over 14 years old who received the examinations of NA and antibodies against SARS-CoV-2 were included. Days of viral shedding and specific antibodies were recorded and assessed. Among NA tests in respiratory samples (throat swabs, nasopharyngeal swabs, sputum and flushing fluid in alveoli), the patients with all-negative NA results accounted for 17.20%, those with single-positive results for 46.63%, and those with multiple-positive results for 36.17% respectively. Besides, the recurrent positive NA results after consecutively negative results appeared in 66 patients (11.70%). For multiple-positive patients, median viral shedding duration was 20 days (range: 1 to 57 days). Of the 205 patients who received 2 or more antibody tests, 141 (68.78%) had decreased IgG and IgM concentrations. IgM decreased to normal range in 24 patients, with a median of 44 days from symptom onset. Viral shedding duration was not significantly correlated with gender, age, disease severity, changes in pulmonary imaging, and antibody concentration. It is concluded that antibody level and antibody change had no significant correlation with the positive rate of NA tests and the conversion rate after continuous negative NA tests. In order to reduce the recurrent positive proportion after discharge, 3 or more consecutive negative NA test results with test interval more than 24 h every time are suggested for the discharge or release from quarantine.

Epidemiological Characteristics of 64 Covid-19 Patients in Errachidia Province (Darâa-Tafilalet region), Morocco: A Retrospective Analysis

At the time of writing this paper, no data was available for the clinical and epidemiological characteristics of African patients with COVID-19. Herein, we profiled retrospectively the epidemiological characteristics (clinical, laboratory, radiological, treatment, and clinical outcomes) of 64 confirmed cases of COVID-19 in the Regional Hospital Center (RHC) of Errachidia in Morocco. The aim of this study was to analyze the epidemiological characteristics and laboratory Findings of Covid-19 patients in Errachidia Province, Morocco. This is a retrospective single-center study that included all COVID-19 confirmed patients (died or discharged) hospitalized in the Regional Center of Errachidia, Morocco, between March 20, 2020 and May 23, 2020. Patients were confirmed by real-time RT-PCR and epidemiological, demographic, clinical, laboratory, treatment, and outcomes of patients were extracted manually from patient's medical records. In a total of 64 patients with COVID-19, 60.9% of patients were men, with a mean age of 41.5 years (SD 18.62). At the admission, 38 patients were asymptomatic (59.4%), and 58 (90.6%) were clinically classified as being in a benign state. Chronic illnesses were the most comorbidities observed, including diabetes with 8 cases (12.5%), hypertension 3 cases (4.7%), and hyperlipidemia 1 patient (1.6%). The main symptoms were cough 15 (23.4%), fever 10 (15.6), diarrhea 8 (12.5%), headache 5 (7.8%), and sore throat 5 (7.8%). Only 7 patients (10.9%) had lung lesions, and lymphopenia was present in only 7 patients (11.1%). The median duration of viral shedding was 14.5 days (9-22). Concerning deceased cases, they were elderly subjects aged 69.75 years, and they have presented dyspnea, breathing problems, and respiratory distress as specific symptoms. In addition, an increase of the medians of serum AST, CRP, and glucose levels was noticed in this group. During hospitalization, they presented acute respiratory distress syndrome (ARDS), and they were transferred to intensive care before they died. This study revealed that covid-19 infection often appeared in a benign form in the studied population (90.6% in this study). This finding may incriminate the implication of some protective parameters such as genetic, nutritional or other factors in the Moroccan population.

Nutritional Support and Clinical Outcome of Severe and Critical Patients With COVID-19 Pneumonia.

Background: In 2020, a novel coronavirus has spread throughout the world. More than four hundred thousand people have died of SARS-CoV-2 pneumonia, most of which were severe and critical patients. No effective antiviral treatment has been verified thus far. Nutrition support has become one of the important treatments for severe and critical patients.Methods: In this retrospective study, 26 severe patients and 22 critical patients with laboratory confirmed COVID-19 were enrolled. We recorded the diet and nutritional treatments in severe and critical patients. Baseline characteristics and clinical outcomes of severe and critical patients were also collected.Results: Average calorie intake of severe patients (19.3 kcal/kg/d) was higher than critical patients (15.3 kcal/kg/d) (P = 0.04). Protein intake was similar in the two groups (0.65 and 0.62 g/kg per day, respectively; P = 0.29). There was no significant difference in the median duration of viral shedding between the severe and critical patients (P = 0.354).Conclusions: A permissive underfeeding strategy that restricts non-protein calories but preserves protein intake is feasible for critical patients with SARS-CoV-2 pneumonia. Viral shedding duration of critical patients was the same as severe patients who received standard feeding. Nevertheless, evidence of the conclusion is not sufficient because of small sample size. To show the real clinical benefit of permissive low-calorie and adequate protein intake in critical SARS-CoV-2 pneumonia patients, a large and pragmatic randomized controlled trial is needed.

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

ObjectivesWe aimed to compare the antiviral effect of hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/r) in patients with COVID-19. MethodsNationwide retrospective case-control study was conducted to compare the effect of HCQ and LPV/r on viral shedding duration among patients with mild-to-moderate COVID-19 using the reimbursement data of National Health Insurance Service. After propensity score matching (PSM), multivariate analysis was conducted to determine statistically significant risk factors associated with prolonged viral shedding. ResultsOverall, 4197 patients with mild-to-moderate COVID-19 were included. Patients were categorized into three groups: LPV/r (n = 1268), HCQ (n = 801), and standard care without HCQ or LPV/r (controls, n = 2128). The median viral shedding duration was 23 (IQR 17–32), 23 (IQR 16–32), and 18 (IQR 12–25) days in the LPV/r, HCQ, and control groups, respectively. Even after PSM, the viral shedding duration was not significantly different between LPV/r and HCQ groups: 23 (IQR, 17–32) days versus 23 (IQR, 16–32) days. On multivariate analysis, old age, malignancy, steroid use, and concomitant pneumonia were statistically significant risk factors for prolonged viral shedding. ConclusionThe viral shedding duration was similar between HCQ and LPV/r treatment groups. There was no benefit in improving viral clearance compared to the control group.

Retrospective analysis of the effect of current clinical medications and clinicopathological factors on viral shedding in COVID-19 patients.

The aim of the present study was to identify the risk factors associated with prolonged shedding in patients with coronavirus disease 2019 (COVID-19), and to evaluate the effects of current clinical and clinicopathological factors on viral shedding in patients. A total of 186 COVID-19 inpatients were enrolled in this multicentre retrospective analysis. Detailed clinical data of each patient were collected, and the factors that affected the duration of viral shedding were retrospectively analysed. The median duration of viral shedding in the 186 COVID-19 patients was 13 days. The median duration of viral shedding was 12 days in non-severe patients, and 17 days in severe patients, and there was a significant difference between the two groups (P<0.001). Multi-factor regression analysis suggested that the onset-hospitalization interval [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.15-1.41; P<0.001] and comorbidity with a chronic disease (OR, 2.43; 95% CI, 1.14-5.17; P=0.021) were independent risk factors for prolonged viral shedding, whereas lopinavir/ritonavir (LPV/r) was an independent protective factor (OR, 0.28; 95% CI, 0.11-0.75; P=0.011). Spearman's rank correlation analysis showed that the onset-drug interval was positively correlated with the duration of viral shedding (r=0.446; P<0.0001). Umifenovir, and low and short courses of glucocorticoids were not associated with prolonged viral shedding. The prolonged viral shedding was the initial causative factor of persistent aggravation of the patient's conditions. The interval between presentation of symptoms and hospitalization as well as complications with a comorbid chronic disease were independent risk factors for prolonged viral shedding. LPV/r shortened the duration of viral shedding, and the smaller the interval between presentation and LPV/r onset was, the faster viral shedding occurred.

Compare the epidemiological and clinical features of imported and local COVID-19 cases in Hainan, China

BackgroundEffective management of imported cases is an important part of epidemic prevention and control. Hainan Province, China reported 168 coronavirus disease 2019 (COVID-19), including 112 imported cases on February 19, 2020, but successfully contained the epidemic within 1 month. We described the epidemiological and clinical characteristics of COVID-19 in Hainan and compared these features between imported and local cases to provide information for other international epidemic areas.MethodsWe included 91 patients (56 imported and 35 local cases) from two designated hospitals for COVID-19 in Haikou, China, from January 20 to February 19, 2020. Data on the demographic, epidemiological, clinical and laboratory characteristics were extracted from medical records. Patients were followed until April 21, 2020, and the levels of antibodies at the follow-ups were also analysed by the Wilcoxon matched-pairs signed ranks test.ResultsOf the 91 patients, 78 (85.7%) patients were diagnosed within the first three weeks after the first case was identified (Day 1: Jan 22, 2020), while the number of local cases started to increase during the third week. No new cases occurred after Day 29. Fever and cough were two main clinical manifestations. In total, 15 (16.5%) patients were severe, 14 (15.4%) had complicated infections, nine (9.9%) were admitted to the intensive care unit, and three died. The median duration of viral shedding in feces was longer than that in nasopharyngeal swabs (19 days vs 16 days, P = 0.007). Compared with local cases, imported cases were older and had a higher incidence of fever and concurrent infections. There was no difference in outcomes between the two groups. IgG was positive in 92.8% patients (77/83) in the follow-up at week 2 after discharge, while 88.4% patients (38/43) had a reduction in IgG levels in the follow-up at week 4 after discharge, and the median level was lower than that in the follow-up at week 2 (10.95 S/Cut Off (S/CO) vs 15.02 S/CO, P < 0.001).ConclusionImported cases were more severe than local cases but had similar prognoses. The level of IgG antibodies declined from week 6 to week 8 after onset. The short epidemic period in Hainan suggests that the epidemic could be quickly brought under control if proper timely measures were taken.

Clinical characteristics and predictors of the duration of SARS-CoV-2 viral shedding in 140 healthcare workers.

BackgroundEpidemiological and clinical features of patients with COVID‐19 have been reported, but none of them focused on medical staff, and few predictors of the duration of viral shedding have been reported. It is urgent to help healthcare workers prevent and recover quickly from the coronavirus disease 2019 (COVID‐19).MethodsWe enrolled 140 medical workers with COVID‐19 in Wuhan. Epidemiological, demographic, clinical, laboratory, radiological treatment and clinical outcome data were collected, and predictors of the duration of viral shedding were explored through multivariable linear regression analysis.ResultsThe medical staff with COVID‐19 presented mild clinical symptoms and showed a low frequency of abnormal laboratory indicators. All the medical staff were cured and discharged, of whom 96 (68.6%) were female, 39 (27.9%) had underlying diseases, the median age was 36.0 years, and 104 (74.3%) were infected whilst working in hospital. The median duration of viral shedding was 25.0 days (IQR:20.0–30.0). Multivariable linear regression analysis showed reducing viral shedding duration was associated with receiving recombinant human interferon alpha (rIFN‐α) treatment, whilst the prolonged duration of viral shedding correlated with the use of glucocorticoid treatment, the durations from the first symptom to hospital admission and the improvement in chest computed tomography (CT) evidence. Moreover, infected healthcare workers with lymphocytes less than 1.1 × 109/L on admission had prolonged viral shedding.ConclusionMedical staff with timely medical interventions show milder clinical features. Glucocorticoid treatment and lymphocytes less than 1.1 × 109/L are associated with prolonged viral shedding. Early admission and rIFN‐α treatment help shorten the duration of viral shedding.

Kinetics of Viral Clearance and Antibody Production Across Age Groups in Children with Severe Acute Respiratory Syndrome Coronavirus 2 Infection

ObjectivesTo improve understanding of transition from viral infection to viral clearance, and antibody response in pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Study designThis retrospective analysis of children tested for SARS-CoV-2 by reverse transcription (RT) polymerase chain reaction (PCR) and immunoglobulin G antibody at a quaternary-care, free-standing pediatric hospital between March 13, 2020, and June 21, 2020, included 6369 patients who underwent PCR testing and 215 patients who underwent antibody testing. During the initial study period, testing focused primarily on symptomatic children; the later study period included asymptomatic patients who underwent testing as preadmission or preprocedural screening. We report the proportion of positive and negative tests, time to viral clearance, and time to seropositivity.ResultsThe rate of positivity varied over time due to viral circulation in the community and transition from targeted testing of symptomatic patients to more universal screening of hospitalized patients. Median duration of viral shedding (RT-PCR positivity) was 19.5 days and time from RT-PCR positivity to negativity was 25 days. Of note, patients aged 6 through 15 years demonstrated a longer time of RT-PCR positivity to negativity, compared with patients aged 16 through 22 years (median 32 vs 18 days, P = .015). Median time to seropositivity, by chemiluminescent testing, from RT-PCR positivity was 18 days, whereas median time to reach adequate levels of neutralizing antibodies (defined as comparable with 160 titer by plaque reduction neutralization testing) was 36 days.ConclusionsThe majority of patients demonstrated a prolonged period of viral shedding after infection with SARS CoV-2. It is unknown whether this correlates with persistent infectivity. Only 17 of 33 patients demonstrated adequate neutralizing antibodies during the time frame of specimen collection. It remains unknown whether immunoglobulin G antibody against spike structured proteins correlates with immunity, and how long antibodies and potential protection persist.

Clinical characteristics, therapeutic management, and prognostic factors of adult COVID-19 inpatients with hematological malignancies

Patients with hematological malignancies with immunodeficiency are at high risk for SARS-CoV-2 infection. We retrospective summarized clinical characteristics of coronavirus disease 2019 (COVID-19) inpatients with hematological malignancies, shared treatment experiences, and analysis prognostic factors. Fourteen patients were enrolled. The median duration of viral shedding was 27.5 days in survivors. The median duration of time to death was 13 days in non-survivors. Non-survivors tend to present lower neutrophil count, more imaging finding of bilateral diffuse patch opacities, more undergoing intensive chemotherapy or immunosuppression. Laboratory and image findings were atypical and diverse. COVID-19 inpatients undergoing intensive chemotherapy or immunosuppression might have increased risk of death. The diagnostic value of specific antibody detection is limited. Therefore, adult COVID-19 inpatients with hematological malignancies present atypical, severe symptoms, decreased virus clearance ability, abnormal antibody response and poor outcome. During the epidemic, the pros and cons need to be carefully weighed while selecting the treatment methods.

Viral Transmission and Clinical Features in Asymptomatic Carriers of SARS-CoV-2 in Wuhan, China.

We report the clinical characteristics, viral shedding duration, and contact tracing for asymptomatic carriers of SARS-CoV-2 in Wuhan, China. The asymptomatic carriers were relatively young (median age: 34.5 years). Chest computed tomography showed no abnormalities. The nasopharyngeal swab was an optimum specimen for RNA testing. The median viral shedding duration was 11.5 days. Notably, 2 months of viral shedding duration were reported in two nurses, which was much longer than previously reported or than usually thought. The transmissibility of SARS-CoV-2 by asymptomatic carriers during the studied period in Wuhan appeared to be weak. Only one patient (1/12) was found to have transmitted the virus to another person. Early asymptomatic carrier detection, isolation, and contact tracing could be useful to mitigate the spread of the disease.