Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19)

van Kampen, Jeroen J. A.; van de Vijver, David A. M. C.; Fraaij, Pieter L. A.; Haagmans, Bart L.; Lamers, Mart M.; Okba, Nisreen; van den Akker, Johannes P. C.; Endeman, Henrik; Gommers, Diederik A. M. P. J.; Cornelissen, Jan J.; Hoek, Rogier A. S.; van der Eerden, Menno M.; Hesselink, Dennis A.; Metselaar, Herold J.; Verbon, Annelies; de Steenwinkel, Jurriaan E. M.; Aron, Georgina I.; van Gorp, Eric C. M.; van Boheemen, Sander; Voermans, Jolanda C.; Boucher, Charles A. B.; Molenkamp, Richard; Koopmans, Marion P. G.; Geurtsvankessel, Corine; van der Eijk, Annemiek A.

Key questions in COVID-19 are the duration and determinants of infectious virus shedding. Here, we report that infectious virus shedding is detected by virus cultures in 23 of the 129 patients (17.8%) hospitalized with COVID-19. The median duration of shedding infectious virus is 8 days post onset of symptoms (IQR 5–11) and drops below 5% after 15.2 days post onset of symptoms (95% confidence interval (CI) 13.4–17.2). Multivariate analyses identify viral loads above 7 log(10) RNA copies/mL (odds ratio [OR] of 14.7 (CI 3.57-58.1; p < 0.001) as independently associated with isolation of infectious SARS-CoV-2 from the respiratory tract. A serum neutralizing antibody titre of at least 1:20 (OR of 0.01 (CI 0.003-0.08; p < 0.001) is independently associated with non-infectious SARS-CoV-2. We conclude that quantitative viral RNA load assays and serological assays could be used in test-based strategies to discontinue or de-escalate infection prevention and control precautions.