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Mechanically ventilated patients shed high titre live SARS-CoV2 for extended periods from both the upper and lower respiratory tract

Saud, Zack, Ponsford, Mark, Bentley, Kirsten ORCID:, Cole, Jade M, Pandey, Manish, Jolles, Stephen, Fegan, Chris ORCID:, Humphreys, Ian ORCID:, Wise, Matt P and Stanton, Richard ORCID: 2022. Mechanically ventilated patients shed high titre live SARS-CoV2 for extended periods from both the upper and lower respiratory tract. Clinical Infectious Diseases 75 (1) , e82-e88. 10.1093/cid/ciac170

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Background SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection control measures both within healthcare settings and the public domain. Methods We prospectively examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit of the University Hospital of Wales. Samples were taken from the oral cavity (saliva), oropharynx (sub-glottic aspirate), or lower respiratory tract (non-directed bronchoalveolar lavage (NBL) or bronchoalveolar lavage (BAL)) and analyzed by both qPCR and plaque assay. Results 117 samples were obtained from 25 patients. qPCR showed extremely high rates of positivity across all sample types, however live virus was far more common in saliva (68%) than in BAL/NBAL (32%). Average titres of live virus were higher in subglottic aspirates (4.5x10 7) than in saliva (2.2x10 6) or BAL/NBAL (8.5x10 6) and reached >10 8 PFU/ml in some samples. The longest duration of shedding was 98 days, while most patients (14/25) shed live virus for 20 days or longer. Conclusions Intensive care unit patients infected with SARS-CoV-2 can shed high titres of virus both in the upper and lower respiratory tract and tend to be prolonged shedders. This information is important for decision making around cohorting patients, de-escalation of PPE, and undertaking potential aerosol generating procedures.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Publisher: Oxford University Press
ISSN: 1058-4838
Funders: MRC
Date of First Compliant Deposit: 8 March 2022
Date of Acceptance: 25 February 2022
Last Modified: 29 Nov 2022 11:03

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