Logistical regression was applied to assess for associations between symptoms, risk factors, and CVS. The difference in symptom prevalence at diagnosis and at CVS was tested using McNemar’s test. Continuous variables were reported as mean and standard deviations, or medians and interquartile ranges (IQR) from the 25th to the 75th percentiles and compared using t-test or the Wilcoxon rank-sum test, as deemed appropriate. Ĭategorical variables were reported as counts and percentages using Chi-square or Fisher’s exact test for comparison, as appropriate. SARS-CoV-2 PCR testing was performed using SARS-CoV-2 qualitative assays using the cobas 6800 / 8800 systems (Roche Molecular Systems), the Abbott m2000 system (Abbott) or a SARS-CoV-2 laboratory-developed test that has received emergency use authorization from the Food and Drug Administration. The study was approved by the Mayo Clinic Institutional Review Board (IRB ID: 20-002629). Ambulatory cases were defined as those cases that were not hospitalized during the course of the illness. Fever was defined as a temperature > 38.5 ☌. Immunocompromised patients were defined as solid organ transplant recipients, patients who had an active hematologic malignancy, and/or who were on anti-neoplastic chemotherapy, immunomodulators, or other immunosuppressive drugs. ![]() Symptoms were recorded based on the current Centers for Disease Control and Prevention (CDC) case definition. Date of symptom onset, symptoms at diagnosis, date of first and subsequent positive SARS-CoV-2 PCR tests, and symptoms at the time of CVS was recorded. Cessation of viral RNA shedding (CVS) was considered to have been achieved on the date of the first of two consecutive negative SARS-CoV-2 PCR results on NP swabs collected at least 24 h apart.ĭemographic, clinical, and laboratory data from each patient were extracted from the electronic health record. Other sample sources (e.g., bronchoalveolar lavage, other respiratory samples) were excluded to avoid testing variability. We excluded deceased patients to capture those who achieved viral RNA clearance. We retrospectively reviewed laboratory-confirmed COVID-19 adult symptomatic cases who had a positive initial SARS-CoV-2 PCR nasopharyngeal (NP) swab and two subsequent negative SARS-CoV-2 PCR NP swab test results at Mayo Clinic, Rochester from February 1, 2020, through May 15, 2020. Here, we aimed to evaluate clinical features as predictors for the cessation of SARS-CoV-2 RNA detection in a cohort of laboratory-confirmed COVID-19 cases. ![]() Understanding viral dynamics of SARS-CoV-2 shedding in relation to symptom evolution and other underlying clinical factors has direct implications in diagnostic stewardship, implementation of effective infection prevention measures, and the development of public health strategies. ![]() There have been questions as to whether this persistent RNA detection represents viable virus, and therefore, transmission risk. Severe disease, in particular, has been associated with prolonged viral RNA detection in several reports, ,, ], and the presence of dyspnea, hypoxia, and tachypnea has also been associated with prolonged shedding in respiratory samples. Studies on SARS-CoV-2 persistence report a median time from symptom onset to persistently negative SARS-CoV-2 PCR tests ranging from 11 to 31 days, ,, ,, ] with positive tests found as late as 55 days from symptom onset. It is known that asymptomatic viral shedding enhances the transmissibility of SARS-CoV-2. There is growing evidence demonstrating that viral shedding begins before a patient is symptomatic, peaks at or shortly after symptom onset, and persists beyond symptom resolution. ![]() Given the challenges in defining this clinically, the World Health Organization has defined COVID-19 as any individual with a positive polymerase chain reaction (PCR) test regardless of symptoms and this has led to reliance on PCR for the diagnosis and management of COVID-19. Clinical presentation is heterogeneous, with fever, cough, and fatigue being the most common clinical symptoms. The COVID-19 pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), continues to expand after first being reported in China in December 2019.
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