TY - JOUR
T1 - Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients
T2 - A systematic review and meta-analysis
AU - Weiss, Anne
AU - Jellingsø, Mads
AU - Sommer, Morten Otto Alexander
PY - 2020
Y1 - 2020
N2 - Background: The spatial and temporal dynamics of SARS-CoV-2 have been described in case series and retrospective studies. In this study, we provide a coherent overview of the duration of viral detection and viral RNA load in COVID-19 patients, stratified by specimen type, clinical severity, and age. Method: We systematically searched PubMed/MEDLINE and Cochrane review database for studies published between 1.11.2019 and 23.04.2020. We pooled the data of selected studies (22/7226 (650 patients) for meta-analysis) to estimate duration of viral detection and visualized viral load over time. Findings: Our analysis showed consistent viral detection from specimen from the upper respiratory tract (URT), the lower respiratory tract (LRT), and faeces, irrespective of the clinical severity of COVID-19. Our analysis suggests that SARS-CoV-2 persists for a longer duration in the LRT compared to the URT in adult patients (5•7 days in mild; 5•9 days in moderate-severe patients). The differences in the duration of viral detection between mild and moderate-severe patients is limited in the LRT, but an indication of longer duration of viral detection for moderate-severe patients was observed in feces (15 days in mild vs. 21 days in moderate-severe patients) and the URT (12 days in mild vs. 16 days in moderate-severe patients). Further, viral load was demonstrated to peak in earlier stages of infection in the URT compared to LRT. Interpretation: This review may aid mathematical modelling and help in defining appropriate endpoints for clinical trails with antivirals in COVID-19. Funding: The project has received funding support from Innovation Fund Denmark.
AB - Background: The spatial and temporal dynamics of SARS-CoV-2 have been described in case series and retrospective studies. In this study, we provide a coherent overview of the duration of viral detection and viral RNA load in COVID-19 patients, stratified by specimen type, clinical severity, and age. Method: We systematically searched PubMed/MEDLINE and Cochrane review database for studies published between 1.11.2019 and 23.04.2020. We pooled the data of selected studies (22/7226 (650 patients) for meta-analysis) to estimate duration of viral detection and visualized viral load over time. Findings: Our analysis showed consistent viral detection from specimen from the upper respiratory tract (URT), the lower respiratory tract (LRT), and faeces, irrespective of the clinical severity of COVID-19. Our analysis suggests that SARS-CoV-2 persists for a longer duration in the LRT compared to the URT in adult patients (5•7 days in mild; 5•9 days in moderate-severe patients). The differences in the duration of viral detection between mild and moderate-severe patients is limited in the LRT, but an indication of longer duration of viral detection for moderate-severe patients was observed in feces (15 days in mild vs. 21 days in moderate-severe patients) and the URT (12 days in mild vs. 16 days in moderate-severe patients). Further, viral load was demonstrated to peak in earlier stages of infection in the URT compared to LRT. Interpretation: This review may aid mathematical modelling and help in defining appropriate endpoints for clinical trails with antivirals in COVID-19. Funding: The project has received funding support from Innovation Fund Denmark.
KW - COVID-19
KW - SARS-CoV-2
KW - Systematic review
KW - Viral dynamics
U2 - 10.1016/j.ebiom.2020.102916
DO - 10.1016/j.ebiom.2020.102916
M3 - Journal article
C2 - 32711256
AN - SCOPUS:85088246095
SN - 2352-3964
VL - 58
JO - EBioMedicine
JF - EBioMedicine
M1 - 102916
ER -