Long-term SARS-CoV-2 RNA shedding and its temporal association to IgG seropositivity

March 26,2021

Dec. 2, 2020

Abstract: Longitudinal characterization of SARS-CoV-2 PCR testing from COVID-19 patient’s nasopharynx and its juxtaposition with blood-based IgG-seroconversion diagnostic assays is critical to understanding SARS-CoV-2 infection durations. Here, we retrospectively analyze 851 SARS-CoV-2-positive patients with at least two positive PCR tests and find that 99 of these patients remain SARS-CoV-2-positive after 4 weeks from their initial diagnosis date. For the 851-patient cohort, the mean lower bound of viral RNA shedding was 17.3 days (SD: 7.8), and the mean upper bound of viral RNA shedding from 668 patients transitioning to confirmed PCR-negative status was 22.7 days (SD: 11.8). Among 104 patients with an IgG test result, 90 patients were seropositive to date, with mean upper bound of time to seropositivity from initial diagnosis being 37.8 days (95% CI: 34.3–41.3). Our findings from juxtaposing IgG and PCR tests thus reveal that some SARS-CoV-2-positive patients are non-hospitalized and seropositive, yet actively shed viral RNA (14 of 90 patients). This study emphasizes the need for monitoring viral loads and neutralizing antibody titers in long-term non-hospitalized shedders as a means of characterizing the SARS-CoV-2 infection lifecycle.

Vineet Agarwal1+, AJ Venkatakrishnan1+, Arjun Puranik1,Christian Kirkup1, Agustin Lopez-Marquez1, Douglas W Challener2, Elitza S Theel2, John C. O Horo2, Matthew J Binnicke2, Walter K Kremers2, William A Faubion Jr2, Andrew D. Badley2, Amy W Williams2, Gregory J Gores2, John D. Halamka2, William G. Morice II2,3, Venky Soundararajan4
1nference, Cambridge, MA 02142
2 Mayo Clinic, Rochester, MN 55905
3Mayo Clinic Laboratories, Rochester, MN 55905
4nference, Cambridge, MA 02142
Correspondence: Venky Soundararajan (venky@nference.net)
© 2020, Agarwal et al. This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.