Abstract
Prolonged viral RNA shedding and recurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in coronavirus disease 2019 (COVID-19) patients have been reported. However, the clinical outcome and pathogenesis remain unclear. In this study, we recruited 43 laboratory-confirmed COVID-19 patients. We found that prolonged viral RNA shedding or recurrence mainly occurred in severe/critical patients (P<0.05). The average viral shedding time in severe/critical patients was more than 50 days, and up to 100 days in some patients, after symptom onset. However, chest computed tomography gradually improved and complete absorption occurred when SARS-CoV-2 RT-PCR was still positive, but specific antibodies appeared. Furthermore, the viral shedding time significantly decreased when the A1,430G or C12,473T mutation occurred (P<0.01 and FDR<0.01) and increased when G227A occurred (P<0.05 and FDR<0.05). High IL1R1, IL1R2, and TNFRSF21 expression in the host positively correlated with viral shedding time (P<0.05 and false discovery rate <0.05). Prolonged viral RNA shedding often occurs but may not increase disease damage. Prolonged viral RNA shedding is associated with viral mutations and host factors.
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Acknowldgements
This work was supported by the Guangzhou Institute of Respiratory Health Open Project (Funds provided by China Evergrande Group) (2020GIRHHMS14), Zhongnanshan Medical Foundation of Guangdong Province (2020B1111340004 and ZNSA-2020003), the Traditional Chinese Medicine Bureau of Guangdong Province (2020ZYYJ05), and the funding from Guangzhou Institute of Respiratory Health. Furthermore, we would like to thank the patients, along with the nurses and clinical staff who provided patient care; the staff at the hospital respiratory medicine departments; the staff at the hospital clinical labs; the technical staff of the State Key Laboratory of Respiratory Disease for their excellent assistance; and the staffs at Guangdong Centers for Disease Control for the diagnosis of SARS-CoV-2 infection. Furthermore, we would also like to thank the AJE team for polishing the English language of this manuscript.
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Compliance and ethics The author(s) declare that they have no conflict of interest. The study conformed to the provisions of the Helsinki Declaration of 1975 (as revised in 2008) concerning Human and Animal Rights and was approved by the ethics committee at the First Affiliated Hospital of Guangzhou Medical University, China (Ethical number: 202036). All the patients provided written informed consent and volunteered to participate in the scientific research.
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Li, Z., Li, Y., Sun, R. et al. Longitudinal virological changes and underlying pathogenesis in hospitalized COVID-19 patients in Guangzhou, China. Sci. China Life Sci. 64, 2129–2143 (2021). https://doi.org/10.1007/s11427-020-1921-5
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DOI: https://doi.org/10.1007/s11427-020-1921-5