Publications - June 2020
Preprint and peer-reviewed publications from RECOVER’s studies
Long-term shedding of viral RNA in COVID-19 prevents timely discharge from the hospital or deescalation of infection prevention and control practices. Key questions are the duration and determinants of infectious virus shedding. We assessed these questions using virus cultures of respiratory tract samples from hospitalized COVID-19 patients as a proxy for infectious virus shedding.
Infectious virus shedding was detected in 23 of the 129 patients (17,8%). The median duration of shedding was 8 days post onset of symptoms (IQR 5 – 11) and the probability of detecting infectious virus dropped below 5% after 15,2 days post onset of symptoms (95% confidence interval (CI) 13,4 – 17,2). Multivariate analyses identified viral loads above 7 log10 RNA copies/mL (odds ratio [OR]; CI 14,7 (3,57-58,1; p<0,001) as independently associated with isolation of infectious SARS-CoV-2 from the respiratory tract. A serum neutralizing antibody titre of at least 1:20 (OR of 0,01 (CI 0,003-0,08; p<0,001) was independently associated with noninfectious SARS-CoV-2.
As children are under-represented in current studies aiming to analyse transmission of SARS-coronavirus 2 (SARS-CoV-2), their contribution to transmission is unclear. Considerable uncertainty remains regarding the influence of different contact behaviour in children versus adults, and the extent to which children can act as sources of infection in general.
We conclude that a considerable percentage of infected people in all age groups, including those who are pre- or mild-symptomatic, carry viral loads likely to represent infectivity. Based on these results and uncertainty about the remaining incidence, we recommend caution and careful monitoring during gradual lifting of non-pharmaceutical interventions. In particular, there is little evidence from the present study to support suggestions that children may not be as infectious as adults.
The COVID-19 pandemic has placed pressure on many national health-care systems worldwide. Due to the rapid surge in caseloads and resource constraints in health systems, in many high-income settings, the focus has been on disease screening, with those who have severe disease prioritised for hospitalisation. But the COVID-19 pandemic has also led to an unprecedented reliance on home care as one pillar of the health-care system to support people with confirmed or suspected COVID-19.
In public health emergencies, informal home care providers are a crucial human resource that improves the community’s health-care capacity, especially in regions with an ageing population and areas with suboptimal health-care systems. Yet our knowledge of the characteristics of these informal home care providers and the challenges they are facing during the COVID-19 pandemic is limited. Further research is needed to direct policy, guidelines, resources, clinical support, quality assurance, and monitoring and outcome evaluation for informal caregivers (panel).