Rapid Expert Consultations on the COVID-19 Pandemic March 14, 2020-April 8, 2020 (2020) / Chapter Skim
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Rapid Expert Consultation on SARS-CoV-2Viral Shedding and Antibody Response forthe COVID-19 Pandemic (April 8, 2020)
Rapid Expert Consultation on SARS-CoV-2Viral Shedding and Antibody Response forthe COVID-19 Pandemic (April 8, 2020)
Pages 63-68
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the optimal duration of isolation of cases. Members of the National Academies of Sciences, Engineering, and Medicine's Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats who were instrumental in preparing this response include Peter Daszak, EcoHealth Alliance; Diane E
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Chair Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats This rapid expert consultation responds to your request concerning (1) the duration of viral shedding by stage of infection, clinical signs and symptoms, and patient attributes; (2)
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These data are likely to be important for the understanding of routes and periods of transmission. It is not uncommon for viral shedding in respiratory secretions to occur 2-3 days prior to first symptoms.6,7,8 Higher amounts of virus and viral RNA are seen early in infection independent of severity of symptoms with sputum and nasopharyngeal samples more likely to be positive than throat swab samples.9,10,11,12,13 More severe clinical disease is associated with longer persistence of viral RNA shedding and may represent a significant occupational transmission risk for health care workers.14,15 Viral RNA shedding for up to a week after the resolution of symptoms is common and in one case has been documented to continue for as long as 49 days although this viral RNA may not represent infectious virus.16,17,18,19 No differences in these parameters have been detected based on age or sex.
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24 During the SARS epidemic in Hong Kong in 2003, the virus was spread in an apartment complex (Amoy Gardens) due to aerosolized waste flushed from toilets that found its way into the air of other apartments through poorly designed bathroom floor drains.
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Some lessons may be gleaned from evidence about the duration of antibody responses to SARS-CoV and MERS-CoV, which are related viruses. Studies of patients who recovered from the SARS outbreak in 2003 show a steady decrease in amounts of antiviral binding IgG over time with 12% negative at 2 years and 50% at 3 years.33,34 Similarly, health care workers with mild to moderate MERS-CoV infection had no detectable antiviral binding IgG 18 months after recovery.35 The response to SARS-CoV-2 is likely to be similar to this closely related virus.
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APPENDIX Authors and Reviewers of This Rapid Expert Consultation This rapid expert consultation was prepared by staff of the National Academies of Sciences, Engineering, and Medicine, and members of the National Academies' Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats: Peter Daszak, EcoHealth Alliance; Diane E Griffin, Johns Hopkins Bloomberg School of Public Health; Kent E
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