At what times during infection is SARS-CoV-2 detectable and no longer detectable using RT-PCR-based tests? A systematic review of individual participant data

Abstract Background Tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral ribonucleic acid (RNA) using reverse transcription polymerase chain reaction (RT-PCR) are pivotal to detecting current coronavirus disease (COVID-19) and duration of detectable virus indicating potential for infectivity. Methods We conducted an individual participant data (IPD) systematic review of longitudinal studies of RT-PCR test results in symptomatic SARS-CoV-2. We searched PubMed, LitCOVID, medRxiv, and COVID-19 Living Evidence databases. We assessed risk of bias using a QUADAS-2 adaptation. Outcomes were the percentage of positive test results by time and the duration of detectable virus, by anatomical sampling sites. Results Of 5078 studies screened, we included 32 studies with 1023 SARS-CoV-2 infected participants and 1619 test results, from − 6 to 66 days post-symptom onset and hospitalisation. The highest percentage virus detection was from nasopharyngeal sampling between 0 and 4 days post-symptom onset at 89% (95% confidence interval (CI) 83 to 93) dropping to 54% (95% CI 47 to 61) after 10 to 14 days. On average, duration of detectable virus was longer with lower respiratory tract (LRT) sampling than upper respiratory tract (URT). Duration of faecal and respiratory tract virus detection varied greatly within individual participants. In some participants, virus was still detectable at 46 days post-symptom onset. Conclusions RT-PCR misses detection of people with SARS-CoV-2 infection; early sampling minimises false negative diagnoses. Beyond 10 days post-symptom onset, lower RT or faecal testing may be preferred sampling sites. The included studies are open to substantial risk of bias, so the positivity rates are probably overestimated.

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PID https://www.doi.org/10.6084/m9.figshare.c.5196135.v1
PID https://www.doi.org/10.6084/m9.figshare.c.5196135
URL http://dx.doi.org/10.6084/m9.figshare.c.5196135.v1
URL http://dx.doi.org/10.6084/m9.figshare.c.5196135
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Author Mallett, Sue, 0000-0002-0596-8200
Author A. Joy Allen
Author Graziadio, Sara
Author Taylor, Stuart A.
Author Sakai, Naomi S.
Author Kile Green
Author Suklan, Jana
Author Hyde, Chris
Author Shinkins, Bethany
Author Zhelev, Zhivko
Author Peters, Jaime
Author Turner, Philip J.
Author Roberts, Nia W.
Author Ruffano, Lavinia Ferrante Di
Author Wolff, Robert
Author Whiting, Penny
Author Winter, Amanda
Author Gauraang Bhatnagar
Author Nicholson, Brian D.
Author Halligan, Steve
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Collected From Datacite
Hosted By figshare
Publication Date 2020-01-01
Publisher figshare
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Language UNKNOWN
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keyword FOS: Biological sciences
keyword FOS: Health sciences
system:type other
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Source https://science-innovation-policy.openaire.eu/search/other?orpId=dedup_wf_001::da85135bb1885a389a3dd2b85aa9c6fb
Author jsonws_user
Last Updated 20 December 2020, 02:45 (CET)
Created 20 December 2020, 02:45 (CET)