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SARS-CoV-2, SARS-CoV-1 and MERS-CoV Viral Load Dynamics, Duration of Viral Shedding and Infectiousness: A Living Systematic Review and Meta-Analysis

21 Pages Posted: 12 Oct 2020

See all articles by Muge Cevik

Muge Cevik

University of St. Andrews - Division of Infection and Global Health

Matthew Tate

University Hospital Wishaw - Respiratory Medicine

Ollie Lloyd

Western General Hospital - NHS Lothian Infection Service

Alberto Enrico Maraolo

AORN dei Colli - First Division of Infectious Diseases

Jenna Schafers

Western General Hospital - NHS Lothian Infection Service

Antonia Ho

University of Glasgow - MRC-University of Glasgow Centre for Virus Research

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Abstract

Background: Viral load kinetics and duration of viral shedding are important determinants for disease transmission. The aim of this review was to characterize viral load dynamics, duration of viral RNA and viable virus shedding of SARS-CoV-2 in various body fluids, and to compare SARS-CoV-2, SARS-CoV-1 and MERS-CoV viral dynamics.

Methods: Medline, EMBASE, Europe PMC, medRxiv, bioRxiv, and grey literature from January 1st 2003 to June 6th 2020. Two authors independently extracted data and assessed study quality and risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist tools. PROSPERO registration: CRD42020181914.

Findings: Seventy-nine studies on SARS-CoV-2, 8 on SARS-CoV-1, and 11 on MERS-CoV were included. Mean SARS-CoV-2 RNA shedding duration in the upper respiratory tract (URT), lower respiratory tract (LRT), stool and serum were 17.0, 14.6, 17.2 and 16.6 days, respectively. Maximum shedding duration in URT, LRT, stool and serum were 83, 59, 35 and 60 days, respectively. Pooled mean SARS-CoV-2 shedding duration was positively associated with age. No study has detected live virus beyond day nine of illness, despite persistently high viral loads. SARS-CoV-2 viral load in the upper URT appears to peak in the first week of illness, while SARS-CoV-1 and MERS-CoV peak later.

Conclusion: Although SARS-CoV-2 RNA shedding in respiratory and stool samples can be prolonged, duration of viable virus is relatively short-lived. SARS-CoV-2 titers in URT peak in the first week of illness. Early case finding and isolation, and public education on the spectrum of illness are key to the effective containment of SARS-CoV-2.

Funding Statement: There was no funding for this study.

Declaration of Interests: All authors have nothing to disclose.

Keywords: SARS-CoV-2, COVID-19, SARS-CoV-1, MERS-CoV, viral shedding, viral dynamics, infectiousness

Suggested Citation

Cevik, Muge and Tate, Matthew and Lloyd, Ollie and Maraolo, Alberto Enrico and Schafers, Jenna and Ho, Antonia, SARS-CoV-2, SARS-CoV-1 and MERS-CoV Viral Load Dynamics, Duration of Viral Shedding and Infectiousness: A Living Systematic Review and Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=3677918 or http://dx.doi.org/10.2139/ssrn.3677918

Muge Cevik (Contact Author)

University of St. Andrews - Division of Infection and Global Health ( email )

The Gateway
North Haugh
St Andrews, Fife KY16 9RJ
United Kingdom

Matthew Tate

University Hospital Wishaw - Respiratory Medicine

Ollie Lloyd

Western General Hospital - NHS Lothian Infection Service ( email )

Edinburgh
United Kingdom

Alberto Enrico Maraolo

AORN dei Colli - First Division of Infectious Diseases ( email )

Italy

Jenna Schafers

Western General Hospital - NHS Lothian Infection Service ( email )

Edinburgh
United Kingdom

Antonia Ho

University of Glasgow - MRC-University of Glasgow Centre for Virus Research ( email )

Adam Smith Business School
Glasgow, Scotland G12 8LE
United Kingdom

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