High nasal and total SARS-CoV-2 RNA levels associated with longer recovery

09 November 2022

3 minutes of reading

Disclosures:
JZ Li reports consulting for Abbvie and receiving a research grant from Merck. Y. Li does not report relevant financial disclosures. Please refer to the study for relevant financial disclosures of all other authors.


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According to a recent study published in Clinical Infectious Diseases.

“Prolonged COVID symptoms limit daily activities and delay returning to work and school, but we still don’t fully understand what causes some people to have longer symptoms than others,” Jonathan Z.Li, MD, infectious disease physician-scientist at Brigham and Women’s Hospital and Harvard Medical School, he told Healio. “The goal of this study is to determine where there is a link between SARS-CoV-2 RNA levels in the nose and plasma with the duration of symptoms.”

covid test

The total body burden of SARS-CoV-2 infection, as well as the amount detected on a nasal swab, could predict how long it will take for patients to recover from COVID-19. Source: Adobe Stock.

The study, called Acceleration of COVID-19 Therapeutic Interventions and Vaccines (ACTIV)-2/A5401, a phase 2/3 multicenter randomized controlled trial with adaptive platform, evaluated the evaluation of therapies for COVID-19 in non-hospitalized adults. Based on the study, non-hospitalized patients 18 years of age or older with documented SARS-CoV-2 infection, no more than 10 days of COVID-19 symptoms, and continuous symptoms 48 hours prior to enrollment were eligible for the study.

Patients were considered part of the high-risk group if they had certain comorbidities, including chronic lung disease or moderate to severe asthma, body mass index greater than 35 kg/mtwohypertension, cardiovascular disease, diabetes or chronic kidney or liver disease and older than 55 years.

In addition, investigators included only participants randomized and receiving placebo by infusion for the first three investigational agents studied in ACTIV-2 (bamlanivimab 7000 mg and bamlanivimab 700 mg, both in phase 2, and amubarvimab/romlusevimab 1000 mg/1000 mg). in phase 2/3) between August 2020 and July 2021.

Overall, 559 participants were included in the study, 7% of whom were vaccinated against COVID-19 prior to study entry and 86% of whom met criteria for increased risk of COVID-19 progression. According to the study, the median symptom score at admission was 10, with 150 of 534 participants with an available admission diary reporting at least one symptom as severe, while three were asymptomatic for all 13 symptoms assessed at admission. to the studio.

Of the study participants, 523 and 467 had available anterior nasal (AN) and plasma SARS-CoV-2 RNA at study entry, respectively. The study showed that detectable plasma RNA (89 of 467), but not AN RNA level, was associated with more severe symptoms at admission (95% CI, 0.8-3.6).

In addition, participants with available AN RNA and a symptom score greater than zero at admission (n = 499) were analyzed. The researchers found that participants with initial AN RNA of 6 log10 copies/mL or more had a significantly longer time to symptom improvement compared to those with AN RNA of less than 2 log10 copies/mL (16 vs. 9 days; adjusted HR = 0.63; 95% CI, 0.47-0.84), as well as prolonged time to resolution of symptoms (25 vs. 15 days; aHR = 0.6, 95% CI, 0.43-0.82).

For selected symptoms, patients with AN RNA of 6 log10 copies/mL or more had late resolution of cough (aHR = 0.63; 95% CI, 0.45-0.87) and shortness of breath (aHR = 0.63; 95% CI, 0.42- 0.96), but no fatigue or body pain. In a similarly adjusted model, they also found that detectable SARS-CoV-2 RNA in plasma was associated with delayed resolution of cough (aHR = 0.67; 95% CI, 0.5-0.9 ), shortness of breath (aHR = 0.67; 95% CI, 0.47-0.97), and body pain (aHR = 0.74; 95% CI, 0.55-0.99) but not fatigue .

Based on these findings, Li said the respiratory tract and total body burden of SARS-CoV-2 infection can be used to predict how long it will take for patients to recover and provide insight into why some patients have delayed recovery.

“The caveat is that most of the participants in this study were not vaccinated; they were recruited when vaccines were not available or when access to vaccines was limited.long-COVID,’” Dr Yijia Li, clinical assistant professor of infectious diseases at the University of Pittsburgh Medical Center, told Healio. “Future studies are warranted to examine these issues.”

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