What is the duration of viral shedding in persons with coronavirus disease 2019 (COVID-19)?

Updated: Jan 23, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Wölfel et al reported that, in a small group of patients with mild COVID-19, nasopharyngeal/oropharyngeal swabs collected during the first week of illness showed infectious virus but not after this period despite high detected rates of SARS-CoV-2 RNA from these sites. [42]

The duration of viral shedding varies significantly and may depend on severity. Among 137 survivors of COVID-19, viral shedding based on testing of oropharyngeal samples ranged from 8-37 days, with a median of 20 days. [43] A different study found that repeated viral RNA tests using nasopharyngeal swabs were negative in 90% of cases among 21 patients with mild illness, whereas results were positive for longer durations in patients with severe COVID-19. [44] In an evaluation of patients recovering from severe COVID-19, Zhou et al found a median shedding duration of 31 days (range, 18-48 days). [45] These studies have all used PCR detection as a proxy for viral shedding. The Korean CDC, investigating a cohort of patients who had prolonged PCR positivity, determined that infectious virus was not present.

Additionally, patients with profound immunosuppression (eg, following hematopoietic stem-cell transplantation, receiving cellular therapies) may shed viable SARS-CoV-2 for at least 2 months. [47, 48]  


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