Evidence map›Paper›PMID 33521734›Full record

SynthesisThe Lancet. Microbe2021

SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis.

Muge Cevik, Matthew Tate, Ollie Lloyd, Alberto Enrico Maraolo, Jenna Schafers, Antonia Ho

3 registry-linked trialsOpen access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Microbe, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 819 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
819citing papers in PubMed, 9 pooled it
31.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04802408 phase2 / phase3active not recruitingnot on this map

SARS-Cov-2 (COVID-19) Nasal Pharyngeal and Oral Pharyngeal Wash (SNOW) Trial

TypeinterventionalSponsorMilton S. Hershey Medical CenterRan2021 to 2026Enrolled171ConditionsCovid19, SARS-CoV InfectionArmsShampoo and saline, Saline and Listerine, Shampoo and Listerine, Saline and Saline
NCT05102708 completednot on this map

Study of COVID-19 Prognostic Factors in Hospitalized Patients

TypeobservationalSponsorFundació Institut de Recerca de l'Hospital de la Santa Creu i Sant PauRan2021 to 2022Enrolled3,725ConditionsCOVID-19ArmsPrognostic factors of severe COVID-19
NCT05852873 phase3active not recruitingnot on this mapstarted 2023, after this paper: background citation

PAxlovid loNg cOvid-19 pRevention triAl With recruitMent In the Community in Norway

TypeinterventionalSponsorHaukeland University HospitalRan2023 to 2027Enrolled2,000ConditionsPost COVID-19 Condition, Unspecified, SARS-CoV2 Infection, COVID-19ArmsNirmatrelvir/ritonavir, Placebo
3 · Its place in the literature

Who cites it

819 citing papers in PubMed, 9 syntheses or guidelines pooled it, 1,480 citations in OpenAlex.

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759 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 2 countries.

Muge CevikDivision of Infection and Global Health Research, School of Medicine, University of St Andrews, Fife, UK.
Matthew TateRespiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK.
Ollie LloydNHS Lothian Infection Service, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK.
Alberto Enrico MaraoloFirst Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy.
Jenna SchafersNHS Lothian Infection Service, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK.
Antonia HoMRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
Western General Hospital · GBMRC University of Glasgow Centre for Virus Research · GBNHS Lothian · GBOspedale D. Cotugno · ITQueen Elizabeth University Hospital · GB

Funding

Medical Research Council MC_PC_19026Medical Research Council MC_UU_12014/9
6 · The paper itself

Abstract

backgroundViral load kinetics and duration of viral shedding are important determinants for disease transmission. We aimed to characterise viral load dynamics, duration of viral RNA shedding, and viable virus shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various body fluids, and to compare SARS-CoV-2, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV) viral dynamics.

methodsIn this systematic review and meta-analysis, we searched databases, including MEDLINE, Embase, Europe PubMed Central,

findings79 studies (5340 individuals) on SARS-CoV-2, eight studies (1858 individuals) on SARS-CoV, and 11 studies (799 individuals) on MERS-CoV were included. Mean duration of SARS-CoV-2 RNA shedding was 17·0 days (95% CI 15·5-18·6; 43 studies, 3229 individuals) in upper respiratory tract, 14·6 days (9·3-20·0; seven studies, 260 individuals) in lower respiratory tract, 17·2 days (14·4-20·1; 13 studies, 586 individuals) in stool, and 16·6 days (3·6-29·7; two studies, 108 individuals) in serum samples. Maximum shedding duration was 83 days in the upper respiratory tract, 59 days in the lower respiratory tract, 126 days in stools, and 60 days in serum. Pooled mean SARS-CoV-2 shedding duration was positively associated with age (slope 0·304 [95% CI 0·115-0·493]; p=0·0016). No study detected live virus beyond day 9 of illness, despite persistently high viral loads, which were inferred from cycle threshold values. SARS-CoV-2 viral load in the upper respiratory tract appeared to peak in the first week of illness, whereas that of SARS-CoV peaked at days 10-14 and that of MERS-CoV peaked at days 7-10.

interpretationAlthough SARS-CoV-2 RNA shedding in respiratory and stool samples can be prolonged, duration of viable virus is relatively short-lived. SARS-CoV-2 titres in the upper respiratory tract peak in the first week of illness. Early case finding and isolation, and public education on the spectrum of illness and period of infectiousness are key to the effective containment of SARS-CoV-2.

fundingNone.

Indexed as

COVID-19Middle East Respiratory Syndrome CoronavirusHumansRNA, ViralSARS-CoV-2Viral LoadVirus SheddingRNA, Viral

Identifiers

PMID33521734
PMCPMC7837230
OpenAlexW3104457017

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.