Virus shedding là gì

We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infectorinfectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% [95% confidence interval, 3057%] of secondary cases were infected during the index cases presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission.

SARS-CoV-2, the causative agent of COVID-19, spreads efficiently, with a basic reproductive number of 2.2 to 2.5 determined in Wuhan1,2. The effectiveness of control measures depends on several key epidemiological parameters [Fig. 1a], including the serial interval [duration between symptom onsets of successive cases in a transmission chain] and the incubation period [time between infection and onset of symptoms]. Variation between individuals and transmission chains is summarized by the incubation period distribution and the serial interval distribution, respectively. If the observed mean serial interval is shorter than the observed mean incubation period, this indicates that a significant portion of transmission may have occurred before infected persons have developed symptoms. Significant presymptomatic transmission would probably reduce the effectiveness of control measures that are initiated by symptom onset, such as isolation, contact tracing and enhanced hygiene or use of face masks for symptomatic persons.

SARS [severe acute respiratory syndrome] was notable, because infectiousness increased around 710 days after symptom onset3,4. Onward transmission can be substantially reduced by containment measures such as isolation and quarantine [Fig. 1a]5. In contrast, influenza is characterized by increased infectiousness shortly around or even before symptom onset6.

In this study, we compared clinical data on virus shedding with separate epidemiologic data on incubation periods and serial intervals between cases in transmission chains, to draw inferences on infectiousness profiles.

Among 94 patients with laboratory-confirmed COVID-19 admitted to Guangzhou Eighth Peoples Hospital, 47/94 [50%] were male, the median age was 47 years and 61/93 [66%] were moderately ill [with fever and/or respiratory symptoms and radiographic evidence of pneumonia], but none were classified as severe or critical on hospital admission [Supplementary Table 1].

A total of 414 throat swabs were collected from these 94 patients, from symptom onset up to 32 days after onset. We detected high viral loads soon after symptom onset, which then gradually decreased towards the detection limit at about day 21. There was no obvious difference in viral loads across sex, age groups and disease severity [Fig. 2].

Separately, based on 77 transmission pairs obtained from publicly available sources within and outside mainland China [Fig. 1b and Supplementary Table 2], the serial interval was estimated to have a mean of 5.8 days [95% confidence interval [CI], 4.86.8 days] and a median of 5.2 days [95% CI, 4.16.4 days] based on a fitted gamma distribution, with 7.6% negative serial intervals [Fig. 1c]. Assuming an incubation period distribution of mean 5.2 days from a separate study of early COVID-19 cases1, we inferred that infectiousness started from 12.3 days [95% CI, 5.917.0 days] before symptom onset and peaked at symptom onset [95% CI, 0.90.9 days] [Fig. 1c]. We further observed that only