• Annukka A R Antar, Tong Yu, Nora Pisanic, Razvan Azamfirei, Jeffrey A Tornheim, Diane M Brown, Kate Kruczynski, Justin P Hardick, Thelio Sewell, Minyoung Jang, Taylor Church, Samantha N Walch, Carolyn Reuland, Vismaya S Bachu, Kirsten Littlefield, Han-Sol Park, Rebecca L Ursin, Abhinaya Ganesan, Oyinkansola Kusemiju, Brittany Barnaba, Curtisha Charles, Michelle Prizzi, Jaylynn R Johnstone, Christine Payton, Weiwei Dai, Joelle Fuchs, Guido Massaccesi, Derek T Armstrong, Jennifer L Townsend, Sara C Keller, Zoe O Demko, Chen Hu, Mei-Cheng Wang, Lauren M Sauer, Heba H Mostafa, Jeanne C Keruly, Shruti H Mehta, Sabra L Klein, Andrea L Cox, Andrew Pekosz, Christopher D Heaney, David L Thomas, Paul W Blair, and Yukari C Manabe.
• Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• Open Forum Infect Dis. 2021 Jun 1; 8 (6): ofab195.

BackgroundSustained molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the upper respiratory tract (URT) in mild to moderate coronavirus disease 2019 (COVID-19) is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection.MethodsNinety-five symptomatic outpatients self-collected midturbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1-3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models.ResultsViral RNA clearance, as measured by SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR), in 507 URT samples occurred a median (interquartile range) 33.5 (17-63.5) days post-symptom onset. Sixteen nasal-OP samples collected 2-11 days post-symptom onset were virus culture positive out of 183 RT-PCR-positive samples tested. All participants but 1 with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8-13 days post-symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.92-0.99; P = .020) and body mass index (BMI) ≥25 kg/m2 (aHR, 0.37; 95% CI, 0.18-0.78; P = .009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as 1 of first 3 COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR, 2.06; 95% CI, 1.02-4.18; P = .044).ConclusionsWe demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

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