Clinical characteristics and predictors of the duration of SARS-CoV-2 viral shedding in 140 healthcare workers

Abstract

Background: Epidemiological and clinical features of patients with COVID-19 have been reported, but none of them focused on medical staff, and few predictors of the duration of viral shedding have been reported. It is urgent to help healthcare workers prevent and recover quickly from the coronavirus disease 2019 (COVID-19).

Methods: We enrolled 140 medical workers with COVID-19 in Wuhan. Epidemiological, demographic, clinical, laboratory, radiological treatment and clinical outcome data were collected, and predictors of the duration of viral shedding were explored through multivariable linear regression analysis.

Results: The medical staff with COVID-19 presented mild clinical symptoms and showed a low frequency of abnormal laboratory indicators. All the medical staff were cured and discharged, of whom 96 (68.6%) were female, 39 (27.9%) had underlying diseases, the median age was 36.0 years, and 104 (74.3%) were infected whilst working in hospital. The median duration of viral shedding was 25.0 days (IQR:20.0-30.0). Multivariable linear regression analysis showed reducing viral shedding duration was associated with receiving recombinant human interferon alpha (rIFN-α) treatment, whilst the prolonged duration of viral shedding correlated with the use of glucocorticoid treatment, the durations from the first symptom to hospital admission and the improvement in chest computed tomography (CT) evidence. Moreover, infected healthcare workers with lymphocytes less than 1.1 × 10⁹ /L on admission had prolonged viral shedding.

Conclusion: Medical staff with timely medical interventions show milder clinical features. Glucocorticoid treatment and lymphocytes less than 1.1 × 109/L are associated with prolonged viral shedding. Early admission and rIFN-α treatment help shorten the duration of viral shedding.

Keywords: COVID-19; SARS-CoV-2; clinical features; healthcare workers; rIFN-α; viral shedding duration.

Fig. 1

Date of Illness Onset of Patients with COVID‐19.

Fig. 2

Factors Influencing Viral Shedding Duration of Patients with COVID‐19. (a) The duration of viral shedding was prolonged when the duration from illness onset to hospital admission was more than seven days. (b) The duration from illness onset to improvement in chest CT could influence viral shedding duration of COVID‐19 conspicuously. (c, d) The rIFN‐α group had shorter viral shedding duration, whilst the glucocorticoid group did the opposite. (e) The lengthened duration of viral shedding was found in the group with lymphocytes less than 1.1 × 10⁹/L. (f) There was no statistical difference in the duration of virus shedding between the elevated d‐dimer group and the normal d‐dimer group. P values were obtained by Mann–Whitney U‐test or one‐way analysis of variance (ANOVA) (more than two groups). rIFN‐α = recombinant human interferon alpha. COVID‐19 = coronavirus disease 2019.