Factors associated with a prolonged negative conversion of viral RNA in patients with COVID-19

doi:10.1016/j.ijid.2021.02.089

. 2021 Apr:105:463-469.

doi: 10.1016/j.ijid.2021.02.089. Epub 2021 Feb 27.

Factors associated with a prolonged negative conversion of viral RNA in patients with COVID-19

Affiliations

¹ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: cyrine.bennasrallah@gmail.com.
² Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: imen11zemni@gmail.com.
³ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: Wafa.dhouib20@yahoo.fr.
⁴ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: haythem.sriha92@gmail.com.
⁵ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: nourhenemezhoud7@gmail.com.
⁶ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: bouslama.samar94@gmail.com.
⁷ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: wael1733@gmail.com.
⁸ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: meriemoumaimabeji@gmail.com.
⁹ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: merioumakacem@gmail.com.
¹⁰ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: hela-abr@hotmail.com.
¹¹ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: manel-ben-fredj@hotmail.fr.
¹² Department of Infectiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: prchawkiloussaief@gmail.com.
¹³ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: belguith_asma@yahoo.fr.

PMID: 33647508
PMCID: PMC7910140
DOI: 10.1016/j.ijid.2021.02.089

Factors associated with a prolonged negative conversion of viral RNA in patients with COVID-19

Cyrine Bennasrallah et al. Int J Infect Dis. 2021 Apr.

. 2021 Apr:105:463-469.

doi: 10.1016/j.ijid.2021.02.089. Epub 2021 Feb 27.

Authors

Affiliations

¹ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: cyrine.bennasrallah@gmail.com.
² Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: imen11zemni@gmail.com.
³ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: Wafa.dhouib20@yahoo.fr.
⁴ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: haythem.sriha92@gmail.com.
⁵ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: nourhenemezhoud7@gmail.com.
⁶ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: bouslama.samar94@gmail.com.
⁷ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: wael1733@gmail.com.
⁸ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: meriemoumaimabeji@gmail.com.
⁹ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: merioumakacem@gmail.com.
¹⁰ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: hela-abr@hotmail.com.
¹¹ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: manel-ben-fredj@hotmail.fr.
¹² Department of Infectiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia. Electronic address: prchawkiloussaief@gmail.com.
¹³ Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia. Electronic address: belguith_asma@yahoo.fr.

PMID: 33647508
PMCID: PMC7910140
DOI: 10.1016/j.ijid.2021.02.089

Abstract

Objectives: The aim of this study was to identify the factors influencing the delay in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA negative conversion.

Methods: A cohort study was conducted that included patients with coronavirus disease 2019 (COVID-19) admitted to the Tunisian national containment center. Follow-up consisted of a weekly RT-PCR test. Multivariate Cox regression analysis was performed to determine independent predictors associated with negative RNA conversion.

Results: Among the 264 patients included, the median duration of viral clearance was 20 days (interquartile range (IQR) 17-32 days). The shortest duration was 9 days and the longest was 58 days. Factors associated with negative conversion of viral RNA were symptoms such as fatigue, fever, and shortness of breath (hazard ratio (HR) 0.600, 95% confidence interval (CI) 0.401-0.897) and face mask use when exposed to COVID-19 cases (HR 2.006, 95% CI 1.247-3.228). The median time to RNA viral conversion was 18 days (IQR 16-21 days) when using masks versus 23 days (IQR 17-36 days) without wearing masks, and 24 days (IQR 18-36 days) for symptomatic patients versus 20 days (IQR 16-30 days) for asymptomatic patients.

Conclusions: The results of this study revealed that during SARS-CoV-2 infection, having symptoms delayed viral clearance, while wearing masks accelerated this conversion. These factors should be taken into consideration for the strategy of isolating infected patients.

Keywords: COVID-19; Coronavirus disease 2019; Negative conversion; SARS-CoV-2; Tunisia; Viral shedding.

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Figures

**Figure 1**
Flow chart of inclusion and exclusion criteria.

**Figure 2**
Overall negative conversion curve for COVID-19 patients.

**Figure 3**
Negative conversion curves for COVID-19 patients according to predictors, by day (d) after first positive RT-PCR: (A) sex; (B) age; (C) symptoms; (D) dyslipidemia; (E) isolated room; (F) was wearing masks when contracted the virus.

See this image and copyright information in PMC

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References

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[1] Bauer Carla M.T., Morissette Mathieu C., Stämpfli Martin R. The influence of cigarette smoking on viral infections: translating bench science to impact COPD pathogenesis and acute exacerbations of COPD clinically. Chest. 2013;143(1):196–206. doi: 10.1378/chest.12-0930. - DOI - PubMed

[2] Bauer Carla M.T., Morissette Mathieu C., Stämpfli Martin R. The influence of cigarette smoking on viral infections: translating bench science to impact COPD pathogenesis and acute exacerbations of COPD clinically. Chest. 2013;143(1):196–206. doi: 10.1378/chest.12-0930. - DOI - PubMed

[3] Bouman Annechien, Heineman Maas Jan, Faas Marijke M. Sex hormones and the immune response in humans. Hum Reprod Update. 2005;11(4):411–423. doi: 10.1093/humupd/dmi008. - DOI - PubMed

[4] Bouman Annechien, Heineman Maas Jan, Faas Marijke M. Sex hormones and the immune response in humans. Hum Reprod Update. 2005;11(4):411–423. doi: 10.1093/humupd/dmi008. - DOI - PubMed

[5] Criteria for Releasing COVID-19 Patients from Isolation. n.d. Accessed 4 February 2021. https://www.who.int/news-room/commentaries/detail/criteria-for-releasing....

[6] Criteria for Releasing COVID-19 Patients from Isolation. n.d. Accessed 4 February 2021. https://www.who.int/news-room/commentaries/detail/criteria-for-releasing....

[7] Gandhi Monica, Beyrer Chris, Goosby Eric. Masks do more than protect others during covid-19: reducing the inoculum of SARS-CoV-2 to protect the wearer. J Gen Intern Med. 2020;(July) doi: 10.1007/s11606-020-06067-8. - DOI - PMC - PubMed

[8] Gandhi Monica, Beyrer Chris, Goosby Eric. Masks do more than protect others during covid-19: reducing the inoculum of SARS-CoV-2 to protect the wearer. J Gen Intern Med. 2020;(July) doi: 10.1007/s11606-020-06067-8. - DOI - PMC - PubMed

[9] Gandhi Monica, Rutherford George W. Facial masking for covid-19 — potential for “Variolation” as we await a vaccine. N Engl J Med. 2020 doi: 10.1056/NEJMp2026913. 0 (0): null. - DOI - PMC - PubMed

[10] Gandhi Monica, Rutherford George W. Facial masking for covid-19 — potential for “Variolation” as we await a vaccine. N Engl J Med. 2020 doi: 10.1056/NEJMp2026913. 0 (0): null. - DOI - PMC - PubMed

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Factors associated with a prolonged negative conversion of viral RNA in patients with COVID-19

Affiliations

Factors associated with a prolonged negative conversion of viral RNA in patients with COVID-19

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