SARS-CoV-2 Viral Shedding and Transmission Dynamics: Implications of WHO COVID-19 Discharge Guidelines

doi:10.3389/fmed.2021.648660

Review

. 2021 Jun 17:8:648660.

doi: 10.3389/fmed.2021.648660. eCollection 2021.

SARS-CoV-2 Viral Shedding and Transmission Dynamics: Implications of WHO COVID-19 Discharge Guidelines

Kingsley Badu^{1

2}, Kolapo Oyebola^{1

3

4}, Julien Z B Zahouli^{1

5

6}, Adeniyi Francis Fagbamigbe^{1

7

8}, Dziedzom K de Souza^{1

9}, Natisha Dukhi^{1

9

10}, Ebenezer F Amankwaa^{1

11}, Mai F Tolba^{1

12

13

14}, Augustina A Sylverken^{1

2

15}, Lydia Mosi^{1

16

17}, Priscilla Kolibea Mante^{1

18}, Damaris Matoke-Muhia^{1

19}, Nowsheen Goonoo^{1

20}

Affiliations

¹ African Academy of Sciences Affiliates, Nairobi, Kenya.
² Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³ Biochemistry and Nutrition Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
⁴ Department of Zoology, Faculty of Science, University of Lagos, Lagos, Nigeria.
⁵ Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
⁶ Centre d'Entomologie Médicale et Vétérinaire, Université Alassane Ouattara, Bouaké, Côte d'Ivoire.
⁷ Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁸ Division of Population and Behavioral Sciences, School of Medicine, St. Andrews University, St. Andrews, United Kingdom.
⁹ College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
¹⁰ Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa.
¹¹ Department of Geography and Resource Development, University of Ghana, Accra, Ghana.
¹² Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
¹³ The Center of Drug Discovery Research and Development, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
¹⁴ School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, New Administrative Capital, Egypt.
¹⁵ Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁶ West African Centre for Cell Biology of Infectious Diseases, University of Ghana, Accra, Ghana.
¹⁷ Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana.
¹⁸ Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁹ Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya.
²⁰ Biomaterials, Drug Delivery and Nanotechnology Unit, Center for Biomedical and Biomaterials Research (CBBR), University of Mauritius, Reduit, Mauritius.

PMID: 34239886
PMCID: PMC8259580
DOI: 10.3389/fmed.2021.648660

Review

SARS-CoV-2 Viral Shedding and Transmission Dynamics: Implications of WHO COVID-19 Discharge Guidelines

Kingsley Badu et al. Front Med (Lausanne). 2021.

. 2021 Jun 17:8:648660.

doi: 10.3389/fmed.2021.648660. eCollection 2021.

Authors

Affiliations

¹ African Academy of Sciences Affiliates, Nairobi, Kenya.
² Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³ Biochemistry and Nutrition Department, Nigerian Institute of Medical Research, Lagos, Nigeria.
⁴ Department of Zoology, Faculty of Science, University of Lagos, Lagos, Nigeria.
⁵ Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
⁶ Centre d'Entomologie Médicale et Vétérinaire, Université Alassane Ouattara, Bouaké, Côte d'Ivoire.
⁷ Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁸ Division of Population and Behavioral Sciences, School of Medicine, St. Andrews University, St. Andrews, United Kingdom.
⁹ College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
¹⁰ Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa.
¹¹ Department of Geography and Resource Development, University of Ghana, Accra, Ghana.
¹² Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
¹³ The Center of Drug Discovery Research and Development, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
¹⁴ School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, New Administrative Capital, Egypt.
¹⁵ Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁶ West African Centre for Cell Biology of Infectious Diseases, University of Ghana, Accra, Ghana.
¹⁷ Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana.
¹⁸ Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁹ Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya.
²⁰ Biomaterials, Drug Delivery and Nanotechnology Unit, Center for Biomedical and Biomaterials Research (CBBR), University of Mauritius, Reduit, Mauritius.

PMID: 34239886
PMCID: PMC8259580
DOI: 10.3389/fmed.2021.648660

Abstract

The evolving nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has necessitated periodic revisions of COVID-19 patient treatment and discharge guidelines. Since the identification of the first COVID-19 cases in November 2019, the World Health Organization (WHO) has played a crucial role in tackling the country-level pandemic preparedness and patient management protocols. Among others, the WHO provided a guideline on the clinical management of COVID-19 patients according to which patients can be released from isolation centers on the 10th day following clinical symptom manifestation, with a minimum of 72 additional hours following the resolution of symptoms. However, emerging direct evidence indicating the possibility of viral shedding 14 days after the onset of symptoms called for evaluation of the current WHO discharge recommendations. In this review article, we carried out comprehensive literature analysis of viral shedding with specific focus on the duration of viral shedding and infectivity in asymptomatic and symptomatic (mild, moderate, and severe forms) COVID-19 patients. Our literature search indicates that even though, there are specific instances where the current protocols may not be applicable ( such as in immune-compromised patients there is no strong evidence to contradict the current WHO discharge criteria.

Keywords: COVID19; SARS-CoV-2; discharge recommendations; transmission dynamics; viral shedding.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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References

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[1] WHO . World Health Organization. Clinical Management of COVID-19 (Interim Guidance). (2020). Available online at: https://www.who.int/publications-detail/clinical-management-of-covid-19, published 27 May 2020 (accessed July 30, 2020).

[2] WHO . World Health Organization. Clinical Management of COVID-19 (Interim Guidance). (2020). Available online at: https://www.who.int/publications-detail/clinical-management-of-covid-19, published 27 May 2020 (accessed July 30, 2020).

[3] WHO . World Health Organization. Technical Guidance Laboratory Middle East Respiratory Syndrome Coronavirus (MERS-CoV). (2020). Available online at: https://www.who.int/csr/disease/coronavirus_infections/technical-guidanc... (accessed July 30, 2020).

[4] WHO . World Health Organization. Technical Guidance Laboratory Middle East Respiratory Syndrome Coronavirus (MERS-CoV). (2020). Available online at: https://www.who.int/csr/disease/coronavirus_infections/technical-guidanc... (accessed July 30, 2020).

[5] WHO . World Health Organization Criteria for Releasing COVID-19 Patients From Isolation. (2020). Available online at: https://www.who.int/news-room/commentaries/detail/criteria-for-releasing... (accessed November 17, 2020).

[6] WHO . World Health Organization Criteria for Releasing COVID-19 Patients From Isolation. (2020). Available online at: https://www.who.int/news-room/commentaries/detail/criteria-for-releasing... (accessed November 17, 2020).

[7] Sepúlveda-Loyola W, Rodriguez-Sanchez I, Perez-Rodriguez P, Ganz F, Torralba R, Oliveria DV, et al. . Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. J Nutr Health Aging. (2020) 24:938–47. 10.1007/s12603-020-1500-7 - DOI - PMC - PubMed

[8] Sepúlveda-Loyola W, Rodriguez-Sanchez I, Perez-Rodriguez P, Ganz F, Torralba R, Oliveria DV, et al. . Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. J Nutr Health Aging. (2020) 24:938–47. 10.1007/s12603-020-1500-7 - DOI - PMC - PubMed

[9] HIQA . Health Information and Quality Authority. Protocol for Evidence Synthesis Support-COVID-19 14 April 2020. (2020). Available online at: https://www.hiqa.ie/sites/default/files/2020-04/Protocol-for-evidence-sy... (accessed July 30, 2020)

[10] HIQA . Health Information and Quality Authority. Protocol for Evidence Synthesis Support-COVID-19 14 April 2020. (2020). Available online at: https://www.hiqa.ie/sites/default/files/2020-04/Protocol-for-evidence-sy... (accessed July 30, 2020)

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SARS-CoV-2 Viral Shedding and Transmission Dynamics: Implications of WHO COVID-19 Discharge Guidelines

Affiliations

SARS-CoV-2 Viral Shedding and Transmission Dynamics: Implications of WHO COVID-19 Discharge Guidelines

Authors

Affiliations

Abstract

Conflict of interest statement

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