Viral Clearance Course of COVID-19 Outbreaks

Shaher M Samrah,1 Abdel-Hameed Al-Mistarehi,2 Tariq Kewan,3 Sohaib M Al-Khatib,4 Ali M Ibnian,1 Randa S Samrah,5 Basheer Y Khassawneh1 1Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; 4Department of Pathology and Laboratory Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 5Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Shaher M SamrahFaculty of Medicine, Jordan University of Science and Technology, P.O.Box: 630001, Irbid, 22110, JordanEmail samrah@just.edu.joAbdel-Hameed Al-MistarehiDepartment of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box: 630001, Irbid, 22110, JordanEmail awalmistarehi18@med.just.edu.joBackground: Coronavirus disease 2019 (COVID-19) viral course and behavior remain unpredictable. This study describes incubation time and viral clearance of COVID-19 hospitalized cases in Northern Jordan.Methods: All COVID-19 confirmed cases hospitalized from March 15 to June 09, 2020, were included. Nasopharyngeal swabs were collected, and COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) was performed every two days in all cases. The viral cure was defined when two negative RT-PCR tests were obtained ≥ 24 hours apart. Viral clearance time (VCT) reflects the time from the first positive nasopharyngeal swab to the first of two consecutive negative tests.Results: In this cohort, a total of 157 patients were included. Most cases resulted from two major outbreaks. The median incubation period was 6 days (IQR, 3– 10) and ranged from 1 to 17 days. The median VCT was 13 days (IQR, 7– 2) and ranged from 1 to 40 days. Symptomatic presentation and abnormal chest radiograph were predictors for a prolonged VCT (p=0.015 and p=0.014, respectively). The median time of resolution of symptoms was 7 days (IQR, 3– 10 days). Most symptomatic cases (91.7%) remained RT-PCR positive for up to 20 days after symptoms resolution, with a median of 13.5 days. VCT significantly correlated with the incubation period (p=0.013).Conclusion: Viral cure lagged for as long as 20 days after resolution of symptoms. Continuing with social-distancing, frequent hand hygiene, and wearing facial mask remains essential and is recommended even after clinical resolution of symptoms.Keywords: viral clearance, viral shedding, incubation period, COVID-19, coronavirus, pandemic, CDC