RT Journal Article SR Electronic T1 Dynamics of SARS-CoV-2 shedding in the respiratory tract depends on the severity of disease in COVID-19 patients JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 2002724 DO 10.1183/13993003.02724-2020 VO 58 IS 1 A1 Dieter Munker A1 Andreas Osterman A1 Hans Stubbe A1 Maximilian Muenchhoff A1 Tobias Veit A1 Tobias Weinberger A1 Michaela Barnikel A1 Jan-Niclas Mumm A1 Katrin Milger A1 Elham Khatamzas A1 Sarah Klauss A1 Clemens Scherer A1 Johannes C. Hellmuth A1 Clemens Giessen-Jung A1 Michael Zoller A1 Tobias Herold A1 Stephanie Stecher A1 Enrico N. de Toni A1 Christian Schulz A1 Nikolaus Kneidinger A1 Oliver T. Keppler A1 Jürgen Behr A1 Julia Mayerle A1 Stefan Munker YR 2021 UL http://erj.ersjournals.com/content/58/1/2002724.abstract AB A fraction of COVID-19 patients progress to a severe disease manifestation with respiratory failure and the necessity of mechanical ventilation. Identifying patients at risk is critical for optimised care and early therapeutic interventions. We investigated the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding relative to disease severity.We analysed nasopharyngeal and tracheal shedding of SARS-CoV-2 in 92 patients with diagnosed COVID-19. Upon admission, standardised nasopharyngeal swab or sputum samples were collected. If patients were mechanically ventilated, endotracheal aspirate samples were additionally obtained. Viral shedding was quantified by real-time PCR detection of SARS-CoV-2 RNA.45% (41 out of 92) of COVID-19 patients had a severe disease course with the need for mechanical ventilation (severe group). At week 1, the initial viral shedding determined from nasopharyngeal swabs showed no significant difference between nonsevere and severe cases. At week 2, a difference could be observed as the viral shedding remained elevated in severely ill patients. A time-course of C-reactive protein, interleukin-6 and procalcitonin revealed an even more protracted inflammatory response following the delayed drop of virus shedding load in severely ill patients. A significant proportion (47.8%) of patients showed evidence of prolonged viral shedding (>17 days), which was associated with severe disease courses (73.2%).We report that viral shedding does not differ significantly between severe and nonsevere COVID-19 cases upon admission to the hospital. Elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between the second and third week, and prolonged viral shedding are associated with a more severe disease course.This work finds that elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between the second and third week, and prolonged viral shedding are associated with a more severe COVID-19 disease course https://bit.ly/3p544zr