Journal
JOURNAL OF GENERAL VIROLOGY
Volume 102, Issue 3, Pages -Publisher
MICROBIOLOGY SOC
DOI: 10.1099/jgv.0.001545
Keywords
COVID-19; SARS-CoV-2; coronavirus; persistence; respiratory syncytial virus influenza A virus
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Funding
- Wellcome Trust Investigator Award [WT103767MA]
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Despite being considered an acute infection followed by the development of immunity, COVID-19 has shown evidence of prolonged shedding, periodic PCR positivity, and cases of reinfection without protective immunity. The structured RNA genome of SARS-CoV-2 may contribute to its persistence and interactions with the host immune response, challenging assumptions about virus clearance and protection from reinfection.
Although coronavirus disease 2019 (COVID-19) is regarded as an acute, resolving infection followed by the development of protective immunity, recent systematic literature review documents evidence for often highly prolonged shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in respiratory and faecal samples, periodic recurrence of PCR positivity in a substantial proportion of individuals and increasingly documented instances of reinfection associated with a lack of protective immunity. This pattern of infection is quite distinct from the acute/resolving nature of other human pathogenic respiratory viruses, such as influenza A virus and respiratory syncytial virus. Prolonged shedding of SARS-CoV-2 furthermore occurs irrespective of disease severity or development of virus-neutralizing antibodies. SARS-CoV-2 possesses an intensely structured RNA genome, an attribute shared with other human and veterinary coronaviruses and with other mammalian RNA viruses such as hepatitis C virus. These are capable of long-term persistence, possibly through poorly understood RNA structure-mediated effects on innate and adaptive host immune responses. The assumption that resolution of COVID-19 and the appearance of anti-SARS-CoV-2 IgG antibodies represents virus clearance and protection from reinfection, implicit for example in the susceptible-infected-recovered (SIR) model used for epidemic prediction, should be rigorously re-evaluated.
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