Int J Biol Sci 2020; 16(10):1698-1707. doi:10.7150/ijbs.45357

Research Paper

Evaluation of SARS-CoV-2 RNA shedding in clinical specimens and clinical characteristics of 10 patients with COVID-19 in Macau

Iek Long Lo1, Chon Fu Lio2, Hou Hon Cheong3, Chin Ion Lei4✉, Tak Hong Cheong5, Xu Zhong6, Yakun Tian7, Nin Ngan Sin8

1. Physician, Consultant, Department of respiratory medicine, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
2. Physician, Macau Academy of Medicine, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
3. Physician, Macau Academy of Medicine, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
4. Physician, Chief of service, Department of medicine, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
5. Physician, Chief of service, Department of respiratory medicine, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
6. Physician, Consultant, Department of respiratory medicine, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
7. Physician, Department of infectious diseases, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
8. Physician, Macau Academy of Medicine, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China

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Citation:
Lo IL, Lio CF, Cheong HH, Lei CI, Cheong TH, Zhong X, Tian Y, Sin NN. Evaluation of SARS-CoV-2 RNA shedding in clinical specimens and clinical characteristics of 10 patients with COVID-19 in Macau. Int J Biol Sci 2020; 16(10):1698-1707. doi:10.7150/ijbs.45357. Available from http://www.ijbs.com/v16p1698.htm

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Abstract

As a city famous for tourism, the public healthcare system of Macau SAR has been under great pressure during the outbreak of the Coronavirus Disease 2019 (COVID-19). In this study, we report clinical and microbiological features of ten COVID-19 patients enrolled in the Centro Hospitalar Conde de São Januário (CHCSJ) between January 21 to February 16, 2020. Clinical samples from all patients including nasopharyngeal swab (NPS)/sputum, urine, and feces were collected for serial virus RNA testing by standard qRT-PCR assay. In total, seven were imported cases and three were local cases. The median duration from Macau arrival to admission in imported cases was 3 days. Four patients required oxygen therapy but none of them needed machinal ventilation. No fatal cases were noted. The most common symptoms were fever (80%) and diarrhea (80%). In the "Severe" group, there was significantly more elderly patients (p=0.045), higher lactate dehydrogenase levels (p=0.002), and elevated C-Reactive protein levels compared to the "Mild to Moderate" group (p<0.001). There were positive SARS-CoV-2 RNA signals in all patients' NPS and stool specimens but negative in all urine specimens. Based on our data on SARS-CoV-2 RNA shedding in stool and the possibility of a lag in viral detection in NPS specimens, the assessment of both fecal and respiratory specimen is recommended to enhance diagnostic sensitivity, and also to aid discharge decision before the role of viral RNA shedding in stool is clarified.

Keywords: novel coronavirus, SARS-CoV-2, COVID-19, qRT-PCR, Macau, nasopharyngeal swab, stool, urine, sputum