Patient and immunological factors associated with delayed clearance of mucosal SARS-CoV-2 RNA and symptom persistence

Mars Stone; Bryan R Spencer; Donald E Warden; Rebecca V Fink; Paula Saa; Jennifer Leddy; Jackie Mulach-Vannoy; Rebecca Townsend; David Krysztof; Alexandria N Hughes; Clara Di Germanio; Debra A Kessler; Steven Kleinman; Michael P Busch; Philip J Norris

doi:10.1093/infdis/jiae132

Patient and immunological factors associated with delayed clearance of mucosal SARS-CoV-2 RNA and symptom persistence

J Infect Dis. 2024 Mar 12:jiae132. doi: 10.1093/infdis/jiae132. Online ahead of print.

Authors

Mars Stone^{1

2}, Bryan R Spencer³, Donald E Warden⁴, Rebecca V Fink⁴, Paula Saa³, Jennifer Leddy¹, Jackie Mulach-Vannoy¹, Rebecca Townsend³, David Krysztof³, Alexandria N Hughes⁴, Clara Di Germanio^{1

2}, Debra A Kessler⁵, Steven Kleinman⁶, Michael P Busch^{1

2}, Philip J Norris^{1

2

7}

Affiliations

¹ Vitalant Research Institute, San Francisco, California, USA.
² Departments of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA.
³ Scientific Affairs, American Red Cross, Rockville, Maryland, USA.
⁴ Westat, Rockville, Maryland, USA.
⁵ New York Blood Center Enterprises, New York, New York, USA.
⁶ University of British Columbia, Vancouver, British Columbia, Canada.
⁷ Departments of Medicine, University of California San Francisco, San Francisco, California, USA.

PMID: 38470857
DOI: 10.1093/infdis/jiae132

Abstract

Serial blood and mucosal samples were characterized for 102 participants enrolled a median of 7.0 days post-COVID-19 diagnosis. Mucosal RNA was detectable a median 31.5 (95% CI 20.5 - 63.5) days, with persistence ≥1 month associated with obesity (BMI ≥30, OR 3.9, 95% CI 1.2 - 13.8) but not age, sex, or chronic conditions. Fifteen participants had likely reinfection; lower serum anti-S IgG levels were associated with reinfection risk. Nearly half of participants (47%) reported symptoms lasting ≥2-3 months; persistence ≥3 months was associated with BMI ≥30 (OR = 4.2 95% CI 1.1 - 12.8) and peak anti-S and anti-NC antibody levels.

Keywords: COVID-19; SARS-CoV-2; antibodies; long-COVID; obesity.

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