key: cord-0758022-ddj7tukx
authors: Yoon, Jin Gu; Yoo, Jin Sae; Lee, Jungmin; Hyun, Hak-Jun; Seong, Hye; Noh, Ji Yun; Cheong, Hee Jin; Kim, Woo Joo; Kim, Young Rong; Heo, Jung Yeon; Bae, Joon-Yong; Cui, Chunguang; Lee, Sohyun; Park, Man-Seong; Song, Joon Young
title: Viable SARS-CoV-2 Shedding Under Remdesivir and Dexamethasone Treatment
date: 2022-03-26
journal: J Infect
DOI: 10.1016/j.jinf.2022.03.022
sha: 0af7e5191ebff5e209055a8bd5e5920b168d8c4b
doc_id: 758022
cord_uid: ddj7tukx

nan

Among the 48 enrolled patients with COVID-19 pneumonia, 50% (n = 24) were men with a median age of 60 years, while 20 patients (41.7%) had comorbidities (Table 1) . High-flow oxygen therapy was required in 85.4% of the patients (n = 41). Mechanical ventilation was required in 31.3% of the patients (n = 15), while 16.7% (n = 8) were supported by extracorporeal membrane oxygenation. Eight patients died during hospitalization. All patients received more than 6 mg/day of dexamethasone, and 46 patients (95.8%) were treated with remdesivir for five days or more. Among the 160 nasopharyngeal specimens, 17 yielded a positive culture result from days 3 to 18 after symptom onset (Fig. 1A) . Infectious virus samples were not detected after the third dose of remdesivir (200 mg intravenously (IV) on day 1, then 100 mg IV daily from day 2) despite high-dose dexamethasone treatment (Fig.   1B ). Rapid antigen test (RAT) was positive in 80% (4/5) of culture-positive samples and in 15.6% (10/64) of culture-negative samples (Fig. S1) . The positive and negative predictive values of RAT for detecting viable viruses were 28.6% and 98.2%, respectively. The geometric mean titer of immunoglobulin-G anti-S antibody on days 7 and 14 after symptom onset were 28.6 U/mL and 217.8 U/mL, respectively (Fig. S2 ).

Based on a clinical trial, the cycle threshold (Ct) value of RT-PCR was not significantly reduced by remdesivir.(5) However, this study showed that SARS-CoV-2 shedding significantly decreased after remdesivir treatment, regardless of the Ct value. Early deisolation can be done after remdesivir treatment, even in patients with severe COVID-19.

RAT is a viable adjunctive tool that guides the decision to terminate the isolation period. (6) Author contributions JGY, MSP and JYS analyzed the data with responsibility for its integrity and prepared the manuscript. All authors contributed to the conception and design of the study and to the interpretation of data. All authors critically revised the manuscript for intellectual content and approved the final draft for submission. 

The authors declare no conflicts of interest. 

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WHO COVID-19 ordinal scale at enrollment, n (%) Score 4, Oxygen by mask or nasal prongs

Non-invasive ventilation or high-flow oxygen, n (%) 39 (81.3%)

Score 6, Intubation and mechanical ventilation