key: cord-0930635-y6gymwkb authors: Nomoto, Hidetoshi; Ishikane, Masahiro; Katagiri, Daisuke; Kinoshita, Noriko; Nagashima, Mami; Sadamasu, Kenji; Yoshimura, Kazuhisa; Ohmagari, Norio title: Cautious handling of urine from moderate to severe COVID-19 patients date: 2020-06-02 journal: Am J Infect Control DOI: 10.1016/j.ajic.2020.05.034 sha: 7414f2c497e75d4ccdb3356ea3e7b72f25421daa doc_id: 930635 cord_uid: y6gymwkb • SARS-CoV-2 RNA can be detected in patients’ specimens. • The duration and severity of SARS-CoV-2 viral shedding in the urine is currently unknown. • We identified continuous viral shedding in the urine of a severe COVID-19 patient. • Careful handling of urine samples from patients with COVID-19 is recommended. lower respiratory tract specimens are screened using quantitative reverse transcription polymerase chain reaction (qRT-PCR) to identify individuals infected with SARS-CoV-2. The virus has also been detected in other specimens, such as the blood, stool, and urine. [2] [3] [4] Although the duration of SARS-CoV-2 viral shedding in the upper and lower respiratory tract and stool has been reported, [5] [6] [7] limited data are available for that in the urine. Here, we investigated the detectability and duration of SARS-CoV-2 RNA in the urine among patients with different severities of COVID-19. From February 7, 2020 to March 24, 2020, we evaluated the presence of SARS-CoV-2 RNA in the urine of patients admitted to the National Center for Global Health and Medicine, a tertiary care institution in Tokyo, Japan. The patients had been diagnosed with COVID-19 by qRT-PCR using nasal or pharyngeal swab specimens. 8 Information on demographics, comorbidities, disease severity, number of days from the onset of COVID-19 to the testing of urine, and qRT-PCR results in the urine (cycle threshold [Ct] values and viral load [VL] as virus copies/mL) were collected. Disease severity was defined as follows: a patient without oxygen demand, mild; a patient with oxygen demand, moderate; and a patient requiring a ventilator to treat respiratory failure, severe. The study protocol was approved by the institutional review board (approval no: NCGM-G-003472-02), and written informed consent for publication was obtained from each patient. Twenty-three specimens from 20 patients were collected ( Table 1) During the study period, SARS-CoV-2 RNA was detected in the urine of two of 20 patients (10%). Only two previous reports have evaluated the presence of this virus in urine. 2, 3 In one study, the virus was detected in one of nine patients (11.1%). 2 Another study examined urine specimens from 72 patients; however, no patients tested positive for SARS-CoV-2 RNA. 3 Although these studies did not evaluate the severity of disease in the tested patients, we considered the severity of disease in patients who were positive for SARS-CoV-2 RNA. No patients with mild disease tested positive for SARS-CoV-2 RNA; however, one patient each in the moderate and severe groups had SARS-CoV-2 RNA in the urine. Thus, we showed that SARS-CoV-2 RNA could be excreted in the urine for at least 4 days. This duration is relatively short compared with those of other specimens, such as pharyngeal swabs (up to 30 days) and stools (14-18 days). 4-6 COVID-19 transmission among health care workers (HCWs) has become a major problem worldwide; 8 thus, HCWs should carefully handle urine samples from patients with moderate to severe disease. There were several limitations to this study. First, because of the small number of patients enrolled, the relationship between clinical severity and SARS-CoV-2 RNA detection in the urine could not be established. Second, we did not evaluate the infectious potential of the virus in the urine. However, a previous study indicated that SARS-CoV-2 RNA isolated from urine may be infectious. 9 An autopsy case suggesting direct infection of the renal tubular epithelium has also been reported. 10 Together, these reports indicate that SARS-CoV-2 RNA in the urine is infectious. In conclusion, our results suggested that SARS-CoV-2 RNA may be excreted in the urine depending on the severity of COVID-19. Although the period of viral shedding in the urine was relatively short, HCWs should also take infection prevention and control measures when handling urine, particularly samples from patients with moderate to severe COVID-19. A novel coronavirus from patients with pneumonia in China SARS-CoV-2 can be detected in urine, blood, anal swabs, and oropharyngeal swabs specimens Detection of SARS-CoV-2 in different types of clinical specimens SARS-CoV-2 enterocolitis with persisting to excrete the virus for approximately two weeks after recovering from diarrhea: a case report A report of three COVID-19 cases with prolonged viral RNA detection in anal swabs The duration of viral shedding of discharged patients with severe COVID-19 Characteristics of SARS-CoV-2 isolated from asymptomatic carrier in Tokyo Characteristics of Health Care Personnel with COVID-19 -United States Isolation of infectious SARS-CoV-2 from urine of a COVID-19 patient Ultrastructural evidence for direct renal infection with SARS-CoV-2 We thank the clinical staff at the National Center for Global Health and Medicine for their dedication to clinical practice and patient care, and Ryota Kumagai, PhD and Takashi Chiba, MT, PhD at the Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan for analysis of SARS-CoV-2 RNA. No specific financial support was provided for this study. All authors declare that they have no conflicts of interest related to this study.