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      Use of exhaled breath condensate (EBC) in the diagnosis of SARS-COV-2 (COVID-19)

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          Abstract

          False negatives from nasopharyngeal swabs (NPS) using reverse transcriptase PCR (RT-PCR) in SARS-CoV-2 are high. Exhaled breath condensate (EBC) contains lower respiratory droplets that may improve detection. We performed EBC RT-PCR for SARS-CoV-2 genes (E, S, N, ORF1ab) on NPS-positive (n=16) and NPS-negative/clinically positive COVID-19 patients (n=15) using two commercial assays. EBC detected SARS-CoV-2 in 93.5% (29/31) using the four genes. Pre-SARS-CoV-2 era controls (n=14) were negative. EBC was positive in NPS negative/clinically positive patients in 66.6% (10/15) using the identical E and S (E/S) gene assay used for NPS, 73.3% (11/15) using the N/ORF1ab assay and 14/15 (93.3%) combined.

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          Virological assessment of hospitalized patients with COVID-2019

          Roman Wölfel, Victor M Corman, Wolfgang Guggemos … (2020)
          Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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            Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis

            Alfonso J. Rodríguez-Morales, Jaime A. Cardona-Ospina, Estefanía Gutiérrez-Ocampo … (2020)
            Introduction An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date. Methods We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI). Results 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5–92.9%), cough (57.6%, 95%CI 40.8–74.4%) and dyspnea (45.6%, 95%CI 10.9–80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0–30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7–51.8), 6.2% (95%CI 3.1–9.3) with shock. Some 13.9% (95%CI 6.2–21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR). Conclusion COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.
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              Respiratory virus shedding in exhaled breath and efficacy of face masks

              Nancy Leung, Daniel Chu, Eunice Shiu … (2020)
              We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Thorax
                Journal ID (iso-abbrev): Thorax
                Journal ID (hwp): thoraxjnl
                Journal ID (publisher-id): thorax
                Title: Thorax
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 0040-6376
                ISSN (Electronic): 1468-3296
                Publication date (Print): October 2020
                Publication date (Electronic): 23 October 2020
                Electronic Location Identifier: thoraxjnl-2020-215705
                Affiliations
                [1 ]departmentDepartment of Molecular Medicine , Royal College of Surgeons in Ireland , Dublin, Ireland
                [2 ]departmentDepartment of Respiratory Medicine , Beaumont Hospital , Dublin, Ireland
                [3 ]departmentData Science Centre , Royal College of Surgeons in Ireland , Dublin, Ireland
                [4 ]departmentDepartment of Oncology , Beaumont Hospital , Dublin, Ireland
                [5 ]departmentDepartment of International Health and Tropical Medicine , Royal College of Surgeons in Ireland , Dublin, Ireland
                Author notes
                [Correspondence to ] Dr Daniel J Ryan, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; danennis100@ 123456gmail.com

                DJR and ST are joint first authors.

                RKM and BTH are joint senior authors.

                Article
                Publisher ID: thoraxjnl-2020-215705
                DOI: 10.1136/thoraxjnl-2020-215705
                PMC ID: 7590263
                PubMed ID: 33097604
                SO-VID: ab908c10-ff3a-4e3e-8ca2-73dcd3c61979
                Copyright © © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

                History
                Date received : 02 July 2020
                Date revision received : 07 October 2020
                Date accepted : 08 October 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001602, Science Foundation Ireland;
                Award ID: 20/COV/0109
                Funded by: North East Cancer Research and Education Trust (NECRET);
                Award ID: 1696
                Categories
                Subject: Brief Communication
                Subject: 2474
                Subject: 2313
                Custom metadata
                access-type free

                ScienceOpen disciplines: Surgery
                Keywords: exhaled airway markers,respiratory infection,viral infection
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: exhaled airway markers, respiratory infection, viral infection

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