Woman With COVID Shed Virus for 61 Days in Longest Case of Its Kind Recorded

A woman with COVID-19 who had a normal immune response to the infection was found to have shed the virus for 61 days. This is the longest known period of viral shedding in an immunocompetent patient, raising questions about how long patients may be contagious for, and the implications for those who are infected for prolonged periods.

Research suggests that the amount of time a person with SARS-CoV-2 will be infectious varies widely and is, to an extent, dependent on how severe their illness is. One way to identify this is based on "viral shedding."

This is where the virus is replicating inside the body and being released into the environment. People with severe cases tend to shed the virus for longer, particularly in those who are immunocompromised or immunodeficient—either as a result of illness or therapy.

In April, scientists announced a case where a woman shed SARS-CoV-2 for 60 days from the onset of symptoms.

Now, a team from the U.K. has reported a COVID-19 case where the sufferer tested positive for the virus through a throat swab after 61 days of symptoms.

The case report, published in the BMJ, identifies a 78-year-old woman who was hospitalized for breathlessness and discharge coming from her tracheostomy site. After being admitted, she tested positive for SARS-CoV-2. She continued to test positive for 61 days.

Over the course of her hospitalization, she was treated with antibiotics but had no experimental or trial therapies. Physicians treating her wore personal protective equipment (PPE) and she was isolated throughout.

"To our knowledge this case is the longest reported duration of viral shedding in COVID-19 in an immunocompetent patient," the team wrote. They said around 17 percent of people hospitalized with COVID-19 become critically ill and, on average, shed the virus for 20 days.

"We could find no clear reason to explain the prolonged period of viral shedding in this patient," they said. "Although the presence of a tracheostomy was unusual, we found no published evidence of an increased duration for COVID-19 or other viral infections in the literature."

They said the prolonged viral shedding may have been the result of the swabs being taken from her tracheostomy, as samples would have come from deeper in her respiratory tract than standard throat and nasal swabs.

Over the course of her hospital stay, the woman's mental state worsened, despite little deterioration in her physical condition. She was discharged 55 days and during a follow-up call a week later, they found she was suffering from "significant emotional distress."

"She described poor sleep, nightmares, hallucinations of 'people in masks,' with significant anxiety if left alone, and had become apathetic towards her previously independent tracheostomy care." The woman, who previously lived alone, is now being assessed for care home placement.

The team said the prolonged isolation she faced during her treatment impacted her well-being. As our understanding of COVID-19 improves, the impact of isolation should be taken into account when considering the best course of treatment for patients affected by prolonged viral shedding.

"Patients requiring prolonged periods of isolation are at risk of significant deterioration in their mental health, and even after discharge from hospital, the trauma of isolation can provoke ongoing psychological distress," they team concluded.

"A clearer understanding of the causes for this and ways to mitigate decline in mental health during isolation is imperative and follow-up of patients is necessary to understand the long-term impacts of the COVID-19 pandemic on mental health."