• Anne Weiss, Mads Jellingsø, and Morten Otto Alexander Sommer.
• UNION therapeutics, Tuborg Havnevej 18, 2900 Hellerup, Denmark.
• EBioMedicine. 2020 Aug 1; 58: 102916.

BackgroundThe spatial and temporal dynamics of SARS-CoV-2 have been described in case series and retrospective studies. In this study, we provide a coherent overview of the duration of viral detection and viral RNA load in COVID-19 patients, stratified by specimen type, clinical severity, and age.MethodWe systematically searched PubMed/MEDLINE and Cochrane review database for studies published between 1.11.2019 and 23.04.2020. We pooled the data of selected studies (22/7226 (650 patients) for meta-analysis) to estimate duration of viral detection and visualized viral load over time.FindingsOur analysis showed consistent viral detection from specimen from the upper respiratory tract (URT), the lower respiratory tract (LRT), and faeces, irrespective of the clinical severity of COVID-19. Our analysis suggests that SARS-CoV-2 persists for a longer duration in the LRT compared to the URT in adult patients (5•7 days in mild; 5•9 days in moderate-severe patients). The differences in the duration of viral detection between mild and moderate-severe patients is limited in the LRT, but an indication of longer duration of viral detection for moderate-severe patients was observed in feces (15 days in mild vs. 21 days in moderate-severe patients) and the URT (12 days in mild vs. 16 days in moderate-severe patients). Further, viral load was demonstrated to peak in earlier stages of infection in the URT compared to LRT.InterpretationThis review may aid mathematical modelling and help in defining appropriate endpoints for clinical trails with antivirals in COVID-19.FundingThe project has received funding support from Innovation Fund Denmark.Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

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