@article{Andersson_M-2020_9520,
title = {SARS-CoV-2 RNA detected in blood products from patients with COVID-19 is not associated with infectious virus},
author = {Andersson, M. and Arancibia-Cárcamo, C. and Auckland, K. and Baillie, J. and Barnes, E. and Beneke, T. and Bibi, S. and Brooks, T. and Carroll, M. and Crook, D. and Dingle, K. and Dold, C. and Downs, L. and Dunn, L. and Eyre, D. and Gilbert Jaramillo, J. and Harvala, H. and Hoosdally, S. and Ijaz, S. and James, T. and James, W. and Jeffery, K. and Justice, A. and Klenerman, P. and Knight, J. and Knight, M. and Liu, X. and Lumley, S. and Matthews, P. and McNaughton, A. and Mentzer, A. and Mongkolsapaya, J. and Oakley, S. and Oliveira, M. and Peto, T. and Ploeg, R. and Ratcliff, J. and Robbins, M. and Roberts, D. and Rudkin, J. and Russell, R. and Screaton, G. and Semple, M. and Skelly, D. and Simmonds, P. and Stoesser, N. and Turtle, L. and Wareing, S. and Zambon, M.},
month = {oct},
year = {2020},
abstract = {Background: Laboratory diagnosis of SARS-CoV-2 infection (the cause of COVID-19) uses PCR to detect viral RNA (vRNA) in respiratory samples. SARS-CoV-2 RNA has also been detected in other sample types, but there is limited understanding of the clinical or laboratory significance of its detection in blood. Methods: We undertook a systematic literature review to assimilate the evidence for the frequency of vRNA in blood, and to identify associated clinical characteristics. We performed RT-PCR in serum samples from a UK clinical cohort of acute and convalescent COVID-19 cases (n=212), together with convalescent plasma samples collected by NHS Blood and Transplant (NHSBT) (n=462 additional samples). To determine whether PCR-positive blood samples could pose an infection risk, we attempted virus isolation from a subset of RNA-positive samples. Results: We identified 28 relevant studies, reporting SARS-CoV-2 RNA in 0-76% of blood samples; pooled estimate 10% (95%CI 5-18%). Among serum samples from our clinical cohort, 27/212 (12.7%) had SARS-CoV-2 RNA detected by RT-PCR. RNA detection occurred in samples up to day 20 post symptom onset, and was associated with more severe disease (multivariable odds ratio 7.5). Across all samples collected ≥28 days post symptom onset, 0/494 (0%, 95%CI 0-0.7%) had vRNA detected. Among our PCR-positive samples, cycle threshold (ct) values were high (range 33.5-44.8), suggesting low vRNA copy numbers. PCR-positive sera inoculated into cell culture did not produce any cytopathic effect or yield an increase in detectable SARS-CoV-2 RNA. There was a relationship between RT-PCR negativity and the presence of total SARS-CoV-2 antibody (p=0.02). Conclusions: vRNA was detectable at low viral loads in a minority of serum samples collected in acute infection, but was not associated with infectious SARS-CoV-2 (within the limitations of the assays used). This work helps to inform biosafety precautions for handling blood products from patients with current or previous COVID-19.},
volume = {5},
issue = {181},
journal = {Wellcome Open Research},
publisher = {Wellcome Open Research},
url = {https://doi.org/10.12688/wellcomeopenres.16002.2},
}
