Evidence for Viral Persistence of SARS-CoV-2 (COVID-19)
Claim: SARS-CoV-2 can persist in the human body long after acute infection resolves. This includes the persistence of viral RNA, protein, and in some cases replication-competent virus.
1. Viral RNA and Protein Persistence (not necessarily infectious virus)
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Cell and tissue studies:
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Steenblock et al., 2021 (Nature Communications): Detected SARS-CoV-2 RNA and protein in intestinal biopsies 4 months post-infection.
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Chertow et al., 2021 (Nature): Autopsy study found SARS-CoV-2 RNA in multiple organs (brain, heart, gut) up to 230 days post-infection.
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Biopsy and fecal samples:
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Zollner et al., 2022 (MedRxiv): Detected viral proteins in gut biopsies 7 months post-infection in individuals with long COVID.
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Natarajan et al., 2022 (Med): SARS-CoV-2 RNA found in feces up to 126 days post-symptom onset.
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Lymphoid tissue:
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Cheung et al., 2023 (bioRxiv): Detected spike protein in lymph nodes up to 15 months after infection.
2. Replication-Competent Virus
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Rare but confirmed:
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Liu et al., 2021 (Emerg Infect Dis): Immunocompromised patient shed replication-competent virus for 143 days.
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Avanzato et al., 2020 (Cell): Infectious virus isolated from an immunocompromised patient for 70 days.
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Common in immunocompromised hosts:
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Choi et al., 2020 (NEJM): Patient with B-cell lymphoma shed viable virus for over 150 days.
3. Post-Acute Sequelae (Long COVID) Correlation
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Persistence markers linked to long COVID:
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Peluso et al., 2021 (Nature Microbiology): Ongoing immune activation and detectable viral proteins in long COVID patients.
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Swank et al., 2022 (bioRxiv): Spike protein detected in plasma of long COVID patients months after infection, absent in controls.
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Gut reservoir hypothesis:
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Chronic symptoms linked to ongoing antigen presence in gut and associated immune dysregulation (Proal and VanElzakker, 2021; Zollner et al., 2022).
4. Duration Ranges (Documented Cases)
| Evidence Type | Max Duration Recorded | Source |
|---|---|---|
| Viral RNA in tissues/organs | 230 days (7.5 months) | Chertow et al., 2021 |
| Viral protein (e.g., spike) | 15 months | Cheung et al., 2023 |
| Fecal RNA shedding | 126 days | Natarajan et al., 2022 |
| Replication-competent virus | 150+ days (immunocomp.) | Choi et al., 2020 |
| Long COVID symptoms | 2+ years in some cases | Multiple cohort studies |
Summary
- RNA and protein fragments persist for months to over a year in various tissues, even in non-immunocompromised individuals.
- Replication-competent virus can persist over 150 days, especially in immunocompromised people.
- Long COVID symptoms correlate with evidence of viral protein persistence and immune activation.