Symptomatic Prolonged Viral Shedding in Long COVID - Our Experience with Remdesivir

Introduction Long COVID may represent many overlapping entities, with different biological causes, risk factors, and outcomes. (Health and Human Services 2022) Prolonged viral shedding (PVS) has been reported in various viruses, occurring commonly in immunocompromised patients. Only case reports describe the successful use of remdesivir in symptomatic COVID-19 with PVS. Objectives Our study aimed to observe treatment outcomes with remdesivir in COVID-19 with PVS and its demographic as well as characteristics. Methods This was a single-center observational study. All adult patients referred to the respiratory unit and subsequently diagnosed as symptomatic PVS with a persistent detected COVID-19 polymerase chain reaction (PCR) from 1 December 2021 to 31 January 2023 were identified and reviewed. Results A total of 14 patients were identified with PVS in COVID-19 but 2 of them had alternative conditions that explained the presentation. Of twelve patients, 7 (58.3%) were aged more than 65, and 7 (58.3%) were in an immunocompromised state. The persistent COVID-19 PCR was detected at 25 (21.5-32.8) days of illness. All patients were hypoxemic with radiologic changes; 10/12 (83.3%) had lymphopenia; 11/12 (91.7%) had c-reactive protein of >40m/L and D-dimer of >1000 μg/L; 6 patients (50%) had cardiac involvement. Eight patients (66.7%) received remdesivir and one of them was given prednisolone concomitantly. Six of these patients (75%) had clinical improvement whereby 4 of them (50%) were discharged well. In non-remdesivir group, only one out of three survived (25%). Conclusion Symptomatic PVS is a hidden entity in long COVID. Patients receiving remdesivir in our cohort had a good clinical outcome.