In nonhospitalized adults suffering from mild-moderate coronavirus disease, age was strongly associated with SARS-CoV-2 shedding, and men exhibited slower viral clearance than females. Identifying characteristics linked with SARS-CoV-2 RNA shedding is beneficial to decipher viral compartmentalization, disease pathogenesis, and viral transmission risks. Investigators, therefore, aimed to determine predictors of viral RNA from the nasopharyngeal swabs and concordance with the other compartments in coronavirus-infected patients.

In ACTIV-2/A5401, a placebo-controlled platform study exploring investigational treatments for SARS-CoV-2 infection, participants were recruited. Quantitative viral RNA testing was performed on the nasopharyngeal and anterior nasal swabs, oral wash/saliva, and plasma at entrance (day 0, pretreatment), as well as on 3rd, 7th, 14th , and 28th day. At entry, predictors of nasopharyngeal RNA levels and concordance of RNA levels (copies/mL) within compartments were determined (n = 537). With the help of censored linear regression models, predictors of alterations over time were assessed in placebo receivers (n = 265).

At study entry, anterior nasal RNA levels were substantially correlated with nasopharyngeal RNA levels (r = 0.84). Raised levels of both were linked to elevated RNA detection in the plasma and oral wash/saliva. Higher nasopharyngeal RNA at the entrance was linked with reduced body mass index (BMI), white non-Hispanic race or ethnicity, older age, SARS-CoV-2 immunoglobulin G seronegativity, and shorter duration of preceding symptoms.

In the adjusted models, BMI and race/ethnicity associations were reduced. However, the link with age remained (for every ten years older, the mean nasopharyngeal RNA was 0.27 log10 copies/mL greater). Women experienced faster decreases in nasopharyngeal RNA than males did from entry to day 3 when longitudinal viral RNA levels in placebo patients were examined (mean change, -2.0 vs. -1.3 log10 copies/mL).

Hence, the shedding of SARS-CoV-2 RNA was consistent between compartments. Men cleared viruses more slowly than women did as they aged, which may account for gender variations in acute COVID-19 results.