Objective:

To investigate the reactivation of chronic viruses in patients hospitalized with COVID-19.

Approach:

• Study Design: A longitudinal study involving 1,154 unvaccinated patients hospitalized with COVID-19 across 20 US hospitals from May 2020 to March 2021.
• Data Collection: Nasal swabs, peripheral blood mononuclear cells, and endotracheal aspirates were collected for up to one year.
• Analysis Method: RNA sequencing was used to identify transcripts from actively replicating viruses and assess immune cell populations, antibody levels, cytokines, proteins, and metabolites.

Key Findings:

• Nearly half of patients had detectable reactivation of at least one chronic virus during acute illness.
• Chronic viral transcripts were found in 550 of 1,148 evaluable patients within the first 40 days.
• Epstein-Barr virus reactivated early in 24% of patients during days one to eight.
• Human alphaherpesvirus 1 and cytomegalovirus appeared later, with varying detection rates.
• Herpesvirus and Anelloviridae transcripts were associated with greater COVID-19 severity.
• Cytomegalovirus and Epstein-Barr virus were linked to one-year mortality in critically ill patients.
• Anelloviridae transcripts were more common among patients reporting persistent physical disability or fatigue.

Interpretation:

The study provides potential laboratory markers for further investigation but does not establish causation between viral reactivation and severe disease or long COVID.

Limitations:

• Sampling limited to three specimen types.
• Participant loss during follow-up.
• Cohort limited to unvaccinated, hospitalized patients infected with early SARS-CoV-2 variants.

Conclusion:

The findings suggest that viral transcript detection can characterize reactivation timing, but routine monitoring's impact on patient care remains unestablished.

Sources:

• Nature Study