Replication-Competent Virus Detected in Blood of a Fatal COVID-19 Case

Here’s a detailed summary for the study “Replication-Competent Virus Detected in Blood of a Fatal COVID-19 Case”:

Study Overview

  • Background: While SARS-CoV-2 primarily infects respiratory tissues, its replication-competent virus has also been found in extrapulmonary tissues like the brain. However, recovering such a virus from blood was previously unachieved.
  • Objective: The study aimed to confirm the presence of viremia (virus in the bloodstream) in a fatal COVID-19 case, with a matching viral sequence in blood and other tissues.

Case Report

  • Patient Profile: The subject was a 76-year-old woman with multiple health issues, admitted to a hospital in fall 2020 with respiratory distress, later testing positive for SARS-CoV-2.
  • Clinical Course: She was treated with dexamethasone, remdesivir, antibiotics, and vasopressors, but developed severe complications and was shifted to comfort measures only. She passed away a day after admission.

Methodology and Findings

  1. Autopsy and Sample Analysis:
    • Post-mortem, her blood was collected and plasma isolated.
    • SARS-CoV-2 RNA and subgenomic RNA, indicative of recent virus replication, were detected in her plasma, lungs, heart, and other tissues.
    • Using a modified Vero cell line for virus isolation from plasma, replication-competent virus was successfully cultured, showing an increase in RNA copies and cytopathic effect in cell cultures.
  2. Genomic Sequencing:
    • Full-length genomic sequencing of samples before and after viral culture showed more than 99% sequence similarity to the WA1 reference sequence, with minor mutations.
    • This confirmed that the virus in her blood was replication-competent and genetically consistent with that in her lungs and heart.

Discussion and Implications

  • Significance: This case demonstrates that replication-competent SARS-CoV-2 can circulate in the blood during COVID-19 and potentially seed various body tissues.
  • Implications for Future Research: The study underlines the need for further research to understand the implications of these findings for different groups, including those with mild illness, vaccinated individuals, and those with waning immunity post-infection or vaccination.


This study’s findings are groundbreaking in confirming that replication-competent SARS-CoV-2 can exist in the bloodstream in severe COVID-19 cases, underscoring the potential systemic impact of the virus. This discovery has significant implications for understanding the full scope of COVID-19’s pathophysiology and for managing severe cases​​.

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