The Post-Acute Phase of SARS-CoV-2 Infection in Two Macaque Species Is Associated with Signs of Ongoing Virus Replication and Pathology in Pulmonary and Extrapulmonary Tissues

Kinga Böszörményi, Stammes MA, Fagrouch ZC, Kiemenyi-Kayere G, Niphuis H, Mortier D, van Driel N, Nieuwenhuis I, Vervenne RAW, Haaksma T, Ouwerling B, Adema D, Acar RF, Zuiderwijk-Sick E, Meijer L, Mooij P, Remarque EJ, Oostermeijer H, Koopman G, Hoste ACR, Sastre P, Haagmans BL, Bontrop RE, Langermans JAM, Bogers WM, Kondova I, Verschoor EJ, and Verstrepen BE

During COVID-19 disease different phases of can be distinguished. The initial or acute phase is viremia in which immune responses determine if infection develops into a mild or severe disease. A convalescent phase is subsequently initiated during which the infection resolves. Here we specifically focused on this post-acute phase using animal models (Macaca mulatta and Macaca fascicularis). We show that even after the alleged resolution of the infection, computed tomography (CT) and positron emission tomography (PET)-CT show pulmonary lesions and activated tracheobronchial lymph nodes in all animals. Moreover, viral RNA was still detectable in 50% of the animals, in the heart, the respiratory tract and surrounding lymph nodes, salivary gland, conjunctiva and other organs, five to six weeks after virus exposure. Most alarming was the finding of subgenomic messenger RNA of the virus in the lungs and tracheobronchial lymph nodes (table), indicative for ongoing virus replication. These results could be relevant for understanding the long-term consequences of COVID-19 in humans.

Published August 2021 in Viruses