Abstract

COVID-19 is known to cause multi-organ dysfunction^1-3 in acute infection, with prolonged symptoms experienced by some patients, termed Post-Acute Sequelae of SARS-CoV-2 (PASC)^4-5. However, the burden of infection outside the respiratory tract and time to viral clearance is not well characterized, particularly in the brain^3,6-14. We performed complete autopsies on 44 patients with COVID-19 to map and quantify SARS-CoV-2 distribution, replication, and cell-type specificity across the human body, including brain, from acute infection through over seven months following symptom onset. We show that SARS-CoV-2 is widely distributed, even among patients who died with asymptomatic to mild COVID-19, and that virus replication is present in multiple extrapulmonary tissues early in infection. Further, we detected SARS-CoV-2 RNA in multiple anatomic sites, including regions throughout the brain, for up to 230 days following symptom onset. Despite extensive distribution of SARS-CoV-2 in the body, we observed a paucity of inflammation or direct viral cytopathology outside of the lungs. Our data prove that SARS-CoV-2 causes systemic infection and can persist in the body for months.

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Authors: Daniel Chertow, Sydney Stein, Sabrina Ramelli, Alison Grazioli, Joon-Yong Chung, Manmeet Singh, Claude Kwe Yinda, Clayton Winkler, James Dickey, Kris Ylaya, Sung Hee Ko, Andrew Platt, Peter Burbelo, Martha Quezado, Stefania Pittaluga, Madeleine Purcell, Vincent Munster, Frida Belinky, Marcos Ramos-Benitez, Eli Boritz, Daniel Herr, Joseph Rabin, Kapil Saharia, Ronson Madathil, Ali Tabatabai, Shahabuddin Soherwardi, Michael McCurdy, Karin Peterson, Jeffrey Cohen, Emmie de Wit, Kevin Vannella, Stephen Hewitt, David Kleiner