Of the 381 persistent infections, 65 had three or more PCR tests taken over the course of their infection. Most (82%) of these individuals demonstrated rebounding viral dynamics, experiencing high, then low, then high viral load dynamics. According to the researchers, this demonstrates that the virus can maintain the ability to actively replicate during prolonged infections.
In the study, people with persistent infections were 55% more likely to report having long-COVID symptoms more than 12 weeks since the start of the infection than people with more typical infections.
Certain individuals showed an extremely high number of mutations, including mutations that define new coronavirus variants, alter target sites for monoclonal antibodies, and introduce changes to the coronavirus spike protein. However, most individuals did not harbor a large number of mutations, suggesting that not every persistent infection will be a potential source for new concerning variants.
Co-lead author of the study Dr. Mahan Ghafari (Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford) said, "Our observations highlight the continuing importance of community based genomic surveillance both to monitor the emergence and spread of new variants, but also to gain a fundamental understanding of the natural history and evolution of novel pathogens and their clinical implications for patients."
Co-lead author Dr. Katrina Lythgoe (Department of Biology and Pandemic Sciences Institute, University of Oxford) said, "Although the link between viral persistence and long COVID may not be causal, these results suggest persistent infections could be contributing to the pathophysiology of long COVID. Indeed, many other possible mechanisms have been suggested to contribute to long COVID including inflammation, organ damage, and micro thrombosis."