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Viral Coinfections in Hospitalized Coronavirus Disease 2019 Patients Recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK Study.

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Davis, Chris 
MacLean, Alasdair 
Pascall, David 
McDonald, Sarah E 


BACKGROUND: We conducted this study to assess the prevalence of viral coinfection in a well characterized cohort of hospitalized coronavirus disease 2019 (COVID-19) patients and to investigate the impact of coinfection on disease severity. METHODS: Multiplex real-time polymerase chain reaction testing for endemic respiratory viruses was performed on upper respiratory tract samples from 1002 patients with COVID-19, aged <1 year to 102 years old, recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK study. Comprehensive demographic, clinical, and outcome data were collected prospectively up to 28 days post discharge. RESULTS: A coinfecting virus was detected in 20 (2.0%) participants. Multivariable analysis revealed no significant risk factors for coinfection, although this may be due to rarity of coinfection. Likewise, ordinal logistic regression analysis did not demonstrate a significant association between coinfection and increased disease severity. CONCLUSIONS: Viral coinfection was rare among hospitalized COVID-19 patients in the United Kingdom during the first 18 months of the pandemic. With unbiased prospective sampling, we found no evidence of an association between viral coinfection and disease severity. Public health interventions disrupted normal seasonal transmission of respiratory viruses; relaxation of these measures mean it will be important to monitor the prevalence and impact of respiratory viral coinfections going forward.


Funder: National Institute for Health Research Health Protection Research Unit; doi:

Funder: EU Platform for

Funder: European Preparedness Against (Re-)emerging Epidemics

Funder: Wellcome Trust; doi:


PCR, SARS-CoV-2, disease severity, respiratory virus, rhinovirus, surveillance

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Open Forum Infect Dis

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Oxford University Press (OUP)
National Institute for Health Research (CO-CIN-01)
Medical Research Council (MC_PC_19059, MC_ST_CVR_2019)
Emerging and Zoonotic Infections at University of Liverpool (200907)
Public Health England (PHE) (200927)
Department for International Development (215091/Z/18/Z)
Bill and Melinda Gates Foundation (OPP1209135)
Liverpool Experimental Cancer Medicine Centre (C18616/A25153)