Posted Date: December 20th, 2021

COVID-19 is known to cause multi-organ dysfunction1-68 3 in acute infection, with

69 prolonged symptoms experienced by some patients, termed Post-Acute Sequelae of SARS70

CoV-2 (PASC)4-5. However, the burden of infection outside the respiratory tract and time

71 to viral clearance is not well characterized, particularly in the brain3,6-14. We performed

72 complete autopsies on 44 patients with COVID-19 to map and quantify SARS-CoV-2

73 distribution, replication, and cell-type specificity across the human body, including brain,

74 from acute infection through over seven months following symptom onset. We show that

75 SARS-CoV-2 is widely distributed, even among patients who died with asymptomatic to

76 mild COVID-19, and that virus replication is present in multiple pulmonary and

77 extrapulmonary tissues early in infection. Further, we detected persistent SARS-CoV-2

78 RNA in multiple anatomic sites, including regions throughout the brain, for up to 230 days

79 following symptom onset. Despite extensive distribution of SARS-CoV-2 in the body, we

80 observed a paucity of inflammation or direct viral cytopathology outside of the lungs. Our

81 data prove that SARS-CoV-2 causes systemic infection and can persist in the body for

82 months.