SARS-CoV-2 viral load is associated with increased disease severity and mortality
Jesse Fajnzylber, James Regan, Kendyll Coxen, Heather Corry, Colline Wong, Alexandra Rosenthal, Daniel Worrall, Françoise Giguel, Alicja Piechocka‐Trocha, Caroline Atyeo, Stephanie Fischinger, Andrew T. Chan, Keith T. Flaherty, Kathryn Hall, Michael Dougan, Edward T. Ryan, Elizabeth Gillespie, Rida Chishti, Yijia Li, Nikolaus Jilg, Dusan Hanidziar, Rebecca M. Baron, Lindsey R. Baden, Athe Tsibris, Katrina Armstrong, Daniel R. Kuritzkes, Galit Alter, Bruce D. Walker, Xu G. Yu, Jonathan Z. Li, Betelihem A. Abayneh, Patrick Allen, Diane Antille, Alejandro B. Balazs, Julia Bals, Max Barbash, Yannic C. Bartsch, Julie Boucau, Siobhan Boyce, Joan Braley, Karen Branch, Katherine Broderick, Julia Carney, Joshua M Chevalier, Manish C. Choudhary, Navin Chowdhury, Trevor Cordwell, George Q. Daley, Susan Davidson, Michaël Desjardins, Lauren Donahue, David A. Drew, Kevin Einkauf, Sampson Elizabeth, Ashley Elliman, Behzad Etemad, Jon Fallon, Liz Fedirko, Kelsey Finn, Jeanne Flannery, Pamela J. Forde, Pilar García‐Broncano, Elise Gettings, David Golan, Kirsten Goodman, Amanda Griffin, Sheila Grimmel, Kathleen Grinke, Ciputra Adijaya Hartana, Meg Healy, Howard M. Heller, Deborah Henault, Grace Holland, Chenyang Jiang, Hannah Jordan, Paulina Kapłonek, Elizabeth W. Karlson, Marshall Karpell, Chantal Kayitesi, Evan C. Lam, Vlasta LaValle, Kristina Lefteri, Xiaodong Lian, Mathias Lichterfeld, Daniel Lingwood, Hang Liu, Jin-Qing Liu, K. A. J. Lopez, Yuting Lu, Sarah Luthern, Ngoc L. Ly, Maureen MacGowan, Karen Magispoc, Jordan Marchewka, Brittani Martino, Roseann McNamara, Ashlin R. Michell, Ilan Millstrom, Noah Miranda, Christian Nambu
Abstract
The relationship between SARS-CoV-2 viral load and risk of disease progression remains largely undefined in coronavirus disease 2019 (COVID-19). Here, we quantify SARS-CoV-2 viral load from participants with a diverse range of COVID-19 disease severity, including those requiring hospitalization, outpatients with mild disease, and individuals with resolved infection. We detected SARS-CoV-2 plasma RNA in 27% of hospitalized participants, and 13% of outpatients diagnosed with COVID-19. Amongst the participants hospitalized with COVID-19, we report that a higher prevalence of detectable SARS-CoV-2 plasma viral load is associated with worse respiratory disease severity, lower absolute lymphocyte counts, and increased markers of inflammation, including C-reactive protein and IL-6. SARS-CoV-2 viral loads, especially plasma viremia, are associated with increased risk of mortality. Our data show that SARS-CoV-2 viral loads may aid in the risk stratification of patients with COVID-19, and therefore its role in disease pathogenesis should be further explored.