COVID-19 Research: New York University Study Shows That SARS-Cov-2 Viral Load Peaks In The Early Stages Of Disease
: Researchers from New York University Langone Health in a retrospective study, found that the viral load of SARS-CoV-2 collected from patients in the emergency department is significantly higher in patients with fewer or milder symptoms who did not require hospitalization, the opposite of what might be expected. They also found that a patient's history of cancer and cardiovascular disease is associated with higher viral loads even after adjusting for age.
The research was designed to determine possible associations between the viral load measured in patients positive for SARS-CoV-2 and their clinical parameters including severity of symptoms, hospital admission vs direct discharge, length of hospitalization, admission to the intensive care unit, length of need for oxygen support, and overall survival.
The study findings were published in the journal published by Elsevier: The American Journal of Pathology
Co-lead investigator Dr Paolo Cotzia, MD, Assistant Professor, Department of Pathology, and Assistant Director, Center for Biospecimen Research and Development, NYU Langone Health said, “It appears that the viral load peaks in the early stages of the disease. Although it is not associated with the duration of symptoms, their severity or outcome, it appears that the viral load is an important epidemiological surrogate marker of infectivity in mildly symptomatic and asymptomatic non-hospitalized patients. Whether the viral load in these patients stays the same or changes in later stages of the disease remains to be investigated and could provide further insights on the dynamics of viral replication."
The study included two hundred and five patients who visited the emergency department at a New York City tertiary care center with confirmed COVID-19. Nasopharyngeal samples were taken at the time of diagnosis. One hundred and sixty-five patients were discharged from the emergency department, and 40 patients were hospitalized. Non-hospitalized patients were younger overall, and other characteristics were similar across the group. The median duration from symptom onset to sample collection for the hospitalized group was five days compared with three days for the discharged patients.
The researchers found that the initial viral load was significantly lower in patients who required hospitalization compared to those who were discharged. The association remained significant even after adjustment for age, sex, race, body mass index, and other existing medical conditions. They also found that a higher viral load was associated with shorter duration of symptoms in all patients and was not associated with disease severity.
Dr George Jour, MD, Assistant Professor, Department of Pathology and Department of Dermatology, Associate Director Molecular Pathology, NYU Langone Health and co-lead investigator said, "Another important finding of our study is that the initial nasopharyngeal viral load reflects the time from onset of symptoms and duration of symptoms. We found that higher viral loads are seen in mild rather than in severe disease because they appear to reflect the time lapsed from the onset of infection. Furthermore
, higher viral loads correlate with the presence of cancer or cardiovascular diseases."
Even though the diagnostic viral load seems to have no prognostic utility for predicting outcomes from COVID-19, the researchers say it may be an important surrogate marker in mildly symptomatic, non-hospitalized patients.
The study findings support the concept that such patients may represent important sources of the virus. The study should increase awareness and should prompt the adherence to strict recommendation of social distancing and mask usage to avoid transmission.
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