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SARS-CoV-2 viral load is associated with increased disease severity and mortality

Author

Listed:
  • Jesse Fajnzylber

    (Brigham and Women’s Hospital, Harvard Medical School)

  • James Regan

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Kendyll Coxen

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Heather Corry

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Colline Wong

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Alexandra Rosenthal

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Daniel Worrall

    (Ragon Institute of MGH, MIT and Harvard, Harvard Medical School)

  • Francoise Giguel

    (Massachusetts General Hospital, Harvard Medical School)

  • Alicja Piechocka-Trocha

    (Ragon Institute of MGH, MIT and Harvard, Harvard Medical School)

  • Caroline Atyeo

    (Ragon Institute of MGH, MIT and Harvard, Harvard Medical School)

  • Stephanie Fischinger

    (Ragon Institute of MGH, MIT and Harvard, Harvard Medical School)

  • Andrew Chan

    (Massachusetts General Hospital, Harvard Medical School)

  • Keith T. Flaherty

    (Massachusetts General Hospital, Harvard Medical School)

  • Kathryn Hall

    (Massachusetts General Hospital, Harvard Medical School)

  • Michael Dougan

    (Massachusetts General Hospital, Harvard Medical School)

  • Edward T. Ryan

    (Massachusetts General Hospital, Harvard Medical School)

  • Elizabeth Gillespie

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Rida Chishti

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Yijia Li

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Nikolaus Jilg

    (Brigham and Women’s Hospital, Harvard Medical School
    Massachusetts General Hospital, Harvard Medical School)

  • Dusan Hanidziar

    (Massachusetts General Hospital, Harvard Medical School)

  • Rebecca M. Baron

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Lindsey Baden

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Athe M. Tsibris

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Katrina A. Armstrong

    (Massachusetts General Hospital, Harvard Medical School)

  • Daniel R. Kuritzkes

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Galit Alter

    (Ragon Institute of MGH, MIT and Harvard, Harvard Medical School
    Massachusetts General Hospital, Harvard Medical School)

  • Bruce D. Walker

    (Ragon Institute of MGH, MIT and Harvard, Harvard Medical School
    Massachusetts General Hospital, Harvard Medical School
    Howard Hughes Medical Institute)

  • Xu Yu

    (Ragon Institute of MGH, MIT and Harvard, Harvard Medical School
    Massachusetts General Hospital, Harvard Medical School)

  • Jonathan Z. Li

    (Brigham and Women’s Hospital, Harvard Medical School)

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.

Suggested Citation

  • Jesse Fajnzylber & James Regan & Kendyll Coxen & Heather Corry & Colline Wong & Alexandra Rosenthal & Daniel Worrall & Francoise Giguel & Alicja Piechocka-Trocha & Caroline Atyeo & Stephanie Fischinge, 2020. "SARS-CoV-2 viral load is associated with increased disease severity and mortality," Nature Communications, Nature, vol. 11(1), pages 1-9, December.
    • Handle: RePEc:nat:natcom:v:11:y:2020:i:1:d:10.1038_s41467-020-19057-5
    DOI: 10.1038/s41467-020-19057-5
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    Cited by:

    1. Celine E Snedden & James O Lloyd-Smith, 2024. "Predicting the presence of infectious virus from PCR data: A meta-analysis of SARS-CoV-2 in non-human primates," PLOS Pathogens, Public Library of Science, vol. 20(4), pages 1-39, April.
    2. Elsa Brunet-Ratnasingham & Sacha Morin & Haley E. Randolph & Marjorie Labrecque & Justin Bélair & Raphaël Lima-Barbosa & Amélie Pagliuzza & Lorie Marchitto & Michael Hultström & Julia Niessl & Rose Cl, 2024. "Sustained IFN signaling is associated with delayed development of SARS-CoV-2-specific immunity," Nature Communications, Nature, vol. 15(1), pages 1-19, December.
    3. Kara W. Chew & Carlee Moser & Eric S. Daar & David A. Wohl & Jonathan Z. Li & Robert W. Coombs & Justin Ritz & Mark Giganti & Arzhang Cyrus Javan & Yijia Li & Manish C. Choudhary & Rinki Deo & Carlos , 2022. "Antiviral and clinical activity of bamlanivimab in a randomized trial of non-hospitalized adults with COVID-19," Nature Communications, Nature, vol. 13(1), pages 1-12, December.
    4. Leslie R. Zwerwer & Tim E. A. Peto & Koen B. Pouwels & Ann Sarah Walker, 2025. "Identification of undetected SARS-CoV-2 infections by clustering of Nucleocapsid antibody trajectories," Nature Communications, Nature, vol. 16(1), pages 1-13, December.
    5. Suzanne Pickering & Harry Wilson & Enrico Bravo & Marianne R. Perera & Jeffrey Seow & Carl Graham & Nathalia Almeida & Lazaros Fotopoulos & Thomas Williams & Atlanta Moitra & Helena Winstone & Tinne A, 2024. "Antibodies to the RBD of SARS-CoV-2 spike mediate productive infection of primary human macrophages," Nature Communications, Nature, vol. 15(1), pages 1-17, December.
    6. Djamel Nehar-Belaid & Asunción Mejías & Zhaohui Xu & Radu Marches & Rushil Yerrabelli & Guo Chen & Sara Mertz & Fang Ye & Pablo J. Sánchez & John S. Tsang & Teresa Aydillo & Lisa Miorin & Anastasija C, 2025. "SARS-CoV-2 induced immune perturbations in infants vary with disease severity and differ from adults’ responses," Nature Communications, Nature, vol. 16(1), pages 1-19, December.
    7. Christopher Cyrus Kuhn & Nirakar Basnet & Satish Bodakuntla & Pelayo Alvarez-Brecht & Scott Nichols & Antonio Martinez-Sanchez & Lorenzo Agostini & Young-Min Soh & Junichi Takagi & Christian Biertümpf, 2023. "Direct Cryo-ET observation of platelet deformation induced by SARS-CoV-2 spike protein," Nature Communications, Nature, vol. 14(1), pages 1-14, December.

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