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Viral Load Dynamics and Clinical Disease Severity in Patients with SARS-CoV-2 Infection

27 Pages Posted: 18 Mar 2020

See all articles by Shufa Zheng

Shufa Zheng

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Jian Fan

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Fei Yu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Baihuan Feng

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Bin Lou

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Qianda Zou

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Guoliang Xie

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Sha Lin

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Ruonan Wang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Xianzhi Yang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Weizhen Chen

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Qi Wang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Dan Zhang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Yanchao Liu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Renjie Gong

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Zhaohui Ma

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Siming Lu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Yanyan Xiao

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Yaxi Gu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Jinming Zhang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

Hangping Yao

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Kaijin Xu

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Xiaoyang Lu

Zhejiang University - Department of Pharmacy

Guoqing Wei

Zhejiang University - Bone Marrow Transplantation Center

Jianying Zhou

Zhejiang University - Department of Respiratory Diseases

Qiang Fang

Zhejiang University - Department of Critical Care Medicine

Hongliu Cai

Zhejiang University - Department of Critical Care Medicine

Yunqing Qiu

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jifang Sheng

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Yu Chen

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Ting-Bo Liang

Zhejiang University - Division of Hepatobiliary and Pancreatic Surgery; The Key Laboratory of Pancreatic Diseases of Zhejiang Province; Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province

More...

Abstract

Background: The SARS-CoV-2 epidemic is currently spreading across the world. A better knowledge of viral loads at different stages of disease progression would help inform clinical management and prevent nosocomial transmission.

Methods: More than 3,000 respiratory, stool, serum and urine samples were collected from 96 laboratory-confirmed COVID-19 patients. SARS-CoV-2 RNA viral load was measured, and the relationship between clinical data and disease severity was analyzed.

Findings: All patients were confirmed by testing respiratory specimens, and 54.22% of the patients had positive in stool and 39.36% had positive in serum. The median virus duration in stool (21 days, IQR 17-29 days) was significantly longer than in respiratory (18 days, IQR 13-28 days) and serum samples (16 days, IQR, 13-20 days) (p<0.001). The median virus duration in the respiratory samples of severe patients (21 days, IQR, 14.5-28.25 days) was significantly longer than in mild patients 13.5 days (IQR, 9.5-20.5 days) (p<0.001). In the mild group, the viral loads peaked in the second week from disease onset, whereas, viral load continued to be high during the third week in the severe group. Age and sex were identified as independent factors of viral duration.

Interpretation: Our study suggests that respiratory samples are still the most effective for detecting SARS-CoV-2, while it is necessary to strengthen the management of stool samples in the prevention and control of the epidemic, especially in the later stage of the disease. As SARS-CoV-2 persists longer with higher load, and peaks later in the respiratory tissue of severe patients, the rational use of antiviral drugs is needed to shorten the duration of the virus and reduce the occurrence of severe cases.

Funding Statement: This work was supported by the China National Mega-Projects for Infectious Diseases (grant number 2017ZX10103008 and 2018ZX10101001); and the National Natural Science Foundation of China (grant numbers 81672014 and 81702079).

Declaration of Interests: All authors: No reported conflicts.

Ethics Approval Statement: This study conformed to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Institutional Review Board of the First Affiliated Hospital of Zhejiang University

Keywords: SARS-CoV-2, COVID-19, Viral Load, Dynamics

Suggested Citation

Zheng, Shufa and Fan, Jian and Yu, Fei and Feng, Baihuan and Lou, Bin and Zou, Qianda and Xie, Guoliang and Lin, Sha and Wang, Ruonan and Yang, Xianzhi and Chen, Weizhen and Wang, Qi and Zhang, Dan and Liu, Yanchao and Gong, Renjie and Ma, Zhaohui and Lu, Siming and Xiao, Yanyan and Gu, Yaxi and Zhang, Jinming and Yao, Hangping and Xu, Kaijin and Lu, Xiaoyang and Wei, Guoqing and Zhou, Jianying and Fang, Qiang and Cai, Hongliu and Qiu, Yunqing and Sheng, Jifang and Chen, Yu and Liang, Ting-Bo, Viral Load Dynamics and Clinical Disease Severity in Patients with SARS-CoV-2 Infection (3/7/2020). Available at SSRN: https://ssrn.com/abstract=3551345 or http://dx.doi.org/10.2139/ssrn.3551345

Shufa Zheng

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jian Fan

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Fei Yu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Baihuan Feng

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Bin Lou

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Qianda Zou

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Guoliang Xie

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Sha Lin

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Ruonan Wang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Xianzhi Yang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Weizhen Chen

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Qi Wang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Dan Zhang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Yanchao Liu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Renjie Gong

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Zhaohui Ma

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Siming Lu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Yanyan Xiao

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Yaxi Gu

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jinming Zhang

Zhejiang University - Key Laboratory of Clinical In Vitro Diagnostic Techniques

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Hangping Yao

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Kaijin Xu

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Xiaoyang Lu

Zhejiang University - Department of Pharmacy

Hangzhou
China

Guoqing Wei

Zhejiang University - Bone Marrow Transplantation Center

Hangzhou
China

Jianying Zhou

Zhejiang University - Department of Respiratory Diseases

China

Qiang Fang

Zhejiang University - Department of Critical Care Medicine

Hangzhou
China

Hongliu Cai

Zhejiang University - Department of Critical Care Medicine

Hangzhou
China

Yunqing Qiu

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jifang Sheng

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases ( email )

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Yu Chen (Contact Author)

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases ( email )

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Ting-Bo Liang

Zhejiang University - Division of Hepatobiliary and Pancreatic Surgery ( email )

Hangzhou
China

The Key Laboratory of Pancreatic Diseases of Zhejiang Province

Hangzhou
China

Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province

Hangzhou
China

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