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

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 load may aid in the risk stratification of patients with COVID-19, and therefore its role in disease pathogenesis should be further explored.

Jesse Faijnzlyber, James Regan, Kendyll Coxen, Heather Corry, Colline Wong, Alexandra Rosenthal, Daniel Worrall, Francoise Gigue, Alicja Piechocka-TTrocha, Caroline Atyeo, Stephanie Fischinger, Andrew Chua, Keith T. Flaherty, Kathryn Hall, Michael Dougan, Edward T. Ryan, Elizabeth Gillespie, Rida Chishti, Yijia Li, Nikolaus Jilg, Dusan Handiziar, Rebecca M. Baron, Lindsey Baden, Athe M. Tsibris, Katrina A. Armstrong, Daniel R. Kuritzkes, Galit Alter, Bruce D. Walker, Xu Yu, Jonathan Z. Liu