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Chronological Changes of Viral Shedding in Adult Inpatients With COVID-19 in Wuhan, China
Jing-Tao Huang1, Ruo-Xi Ran2, Zhi-Hua Lv1
1Department of Clinical Laboratory, Renmin Hospital, Wuhan University, Wuhan, China.
Insights
Viral load of SARS-CoV-2 in COVID-19 patients peaked early and varied by severity. Higher viral loads were found in sputum and respiratory samples, correlating with cardiovascular markers and negatively with blood counts, aiding early severity prediction.
Area of Science:
- Virology
- Infectious Diseases
- Clinical Medicine
Background:
- The COVID-19 pandemic, caused by SARS-CoV-2, emerged in Wuhan in December 2019.
- While COVID-19 characteristics are known, the link between laboratory findings and viral load needs more detail.
Purpose of the Study:
- To investigate the relationship between serial SARS-CoV-2 viral loads and illness severity in adult inpatients.
- To explore correlations between viral load and various laboratory parameters.
Main Methods:
- Adult COVID-19 inpatients (general, severe, critical) with multiple nucleic acid tests were studied.
- Data on laboratory, demographic, and clinical features were extracted from electronic medical records.
- Polynomial curve fitting analyzed the association between serial viral loads and disease severity.
Main Results:
- SARS-CoV-2 viral load peaked 2-4 days post-admission, with critical patients showing the highest loads.
- Sputum samples had higher viral loads than nasal/pharyngeal swabs (P=.026).
- Viral load correlated positively with cardiovascular markers and negatively with blood counts and lymphocyte subsets.
Conclusions:
- Serial viral loads indicate shedding and potential resurgence during treatment, serving as an early warning for severity.
- Understanding viral load dynamics can help refine antiviral interventions for COVID-19 patients.
Background:
In December 2019, the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan. Epidemiological and clinical characteristics of patients with COVID-19 have been reported, but the relationships between laboratory features and viral load has not been comprehensively described.
Methods:
Adult inpatients (≥18 years old) with COVID-19 who underwent multiple (≥5 times) nucleic acid tests with nasal and pharyngeal swabs were recruited from Renmin Hospital of Wuhan University, including general patients (n = 70), severe patients (n = 195), and critical patients (n = 43). Laboratory data, demographic data, and clinical data were extracted from electronic medical records. The fitted polynomial curve was used to explore the association between serial viral loads and illness severity.
Results:
Viral load of SARS-CoV-2 peaked within the first few days (2-4 days) after admission, then decreased rapidly along with virus rebound under treatment. Critical patients had the highest viral loads, in contrast to the general patients showing the lowest viral loads. The viral loads were higher in sputum compared with nasal and pharyngeal swab (P = .026). The positive rate of respiratory tract samples was significantly higher than that of gastrointestinal tract samples (P < .001). The SARS-CoV-2 viral load was negatively correlated with portion parameters of blood routine and lymphocyte subsets and was positively associated with laboratory features of cardiovascular system.
Conclusions:
The serial viral loads of patients revealed whole viral shedding during hospitalization and the resurgence of virus during the treatment, which could be used for early warning of illness severity, thus improve antiviral interventions.
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