With inputs from Dr Monica Vasudev

992: DG alert: Non-hospitalized patients with COVID-19, with less severe symptoms, have been found to have a higher SARS-CoV-2 viral load (VL) compared to hospitalized patients with more severe symptoms in a study published in The American Journal of Pathology .

In a cohort of 205 patients treated at a tertiary care center in New York City who had been tested using both qualitative RT-PCR and quantitative RT-PCR to obtain diagnostic SARS-CoV-2 VL at initial presentation, investigators noted that diagnostic VL was significantly lower in hospitalized patients compared to those who had not been hospitalized, after adjusting for age, sex, race, body mass index, and comorbidities.

Additionally, higher VL was shown to be tied to shorter duration of symptoms in all patients in the study (P< .001). Among hospitalized patients only, higher VL also had an association with shorter duration of symptoms (P = .002) and with shorter hospital stay (P = .013). There appeared to be no significant association between VL, admission to intensive care unit, length of oxygen support, and overall survival.

Non-hospitalized patients were younger (median age, 45 vs 60 years; P< .001). The median symptom duration from onset of symptoms to nasopharyngeal swab collection in the hospitalized patients was 5 days compared with 3 days in the non-hospitalized patients (P = .017).

In the hospital setting, the information from VL can help ascertain as to which patient would receive a negative pressure room.

In the outpatient setting, the VL information can be used to emphasize the significance of self-isolation and face coverings in order to limit the risk of spread of infection.

Comments: The virus becomes non replicative by 9 days. In hospitalized patients, the viral load in this study was done later in the disease course and hence could have been lower.

[SOURCE: American Journal of Pathology]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA