SARS-CoV-2 viral load is associated with increased disease severity and mortality
Authors: Fajnzylber Jesse , Regan James , Coxen Kendyll , Corry Heather , Wong Colline , Rosenthal Alexandra , Worrall Daniel , Giguel Francoise , Piechocka-Trocha Alicja , Atyeo Caroline , Fischinger Stephanie , Chan Andrew , Flaherty Keith T. , Hall Kathryn , Dougan Michael , Ryan Edward T. , Gillespie Elizabeth , Chishti Rida , Li Yijia , Jilg Nikolaus , Hanidziar Dusan , Baron Rebecca M. , Baden Lindsey , Tsibris Athe M. , Armstrong Katrina A. , Kuritzkes Daniel R. , Alter Galit , Walker Bruce D. , Yu Xu , Li Jonathan Z. ,   The Massachusetts Consortium for Pathogen Readiness, Abayneh Betelihem A. , Allen Patrick , Antille Diane , Balazs Alejandro , Bals Julia , Barbash Max , Bartsch Yannic , Boucau Julie , Boyce Siobhan , Braley Joan , Branch Karen , Broderick Katherine , Carney Julia , Chevalier Josh , Choudhary Manish C. , Chowdhury Navin , Cordwell Trevor , Daley George , Davidson Susan , Desjardins Michael , Donahue Lauren , Drew David , Einkauf Kevin , Elizabeth Sampson , Elliman Ashley , Etemad Behzad , Fallon Jon , Fedirko Liz , Finn Kelsey , Flannery Jeanne , Forde Pamela , Garcia-Broncano Pilar , Gettings Elise , Golan David , Goodman Kirsten , Griffin Amanda , Grimmel Sheila , Grinke Kathleen , Hartana Ciputra Adijaya , Healy Meg , Heller Howard , Henault Deborah , Holland Grace , Jiang Chenyang , Jordan Hannah , Kaplonek Paulina , Karlson Elizabeth W. , Karpell Marshall , Kayitesi Chantal , Lam Evan C. , LaValle Vlasta , Lefteri Kristina , Lian Xiaodong , Lichterfeld Mathias , Lingwood Daniel , Liu Hang , Liu Jinqing , Lopez Kell , Lu Yuting , Luthern Sarah , Ly Ngoc L. , MacGowan Maureen , Magispoc Karen , Marchewka Jordan , Martino Brittani , McNamara Roseann , Michell Ashlin , Millstrom Ilan , Miranda Noah , Nambu Christian , Nelson Susan , Noone Marjorie , Novack Lewis , O’Callaghan Claire , Ommerborn Christine , Osborn Matthew , Pacheco Lois Chris , Phan Nicole , Pillai Shiv , Porto Falisha A. , Rassadkina Yelizaveta , Reissis Alexandra , Ruzicka Francis , Seiger Kyra , Selleck Kathleen , Sessa Libera , Sharpe Arlene , Sharr Christianne , Shin Sally , Singh Nishant , Slaughenhaupt Sue , Sheppard Kimberly Smith , Sun Weiwei , Sun Xiaoming , Suschana Elizabeth , Talabi Opeyemi , Ticheli Hannah , Weiss Scott T. , Wilson Vivine , Zhu Alex 
Published: October 2020

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.