SARS-CoV-2 Viral Load in the Nasopharynx at Time of First Infection Among Unvaccinated Individuals
Authors: Fisher Leigh H. , Kee Jia Jin , Liu Albert , Espinosa Claudia M. , Randhawa April K. , Ludwig James , Magaret Craig A. , Robinson Samuel T. , Gilbert Peter B. , Hyrien Ollivier , Kublin James G. , Rouphael Nadine , Falsey Ann R. , Sobieszczyk Magdalena E. , El Sahly Hana M. , Grinsztejn Beatriz , Gray Glenda E. , Kotloff Karen L. , Gay Cynthia L. , Leav Brett , Hirsch Ian , Struyf Frank , Dunkle Lisa M. , Neuzil Kathleen M. , Corey Lawrence , Huang Yunda , Goepfert Paul A. , Walsh Stephen R. , Baden Lindsey R. , Janes Holly ,   COVID-19 Prevention Network (CoVPN), Adams Atoya , Miller Eric , Rankin Bruce G. , Shinn Steven , Follmann Dean , Miller Jacqueline , Sadoff Jerald , Nash Marshall , Green Sinikka L. , Jacobsen Colleen , Krishnankutty Jayasree , Phungwayo Sikhongi , Glover Richard M. , Slechta Stacy , Holdeman Troy , Hartvickson Robyn , Grant Amber , Poling Terry L. , Klein Terry D. , Klein Thomas C. , Klein Tracy R. , Smith William B. , Gibson Richard L. , Winbigler Jennifer , Parker Elizabeth , Wijewardane Priyantha N. , Bravo Eric , Thessing Jeffrey , Maxwell Michelle , Horn Amanda , Mary Healy Catherine , Akamine Christine , Chu Laurence , Chouteau R. Michelle , Cotugno Michael J. , Bauer George H. , Hachigian Greg , Oshita Masaru , Cancilla Michael , Kiersey Kristen , Seger William , Antwi Mohammed , Green Allison , Kim Anthony , Desjardins Michael , Johnson Jennifer A. , Sherman Amy , Borger Judith , Saleem Nafisa , Solis Joel , Carmen Medina Martha , Keating Westly , Garcia Edgar , Bueno Cynthia , Segall Nathan , Denham Douglas S. , Weiss Thomas , Avworo Ayoade , Hedges Parke , Becher Strout Cynthia , Santiago Rica , Davis Yvonne , Howenstine Patty , Bondell Alison , Marks Kristin , Wang Tina , Wilkin Timothy , Vogler Mary , Johnston Carrie , Andrasik Michele P. , Andriesen Jessica G. , Broder Gail , Eaton Niles , Gelderblom Huub G. , McClennen Rachael , Michael Nelson , Robb Merlin , Sopher Carrie , Miller Vicki E. , Santiago Fredric , Gomez Blanca , Valika Insiya , Starr Amy , Cantos Valeria D. , Kandiah Sheetal , del Rio Carlos , Edupuganti Srilatha , Graciaa Daniel S. , Anderson Evan J. , Camacho-Gonzalez Andres , Kamidani Satoshi , Rostad Christiana A. , Teherani Meghan , Diemert David J. , Malkin Elissa , Siegel Marc , Roberts Afsoon , Simon Gary , Balani Bindu , Stephenson Carolene , Sperber Steven , Cicogna Cristina , Zervos Marcus J. , Kilgore Paul , Ramesh Mayur , Herc Erica , Zenlea Kate , Burgher Abram , Milliken Ann M. , Davis Joseph D. , Levy Brendan , Kelman Sandra , Doust Matthew W. , Sample Denise , Erickson Sandra , Christensen Shane G. , Matich Christopher , Longe James , Witbeck John , Peterson James T. , Clark Alexander , Kelty Gerald , Pena-Renteria Issac , Koren Michael J. , Bartilucci Darlene , Patel Alpa , Tran Carolyn , Kennelly Christina , Brownlee Robert , Coleman Jacob , Webster Hala , Fierro Carlos A. , Leistner Natalia , Thompson Amy , Gonzalez Celia , Jackson Lisa A , Suyehira Janice , Haber Milton , Regalado Maria M. , Procasky Veronica , Lutat Alisha , Griffin Carl P. , Hollister Ripley R. , Brown Jeremy , Ronk Melody , Harper Wayne L. , Cohen Lisa , Eckert Lynn , Hong Matthew , Rouhbakhsh Rambod , Danford Elizabeth , Johnson John , Calderone Richard , Khetan Shishir K. , Olanrewaju Oyebisi , Zhai Nan , Nieves Kimberly , O'Brien Allison , Bradley Paul S , Lilienthal Amanda , Callis Jim , Brosz Adam B , Clement Andrea , West Whitney , Friesen Luke , Cramer Paul , Eder Frank S , Little Ryan , Engler Victoria , Rattenbury-Shaw Heather , Ensz David J. , Oplinger Allie , Essink Brandon J. , Meyer Jay , Raiser Frederick , Mueller Kimberly , Vrbicky Keith W. , Harper Charles , Nutsch Chelsie , Lewis Wendell , Laflan Cathy , Whatley Jordan L. , Harrell Nicole , Shannon Amie , Rowell Crystal , Dedon Christopher , Makhene Mamodikoe , Gottschlich Gregory M. , Harden Kate , Gottschlich Melissa , Smith Mary , Powell Richard , Kimmel Murray A. , Pinto Simmy , Vachris Timothy P. , Hutchens Mark , Daniels Stephen , Wells Margaret , Van Der Leden Mimi , Jackson-Booth Peta-Gay , Baron Mira , Kane Pamela , Seversen Shannen , Kryvicky Mara , Lord Julia , Saleh Jamshid , Miles Matthew , Lupercio Rafael , McGettigan John W. , Patton Walter , Brakema Riemke , Choquette Karin , McGettigan Jonlyn , Kirstein Judith L. , Bernard Marcia , Manning Mary Beth , Rothenberg Joan , Briskin Toby , Roadman Denise , Tedder-Edwards Sharita , Schwartz Howard I. , Mederos Surisday , Swaminathan Shobha , Nyaku Amesika , Varughese Tilly , DallaPiazza Michelle , Frey Sharon E. , Graham Irene , Abate Getahun , Hoft Daniel , Allen Leland N. , Edwards Leslie A. , Davis William S. , Mena Jessica M. , Kutner Mark E. , Caso Jorge , Hernandez Moran Maria , Carvajal Marianela , Mendez Janet , Wadsworth Larkin T. , Adams Michael R. , Iverson Leslie , Newberg Joseph L. , Pearlman Laura , Nugent Paul J. , Reynolds Michele D. , Bashour Jennifer , Schmidt Robert , Sheth Neil P. , Steil Kenneth , Toma Ramy J. , Kirby William , Folmar Pink , Williams Samantha , Pickrell Paul , Mott Stefanie , Linebarger Carol Ann , Malbari Hussain , Pampe David , Fragoso Veronica G. , Holloway Lisa , McKeown-Bragas Cecilia , Becker Teresa , Williams Barton G. , Jones William H. , Clark Jesse L. , Shoptaw Steven , Vertucci Michele , Hernandez Will , Spector Stephen A. , Moodley Amaran , Blumenthal Jill , Stangl Lisa , Deutsch Karen , Mullane Kathleen M. , Pitrak David , Nuss Cheryl , Pi Judy , Fichtenbaum Carl , Powers-Fletcher Margaret , Saemann Michelle , Kohrs Sharon , Campbell Thomas B. , Lauria Andrew , Mancilla Jose C. , Dunlevy Hillary , Novak Richard M. , Wendrow Andrea , Borgetti Scott , Ladner Ben , Laurens Matthew , Chrisley Lisa , Young Cheryl , Doblecki-Lewis Susanne , Alcaide Maria L. , Gonzales-Zamora Jose , Morris Stephen , Wohl David , Eron Joseph , Frank Ian , Dunbar Debora , Metzger David , Momplaisir Florence , Martin Judith , Hoberman Alejandro , Shope Timothy , Muniz Gysella , Rupp Richard , Stanford Amber , Berman Megan , Porterfield Laura , Lewis Michael , Ghadishah Elham , Yusin Joseph , Pham Mai , Creech Clarence B. , Walker Shannon , Rolsma Stephanie , Samuels Robert , Thomsen Isaac , Kalams Spyros A. , Wilson Greg , Lucksinger Gregg H. , Parks Kevin , Israelsen Ryan , Ostovar Jaleh , Kelly Kary , Overcash Jeffrey S. , Chu Hanh , Lee Kia , De La Cruz Luis I. , Clemons Steve , Everette Elizabeth , Studdard Suzanna , Mohan Gowdhami , Tyson Stefanie , Peay Alyssa-Kay , Johnson Danyel , Feldman Gregory J. , Suen May-Yin , Muenzner Jacqueline , Boscia Joseph , Siddiqui Farhan , Sanders John , Peacock James , Nasim Julio , Levin Michael L. , Hussey Julie , Kulic Marcy , McKenzie Mark M. , Deese Teresa , Osmundsen Erica , Sweet Christy , Ebuh Valentine M. , Elnagar Elwaleed , Ebuh Georgette , Iwuala Genevieve , Han-Conrad Laurie J. , Simmons Todd , Tarakjian Denis , Ackermann Jeremy , Adams Mark S. , Alemán José O. , Al-Ibrahim Mohamed S. , Andes David R. , Andrews Jeb , Arduino Roberto C. , Bäcker Martín , Badillo Diana , Bainbridge Emma , Batteiger Teresa A. , Bazan Jose A. , Bedimo Roger J. , Benitez Jorge A. , Bennett Annette R. , Bernstein David I. , Bialobok Kristin , Boas Rebecca , Brady Judith , Branche Angela R. , Brown Cynthia , Bunce Catherine A. , Call Robert S. , Campbell Wesley , Carmody Ellie , Carpenter Christopher , Carsons Steven E. , Castellon Marvin , Castro Mario , Catan Hannah , Chang Jennifer , Chebib Mouna G. , Chen Corey M. , Cheng Margaret , Chow Brian D. W. , Ciambruschini Annie , Connor Joseph P. , Conway James H. , Cooney Maureen , Curlin Marcel , De La Matta Rodriguez Claudia , Dedon Jon F. , Degan Emily , Dickey Michelle , Dietz Craig , Dong Jennifer L , Dorcely Brenda , Dube Michael P. , Dyer Carmel B. , Eckhardt Benjamin , Ellerbeck Edward , Ewers Evan C. , Falk Amy , Feijoo Brittany , Felsen Uriel R. , Fiel Tom , Fitz-Patrick David , Fogarty Charles M. , Ford Stacy , Forero Lina M. , Formentini Elizabeth , Franco-Vitteri Doris , Frenck Robert W. , Gharib Elie , Gharib Suzanne , Rucker Rola G. , Goldenberg James N. , González Luis H. , Gray Brett , Greene Rusty , Grossberg Robert M. , Guanira-Carranza Juan V. , Gilberto Guerreros Benavides Alfredo , Guillory Clint C. , Gunaratne Shauna H. , Halpert David , Hamilton Holli , Hartman William R. , Hatlen Timothy J. , Henderson Sheryl L. , Herati Ramin , Hernandez Guarin Laura , Hilder Robin , Ho Ken , Hojat Leila , Hosek Sybil G. , Jacobson Jeffrey M. , Jay Melanie , Johnson Diane H. , Jones Kathleen S. , Jones-López Edward C. , Justman Jessica E. , Kahney Scott , Katz Lois , Katz Melinda , Kaul Daniel , Keefer Michael C. , Kennedy Ashley , Knishinsky Jennifer , Kogelman Laura , Koletar Susan L. , Kottkamp Angelica , Laguio-Vila Maryrose , Landovitz Raphael J. , Lee Jessica L. , Giuvanela Llerena Zegarra Eneyda , Lok Anna S. , Lovell James , Lubelchek Ronald , Lucaj John , Luckasen Gary , Luetkemeyer Annie , Lucia Lugogo Njira , Maenza Janine , Malvestutto Carlos , Mauri Monica , Maves Ryan C. , Mayer Kenneth H. , McCartney Michael J. , McCort Margaret E. , McElrath M. Juliana , McNairy Meredith , Merino Fernando L. , Meyerowitz Eric A. , Mitchell Carol L. , Monaco Cynthia L. , Muhammad Sauda , Muñoz-Gómez Sigridh , Munsiff Sonal , Nee Paul , Nollen Nicole L. , Noor Asif , Nuñez Lagos Claudio , Okulicz Jason F. , Oliver Patrick A. , Ortega Jessica , Palmer Steven , Parameswaran Lalitha , Parikh Purvi , Parker Susan , Parungao Reza , Pavie Juana R. , Madan Rebecca P. , Peralta Henry , Petts Jennifer , Pierce Kristen K. , Pretell Alva E. Javier , Purpura Lawrence J. , Raabe Vanessa , Recuenco Sergio E. , Richards Tamara , Riddler Sharon A. , Rizzardi Barbara , Rokser Rachel , Rolle Charlotte-Paige , Rosen Adam , Rosen Jeffrey , Freese Lena R. , Santolaya María E. , Schipani Linda M. , Schwartz Adam , Schwasinger-Schmidt Tiffany , Scott Hyman , Sha Beverly E. , Shankaran Shivanjali , Shapiro Adrienne E. , Sharp Stephan C. , Shopsin Bo , Sims Matthew D. , Skipper Stephanie , Smith Derek M. , Smith Michael J. , Sobhanie M. Mahdee , Sovic Brit , Sterling Stephanie , Striker Robert , Tafur Bances Karla Beatriz , Talaat Kawsar R. , Tavel Edward M. , Tieu Hong V , Tomaszewski Christian , Tomlinson Ryan , Torres Juan P. , Torres Julian A. , Treanor John J , Tukuru Sade , Ulrich Robert J. , Utz Gregory C. , Viar Veronica , Viau Colindres Roberto A. , Walsh Edward E. , Walsh Mary C. , Walter Emmanuel B. , Weidler Jessica L. , Wu Yi H. , Yang Kinara S. , Yrivarren Giorza Juan Luis , Zemanek Arthur L. , Zhang Kevin , Zingman Barry S. , Gorman Richard , Paez Carmen A. , Swann Edith , Takuva Simbarashe G. , Greninger Alex , Roychoudhury Pavitra , Coombs Robert W. , Jerome Keith R. , Castellino Flora , Tong Xiaomi , Pavetto Corrina , Gipson Teletha , Tong Tina , Lee Marina , Zhou James , Fay Michael , McQuarrie Kelly , Nnadi Chimeremma , Sogbetun Obiageli , Ahmad Nina , De Proost Ian , Hoseyni Cyrus , Coplan Paul , Khan Najat , Ronco Peter , Furey Dawn , Meck Jodi , Vingerhoets Johan , Brandenburg Boerries , Custers Jerome , Hendriks Jenny , Juraszek Jarek , de Groot Anne Marit , Van Roey Griet , Heerwegh Dirk , Van Dromme Ilse , Méndez Galván Jorge F. , Carrascal Monica B. , Sordo Duran Adriana , Sanchez Guerrero Laura Ruy , Gómora Madrid Martha Cecilia , Barrat Hernández Alejandro Quintín , Molina Guizar Sharzhaad , González Estrada Denisse Alejandra , Martínez Pérez Silvano Omar , Zárate Hinojosa Zindy Yazmín , Ruiz-Palacios Guillermo Miguel , Cruz-Valdez Aurelio , Pacheco-Flores Janeth , Lara Anyela , Díaz-Miralrio Secia , Reyes Fentanes María José , Olmos Vega Jocelyn Zuleica , Pineda Méndez Daniela , Cano Martínez Karina , Alvarez León Winniberg Stephany , Ruiz Herrera Vida Veronica , Vázquez Saldaña Eduardo Gabriel , Camacho Choza Laura Julia , Vega Orozco Karen Sofia , Ortega Domínguez Sandra Janeth , Chacón Jorge A. , Rivera Juan J. , Cutz Erika A. , Ortegón Maricruz E. , Rivera María I. , Browder David , Burch Cortney , Moye Terri , Bondy Paul , Browder Lesley , Manning Rickey D. , Hurst James W. , Sturgeon Rodney E. , Wakefield Paul H. , Kirby John A. , Andersen James , Fearon Szheckera , Negron Rosa , Medina Amy , Hill John M. , Rajasekhar Vivek , Williams Hayes , Cade LaShondra , Fouts Rhodna , Moya Connie , Anderson Corey G. , Devine Naomi , Ramsey James , Perez Ashley , Tatelbaum David , Jacobs Michael , Menasche Kathleen , Mirkil Vincent , Winkle Peter J. , Haggag Amina Z. , Haynes Michelle , Villegas Marysol , Raja Sabina , Riesenberg Robert , Plavin Stanford , Lerman Mark , Woodside Leana , Johnson Maria , Healy C. Mary , Whitaker Jennifer A. , Keitel Wendy A. , Atmar Robert L. , Horwith Gary , Mason Robin , Johnson Lisa , Dora Tambra , Murray Deborah , Ledbetter Logan , Ewing Beverly , Stephenson Kathryn E. , Tan Chen S. , Zash Rebecca , Ansel Jessica L. , Jaegle Kate , Guiney Caitlin J. , Henderson Jeffrey A. , O'Leary Marcia , Enright Kendra , Kessler Jill , Ducheneaux Pete , Inniss Asha , Brandon Donald M. , Davis William B. , Lawler Daniel T. , Oppong Yaa D. , Starr Ryan P. , Syndergaard Scott N. , Shelly Rozeli , Islam Majumder Mashrur , Sugimoto Danny , Dugas Jeffrey , Rijos Dolores , Shelton Sandra , Hong Stephan , Schwartz Howard , Sanchez-Crespo Nelia , Schwartz Jennifer , Piedra Terry , Corral Barbara , Medina Carmen , Dever Michael E. , Shah Mitul , Delgado Michael , Scott Tameika , Usdan Lisa S. , McGill Lora J. , Arnold Valerie K. , Scatamacchia Carolyn , Anthony Codi M. , Merchant Rajan , Yoon Anelgine C. , Hill Janet , Ng-Price Lucy , Thompson-Seim Teri , Ackerman Ronald , Ackerman Jamie , Aristy Florida , Ketter Nzeera , Finley Jon , Stull Mildred , Murray Monica , Rizvi Zainab , Guerrero Sonia , Paliwal Yogesh K. , Paliwal Amit , Gordon Sarah , Gordon Bryan , Montano-Pereira Cynthia , Galloway Christopher , Montros Candice , Aleman Lily , Shairi Samira , Van Ever Wesley , Freeman George H. , Harmon Esther L. , Cross Marshall A. , Sales Kacie , Gular Catherine Q. , Hepburn Matthew , Alderson Nathan , Harshell Shana , Mahgoub Siham , Maxwell Celia , Mellman Thomas , Thompson Karl M. , Wortman Glenn , Kingsley Jeff , Pixler April , Curry LaKondria , Afework Sarah , Swanson Austin , Jacqmein Jeffry , Bowers Maggie , Robison Dawn , Mosteller Victoria , Garvey Janet , Easley Mary , Kurnat Rebecca J. , Cornelison Raymond , Gower Shanda , Schnitz William , Heinzig-Cartwright Destiny S. , Lewis Derek , Newton Fred E. , Duhart Aeiress , Watkins Breanz , Ball Brandy , York Jill , Pickle Shelby , Musante David B. , Silver William P. , Belhorn Linda R. , Viens Nicholas A. , Dellaero David , Patel Priti , Lisec Kendra , Safirstein Beth , Zapata Luz , Gonzalez Lazaro , Quevedo Evelyn , Irani Farah , Grillo Joseph , Potts Amy , White Julie , Flume Patrick , Headden Gary , Taylor Brandie , Warden Ashley , Chamberlain Amy , Jeanfreau Robert , Jeanfreau Susan , Matherne Paul G. , Caldwell Amy , Stahl Jessica , Vowell Mandy , Newhouse Lauren , Berthaud Vladimir , Takizala Zudi-Mwak , Beninati Genevieve , Snell Kimberly , Baker Sherrie , Walker James , Harrison Tavane , Miller Meagan , Otto Janet , Gray Roni , Wilson Christine , Nemecek Tiffany , Harrington Hannah , Eppenbach Sally , Lewis Wendell , Bourgeois Tana , Folsom Lyndsea , Holt Gregory , Mirsaeidi Mehdi , Calderon Rafael , Lichtenberger Paola , Quintero Jalima , Martinez Becky , Immergluck Lilly , Johnson Erica , Chan Austin , Fas Norberto , Thomas-Seaton LaTeshia , Khizer Saadia , Staben Jonathan , Beresnev Tatiana , Jahromi Maryam , Marovich Mary A. , Hutter Julia , Nason Martha , Ledgerwood Julie , Mascola John , Leibowitz Mark , Morales Fernanda , Delgado Mike , Sanchez Rosario , Vega Norma , Áñez Germán , Albert Gary , Coston Erin , Desai Chinar , Dunbar Haoua , Eickhoff Mark , Garcia Jenina , Kautz Margaret , Lee Angela , Lewis Maggie , McGarry Alice , McKnight Irene , Nelson Joy , Newingham Patrick , Price-Abbott Patty , Reed Patty , Vegas Diana , Wilkinson Bethanie , Smith Katherine , Woo Wayne , Cho Iksung , Glenn Gregory M. , Dubovsky Filip , Fried David L. , Haughey Lynne A. , Stanton Ariana C. , Stevens Rameaka Lisa , Rosenberg David , Tomatsu Lee , Gonzalez Viviana , Manalo Millie , Grunstra Bernard , Quinn Donald , Claybrook Phillip , Olds Shelby , Dye Amy , Cannon Kevin D. , Chadwick Mesha M. , Jordan Bailey , Hussey Morgan , Nevarez Hannah , Kelley Colleen F. , Chung Michael , Moran Caitlin , Rebolledo Paulina , Bacher Christina , Barranco-Santana Elizabeth , Rodriguez Jessica , Mendoza Rafael , Ruperto Karen , Olivieri Odette , Ocaña Enrique , Wylie Paul E. , Henderson Renea , Jenson Natasa , Yang Fan , Kelley Amy , Finkelstein Kenneth , Beckmann David , Hutchins Tanya , Garcia Escallon Sebastian , Johnson Kristen , Sligh Teresa S. , Desai Parul , Huynh Vincent , Lopez Carlos , Mendoza Erika , Adelglass Jeffrey , Naifeh Jerome G. , Kucera Kristine J. , Chughtai Waseem , Jaffer Shireen H. , Davis Matthew G. , Foley Jennifer , Burgett Michelle L. , Shlotzhauer Tammi L. , Ingalsbe-Geno Sarah M. , Duncanson Daniel , Kush Kelly , Nesbitt Lori , Sonnier Cora , McCarter Jennifer , Butcher Michael B. , Fry James , Percy Donna , Freudemann Karen , Gebhardt Bruce C. , Mangu Padma N. , Schroeck Debra B. , Davit Rajesh K. , Hennekes Gayle D. , Luft Benjamin J. , Carr Melissa , Nachman Sharon , Pellecchia Alison , Smith Candace , Valenti Bruno , Bermudez Maria I. , Peraita Noris , Delgado Ernesto , Arrazcaeta Alicia , Ramirez Natalie , Amador Carmen , Marafioti Horacio , Dang Lyly , Clement Lauren , Berry Jennifer , Allaw Mohammed , Geuss Georgettea , Miles Chelsea , Bittner Zachary , Werne Melody , Calinescu Cornell , Rodman Shannon , Rindt Joshua , Cooksey Erin , Harrison Kristina , Cooper Deanna , Horton Manisha , Philyaw Amanda , Jennings William , Alvarado Hilario , Baka Michele , Regalado Malina , Murray Linda , Naguib Sherif , Singletary Justin , Richmond Sha-Wanda , Omodele Sarah , Oppenheim Emily , Martinez Reuben , Andriulis Victoria , Singer Leonard , Blevins Jeanne , Thomas Meagan , Hull Christine , Pereira Isabel , Rivero Gina , Okonya Tracy , Downing Frances , Miller Paulina , Rhee Margaret , Stapleton Katherine , Klein Jeffrey , Hong Rosamond , Swan Suzanne , Wahlin Tami , Bennett Elizabeth , Salzl Amy , Phan Sharine , White Jewel J. , Occhino Amanda , Paiano Ruth , McLaughlin Morgan , Swieboda Elisa , Garcia-Fragoso Veronica , Becerra Maria G. , White Toni , Turley Christine B. , McWilliams Andrew , Esinhart Tiffany , Montoya Natasha , Huskey Shamika , Paul Leena , Tashima Karen , Johnson Jennie , Neill Marguerite , Sanchez Martha , Rybak Natasha , Mileno Maria , Cohen Stuart H. , Ruiz Monica , Boswell Dean M. , Robison Elizabeth E. , Reynolds Trina L. , Neumeister Sonja , Zorrilla Carmen D. , Rivera Juana , Ibarra Jessica , García Iris , Sierra Dianca , Ramon Wanda , Fiorillo Suzanne , Pitotti Rebecca , Anderson Victoria R. , Castillo Mancilla Jose , Le Nga , Winokur Patricia L. , Ince Dilek , Hegmann Theresa , Meier Jeffrey , Stapleton Jack , Stulken Laura , McArthur Monica , Berry Andrea , Tapia Milagritos , Hammershaimb Elizabeth , Robinson Toni , MacBryde Rosa , Kline Susan , Billings Joanne L. , Cavert Winston , Forgosh Les B. , Schacker Timothy W. , Bold Tyler D. , Dandachi Dima , Nelson Taylor , Bran Andres , Geiger Grant , Naqvi S. Hasan , Florescu Diana F. , Starlin Richard , Kline David , Zimmer Andrea , Abbas Anum , Wilson Natasha , Eron Joseph J. , Sciaudone Michael , Rosengren A. Lina , Kizer John S. , Rutstein Sarah E. , Rodriguez Carina A. , Bruce Elizabeth , Sanders Lisa J. , Kim Kami , Casey Denise , Taylor Barbara S. , Patterson Thomas , Pinilla Ruth S. , Bullock Delia , Ponce Philip , Patterson Jan , McClelland R. Scott , Lane Dakotah C. , Wald Anna , James Frank , Duke Elizabeth , Hauge Kirsten , Heimonen Jessica , Goecker Erin A. , Fong Youyi , Kauffman Carol , Linder Kathleen , Nofz Kimberly , McConnell Andrew , Buynak Robert J. , Webb Angella , Petty Taryn , Andree Stephanie , Sanchez Erica , Mackey Nolan , Baudelaire Clarisse , Dzigiel Sarah , Marquez Adrienna , Quillin Kim , King Michelle , Abad Vanessa , Knowles Jennifer , Waters Michael , Zepeda Karla , Coslet Jordan , Tovar Dalia , Shaw Marian E. , Turner Mark A. , Huffine Cory J. , Huffine Esther S. , Ake Julie A. , Secord Elizabeth , McGrath Eric , Levy Phillip , Stewart Brittany , Cromer Charnell , Walters Ayanna , Ellsworth Grant , Greene Caroline , Galloway Sarah , Kapadia Shashi , DeHaan Elliot , Wilson Clint , Milligan Jason , Raley Danielle , Bocchini Joseph , McClenathan Bruce , Hussain Mary , Lomasney Evelyn , Hall Evelyn , Lamberth Sherry , Schmeck Christy , Leathers Vickie 
Published: May 2024

Importance

SARS-CoV-2 viral load (VL) in the nasopharynx is difficult to quantify and standardize across settings, but it may inform transmission potential and disease severity.

Objective

To characterize VL at COVID-19 diagnosis among previously uninfected and unvaccinated individuals by evaluating the association of demographic and clinical characteristics, viral variant, and trial with VL, as well as the ability of VL to predict severe disease.

Design, Setting, and Participants

This secondary cross-protocol analysis used individual-level data from placebo recipients from 4 harmonized, phase 3 COVID-19 vaccine efficacy trials sponsored by Moderna, AstraZeneca, Janssen, and Novavax. Participants were SARS-CoV-2 negative at baseline and acquired COVID-19 during the blinded phase of the trials. The setting included the US, Brazil, South Africa, Colombia, Argentina, Peru, Chile, and Mexico; start dates were July 27, 2020, to December 27, 2020; data cutoff dates were March 26, 2021, to July 30, 2021. Statistical analysis was performed from November 2022 to June 2023.

Main Outcomes and Measures

Linear regression was used to assess the association of demographic and clinical characteristics, viral variant, and trial with polymerase chain reaction–measured log10 VL in nasal and/or nasopharyngeal swabs taken at the time of COVID-19 diagnosis.

Results

Among 1667 participants studied (886 [53.1%] male; 995 [59.7%] enrolled in the US; mean [SD] age, 46.7 [14.7] years; 204 [12.2%] aged 65 years or older; 196 [11.8%] American Indian or Alaska Native, 150 [9%] Black or African American, 1112 [66.7%] White; 762 [45.7%] Hispanic or Latino), median (IQR) log10 VL at diagnosis was 6.18 (4.66-7.12) log10 copies/mL. Participant characteristics and viral variant explained only 5.9% of the variability in VL. The independent factor with the highest observed differences was trial: Janssen participants had 0.54 log10 copies/mL lower mean VL vs Moderna participants (95% CI, 0.20 to 0.87 log10 copies/mL lower). In the Janssen study, which captured the largest number of COVID-19 events and variants and used the most intensive post-COVID surveillance, neither VL at diagnosis nor averaged over days 1 to 28 post diagnosis was associated with COVID-19 severity.

Conclusions and Relevance

In this study of placebo recipients from 4 randomized phase 3 trials, high variability was observed in SARS-CoV-2 VL at the time of COVID-19 diagnosis, and only a fraction was explained by individual participant characteristics or viral variant. These results suggest challenges for future studies of interventions seeking to influence VL and elevates the importance of standardized methods for specimen collection and viral load quantitation.