Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.,The BMJ

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Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.
The BMJ ( IF 93.6 ) Pub Date : 2020-04-21 , DOI: 10.1136/bmj.m1443
Shufa Zheng _{1,

2,

3,

4} , Jian Fan _{2,

3,

4} , Fei Yu _{2,

3,

4} , Baihuan Feng _{2,

3,

4} , Bin Lou _{2,

3,

4} , Qianda Zou _{2,

3,

4} , Guoliang Xie _{2,

3,

4} , Sha Lin _{2,

3} , Ruonan Wang _{2,

3} , Xianzhi Yang _{2,

3} , Weizhen Chen _{2,

3,

4} , Qi Wang _{2,

3,

4} , Dan Zhang _{2,

3,

4} , Yanchao Liu _{2,

3} , Renjie Gong _{2,

3} , Zhaohui Ma _{2,

3} , Siming Lu _{2,

3} , Yanyan Xiao _{2,

3} , Yaxi Gu _{2,

3} , Jinming Zhang _{2,

3} , Hangping Yao ₁ , Kaijin Xu ₁ , Xiaoyang Lu ₅ , Guoqing Wei ₆ , Jianying Zhou ₇ , Qiang Fang ₈ , Hongliu Cai ₈ , Yunqing Qiu ₁ , Jifang Sheng ₁ , Yu Chen _{1,

2,

3,

4} , Tingbo Liang _{9,

10,

11}

Affiliation

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.
Centre of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China.
Department of Pharmacy, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Bone Marrow Transplantation Centre, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Respiratory Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Critical Care Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Zhejiang Provincial Key Laboratory of Pancreatic Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
The Innovation Centre for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.

OBJECTIVE To evaluate viral loads at different stages of disease progression in patients infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first four months of the epidemic in Zhejiang province, China. DESIGN Retrospective cohort study. SETTING A designated hospital for patients with covid-19 in Zhejiang province, China. PARTICIPANTS 96 consecutively admitted patients with laboratory confirmed SARS-CoV-2 infection: 22 with mild disease and 74 with severe disease. Data were collected from 19 January 2020 to 20 March 2020. MAIN OUTCOME MEASURES Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed. RESULTS 3497 respiratory, stool, serum, and urine samples were collected from patients after admission and evaluated for SARS-CoV-2 RNA viral load. Infection was confirmed in all patients by testing sputum and saliva samples. RNA was detected in the stool of 55 (59%) patients and in the serum of 39 (41%) patients. The urine sample from one patient was positive for SARS-CoV-2. The median duration of virus in stool (22 days, interquartile range 17-31 days) was significantly longer than in respiratory (18 days, 13-29 days; P=0.02) and serum samples (16 days, 11-21 days; P<0.001). The median duration of virus in the respiratory samples of patients with severe disease (21 days, 14-30 days) was significantly longer than in patients with mild disease (14 days, 10-21 days; P=0.04). In the mild group, the viral loads peaked in respiratory samples in the second week from disease onset, whereas viral load continued to be high during the third week in the severe group. Virus duration was longer in patients older than 60 years and in male patients. CONCLUSION The duration of SARS-CoV-2 is significantly longer in stool samples than in respiratory and serum samples, highlighting the need to strengthen the management of stool samples in the prevention and control of the epidemic, and the virus persists longer with higher load and peaks later in the respiratory tissue of patients with severe disease.

更新日期：2020-04-21

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