Estimating infectiousness throughout SARS-CoV-2 infection course

• Published in: Science (American Association for the Advancement of Science) Vol. 373; no. 6551
• Main Authors: Jones, Terry C., Biele, Guido, Mühlemann, Barbara, Veith, Talitha, Schneider, Julia, Beheim-Schwarzbach, Jörn, Bleicker, Tobias, Tesch, Julia, Schmidt, Marie Luisa, Sander, Leif Erik, Kurth, Florian, Menzel, Peter, Schwarzer, Rolf, Zuchowski, Marta, Hofmann, Jörg, Krumbholz, Andi, Stein, Angela, Edelmann, Anke, Corman, Victor Max, Drosten, Christian
• Format: Journal Article
• Language: English
• Published: United States The American Association for the Advancement of Science 09.07.2021; American Association for the Advancement of Science
• Subjects: Adolescent; Adult; Adults; Age; Age Factors; Aged; Aged, 80 and over; Asymptomatic; Asymptomatic Infections; Caco-2 Cells; Cell culture; Child; Child, Preschool; Children; Clinical significance; Containment; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - transmission; COVID-19 - virology; COVID-19 Nucleic Acid Testing; Disease transmission; Estimates; Female; Germany; Hospitalization; Humans; Infant; Infections; Infectivity; Load distribution; Male; Mean; Middle Aged; Online; Parameters; Patients; Peak load; Probability; Replication; Respiratory diseases; SARS-CoV-2 - isolation & purification; SARS-CoV-2 - pathogenicity; SARS-CoV-2 - physiology; Severe acute respiratory syndrome coronavirus 2; Viral diseases; Viral infections; Viral Load; Virology; Virus Replication; Virus Shedding; Viruses; Young Adult; Germany
• ISSN: 0036-8075; 1095-9203; 1095-9203
• DOI: 10.1126/science.abi5273

The role that individuals with asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus 2 have in transmission of the virus is not well understood. Jones et al. investigated viral load in patients, comparing those showing few, if any, symptoms with hospitalized cases. Approximately 400,000 individuals, mostly from Berlin, were tested from February 2020 to March 2021 and about 6% tested positive. Of the 25,381 positive subjects, about 8% showed very high viral loads. People became infectious within 2 days of infection, and in hospitalized individuals, about 4 days elapsed from the start of virus shedding to the time of peak viral load, which occurred 1 to 3 days before the onset of symptoms. Overall, viral load was highly variable, but was about 10-fold higher in persons infected with the B.1.1.7 variant. Children had slightly lower viral loads than adults, although this difference may not be clinically significant. Science , abi5273, this issue p. eabi5273 Analysis of thousands of people who tested positive in Germany reveals that many were asymptomatic and a minority exhibited high viral loads. Two elementary parameters for quantifying viral infection and shedding are viral load and whether samples yield a replicating virus isolate in cell culture. We examined 25,381 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Germany, including 6110 from test centers attended by presymptomatic, asymptomatic, and mildly symptomatic (PAMS) subjects, 9519 who were hospitalized, and 1533 B.1.1.7 lineage infections. The viral load of the youngest subjects was lower than that of the older subjects by 0.5 (or fewer) log 10 units, and they displayed an estimated ~78% of the peak cell culture replication probability; in part this was due to smaller swab sizes and unlikely to be clinically relevant. Viral loads above 10 9 copies per swab were found in 8% of subjects, one-third of whom were PAMS, with a mean age of 37.6 years. We estimate 4.3 days from onset of shedding to peak viral load (10 8.1 RNA copies per swab) and peak cell culture isolation probability (0.75). B.1.1.7 subjects had mean log 10 viral load 1.05 higher than that of non-B.1.1.7 subjects, and the estimated cell culture replication probability of B.1.1.7 subjects was higher by a factor of 2.6.