The importance of monitoring viral activity and viral load of SARS-CoV-2


Professor O. Burgasova(1), MD; A. Samkov(2); V. Gushchin(3); I. Tyurin(2), Candidate
of Medical Sciences
1-Peoples' Friendship University of Russia, Moscow
2-Infectious Diseases Clinical Hospital No.1 of the Moscow City Health Department
3-N.F. Gamaleya National Research Center for Epidemiology and Microbiology, Moscow

The COVID-19 pandemic has made it possible to study many aspects of the laboratory diagnosis of this infection, including the assessment of the viral load and viral activity of SARS-CoV-2. The review presents data on modern views on the virological characteristics of the SARS-CoV-2 virus, however, many aspects of this problem remain debatable. The issues of the relationship between the level of viral load and the clinical profile of patients are proposed for discussion, and the possibility of using the obtained data in practical healthcare is discussed. The control of viral load in patients with COVID-19 has not only a certain clinical significance, but is also undoubtedly important in the epidemiological aspect. Monitoring of a number of SARS-CoV-2 parameters. will allow to solve practical problems in the context of the ongoing pandemic.

infectious diseases
viral load
viral activity

  1. Григоренко Е.И. Значение вирусной нагрузки при хронической HBV-инфекции. Крымский терапевтический журнал. 2008; 1 (10): 12–4 [Grigorenko H.I. Value of the viral load at a chronic HBV-infection. Krymskii terapevticheskii zhurnal. 2008; 1 (10): 12–4 (in Russ.)].
  2. Амвросьева Т., Поклонская Н. COVID-19: лабораторная диагностика. Наука и инновации. 2020; 7: 22–7 [Amvrosieva T.V., Paklonskaya N.V. COVID-19: Laboratory diagnostics. Nauka i innovatsii. 2020; 7: 22–7 (in Russ.)]. DOI: 10.29235/1818-9857-2020-7-22-27
  3. Dinnes J., Deeks J.J., Adriano A. et al. Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection. Cochrane Database Syst Rev. 2020; 8 (8): CD013705. DOI: 10.1002/14651858.CD013705
  4. Kruglova N., Siniavin A., Gushchin V. et al. Different Neutralization Sensitivity of SARS-CoV-2 Cell-to-Cell and Cell-Free Modes of Infection to Convalescent Sera. Viruses [Internet]. 2021; 13 (6). DOI: 10.3390/v13061133
  5. Cevik M., Tate M., Lloyd O. et al. SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis. Lancet Microbe. 2021; 2 (1): e13-e22. DOI: 10.1016/S2666-5247(20)30172-5
  6. Орлова Е.А., Огарков О.Б., Жданова С.Н. и др. Вирусная нагрузка при COVID-19: недооцененный клинический и эпидемиологический маркер. Acta Biomedica Scientifica. 2021; 6 (1): 33–9 [Orlova E.A., Ogarkov O.B., Zhdanova S.N. et al. Viral Load in COVID-19: Underestimated Clinical and Epidemiological Marker. Acta Biomedica Scientifica. 2021;6(1):33-3 (in Russ.)]. DOI: 10.29413/ABS.2021-6.1.5
  7. Cheng V.C., Hung I.F., Tang B.S. et al. Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome. Clin Infect Dis. 2004; 38 (4): 467–75. DOI: 10.1086/382681
  8. Hung I.F.N., Cheng V.C.C., Wu A.K.L. et al. Viral loads in clinical specimens and SARS manifestations. Emerg Infect Dis. 2004; 10 (9): 1550–7. DOI: 10.3201/eid1009.040058
  9. To K.K.W., Tsang O.T.Y., Leung W.S. et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020; 20 (5): 565–74. DOI: 10.1016/S1473-3099(20)30196-1
  10. Xu K., Chen Y., Yuan J. et al. Factors associated with prolonged viral RNA shedding in patients with coronavirus disease 2019 (COVID-19). Clin Infect Dis. 2020; 71 (15): 799–806. DOI: 10.1093/cid/ciaa351
  11. He X., Lau E.H.Y., Wu P. et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020; 26 (5): 672–5. DOI: 10.1038/s41591-020-0869-5
  12. Wu J.T., Leung K., Bushman M. et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nat Med. 2020; 26 (4): 506–10. DOI: 10.1038/s41591-020-0822-7
  13. Guan W., Ni Z., Hu Y. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382 (18): 1708–20. DOI: 10.1056/NEJMoa2002032
  14. Fajnzylber J., Regan J., Coxen K. et al. SARS-CoV-2 viral load is associated with increased disease severity and mortality. Nat Commun. 2020; 11 (1): 1–9. DOI: 10.1038/s41467-020-19057-5
  15. Dadras O., Afsahi A.M., Pashaei Z. et al. The relationship between COVID-19 viral load and disease severity: A systematic review. Immun Inflamm Dis. 2022; 10 (3): e580. DOI: 10.1002/iid3.580
  16. Salto-Alejandre S., Berastegui-Cabrera J., Camacho-Martinez P. et al. SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome. Sci Rep. 2021; 11 (1): 12931. DOI: 10.1038/s41598-021-92400-y
  17. Wick K.D., Leligdowicz A., Willmore A. et al. Plasma SARS-CoV-2 nucleocapsid antigen levels are associated with progression to severe disease in hospitalized COVID-19. Crit Care. 2022; 26 (1): 278. DOI: 10.1186/s13054-022-04153-3
  18. van Hensbergen M., den Heijer C.D.J., Mujakovic S. et al. Evaluation of symptomatology and viral load among residents and healthcare staff in long-term care facilities: A coronavirus disease 2019 retrospective case-cohort study. PLoS One. 2022; 17 (11): e0276796. DOI: 10.1371/journal.pone.0276796
  19. Tejerina F., Catalan P., Rodriguez-Grande C. et al. Post-COVID-19 syndrome. SARS-CoV-2 RNA detection in plasma, stool, and urine in patients with persistent symptoms after COVID-19. BMC Infect Dis. 2022; 22 (1): 211. DOI: 10.1186/s12879-022-07153-4
  20. Magleby R., Westblade L.F., Trzebucki A. et al. Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019. Clin Infect Dis. 2021; 73 (11): e4197–e4205. DOI: 10.1093/cid/ciaa851
  21. Одилов А.А., Волков А.В., Абдуллаев А.О. и др. Количественный анализ уровня вирусной нагрузки SARS-CoV-2 в легких умерших пациентов с COVID-19. Туберкулез и болезни легких. 2021; 99 (11): 7–15 [Odilov A.A., Volkov A.A., Аbdullaev A.O. et al. Quantitative Analysis of SARS-CoV-2 Viral Load in the Lungs of COVID-19 Deceased Patients. Tuberculosis and Lung Diseases. 2021; 99 (11): 7–15 (in Russ.)]. DOI: 10.21292/2075-1230-2021-99-11-7-15
  22. He X., Lau E.H.Y., Wu P. et al. Temporal dynamics in viral shedding and transmissibility of COVID-19 [published correction appears in Nat Med. 2020 Sep;26(9):1491-1493]. Nat Med. 2020; 26 (5): 672–5. DOI: 10.1038/s41591-020-0869-5
  23. Дедов Д.В. Новая коронавирусная инфекция: клинико-патогенетические аспекты, профилактика, значение витаминов и микроэлементов. Врач. 2022; 33 (2): 47–9 [Dedov D. New coronavirus infection: clinical and pathogenetic aspects, prevention, importance of vitamins and trace elements. Vrach. 2022; 33 (2): 47–9 (in Russ.)]. DOI: 10.29296/25877305-2022-02-07