Changes in SARS-CoV-2 viral load and mortality during the initial wave of the pandemic in New York City

• Published in: PloS one 2021-11, Vol.16 (11), p.e0257979-e0257979
• Main Authors: Satlin, Michael J, Zucker, Jason, Baer, Benjamin R, Rajan, Mangala, Hupert, Nathaniel, Schang, Luis M, Pinheiro, Laura C, Shen, Yanhan, Sobieszczyk, Magdalena E, Westblade, Lars F, Goyal, Parag, Wells, Martin T, Sepulveda, Jorge L, Safford, Monika M
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 - virology; COVID-19 Nucleic Acid Testing - statistics & numerical data; Disease control; Disease transmission; Evaluation; Female; Health promotion; Hospital Mortality - trends; Humans; Laboratories; Male; Medicine and Health Sciences; Mortality; New York; Pandemics; Patients; Polymerase chain reaction; Public health; Research and Analysis Methods; Reverse transcription; SARS-CoV-2 - isolation & purification; SARS-CoV-2 - pathogenicity; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Viral diseases; Viral Load - statistics & numerical data; Zucker, Benjamin
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0257979

Public health interventions such as social distancing and mask wearing decrease the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they decrease the viral load of infected patients and whether changes in viral load impact mortality from coronavirus disease 2019 (COVID-19). We evaluated 6923 patients with COVID-19 at six New York City hospitals from March 15-May 14, 2020, corresponding with the implementation of public health interventions in March. We assessed changes in cycle threshold (CT) values from reverse transcription-polymerase chain reaction tests and in-hospital mortality and modeled the impact of viral load on mortality. Mean CT values increased between March and May, with the proportion of patients with high viral load decreasing from 47.7% to 7.8%. In-hospital mortality increased from 14.9% in March to 28.4% in early April, and then decreased to 8.7% by May. Patients with high viral loads had increased mortality compared to those with low viral loads (adjusted odds ratio 2.34). If viral load had not declined, an estimated 69 additional deaths would have occurred (5.8% higher mortality). SARS-CoV-2 viral load steadily declined among hospitalized patients in the setting of public health interventions, and this correlated with decreases in mortality.