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SARS-CoV-2 viral load: Implication in COVID-19 pathogenesis, clinical presentation, diagnosis, treatment, prognosis and infectivity

 Department of Internal Medicine, (Division of Infectious Disease), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Correspondence Address:
Prasan Kumar Panda,
Department of Internal Medicine, Division of Infectious Disease, All India Institute of Medical Sciences, Rishikesh, Uttarakhan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JME.JME_134_20

The SARS-CoV-2 viral load may have importance in assessing COVID-19's pathogenesis, clinical presentation, diagnosis, treatment, prognosis and infectivity. The severity of the disease has been attributed to the dysregulated immune mechanisms, but studies have suggested a correlation between disease severity and viral loads although evidence is not strong enough in justifying the same. Viraemia is shown to be keenly related to the disease progression. Viraemia has an association with increased Interleukin-6 levels and poorer prognosis. In terms of symptomatology, any definite correlations are not yet deduced, with no difference in viral loads among symptomatic and asymptomatic individuals. Reduction of viral load may be used as a marker of treatment success. Cycle threshold (Ct) values correlate with the SARS-CoV-2 viral loads. Ct values have shown a correlation with viral cultures and sub-genomic RNA values, both of which are considered the gold standard for determining infectivity but are expensive. Thereby, Ct value titres form an economical basis for deciding the de-isolation of the patients, which has implications in better resource management. Various limitations of viral load testing, especially of Ct values including human and laboratory factors are also discussed.

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