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Observational Study
. 2021 Jun;53(4):530-535.
doi: 10.1016/j.pathol.2021.01.007. Epub 2021 Mar 20.

SARS-CoV-2 viral load dynamics and real-time RT-PCR cycle threshold interpretation in symptomatic non-hospitalised individuals in New Zealand: a multicentre cross sectional observational study

Affiliations
Observational Study

SARS-CoV-2 viral load dynamics and real-time RT-PCR cycle threshold interpretation in symptomatic non-hospitalised individuals in New Zealand: a multicentre cross sectional observational study

Andrew Fox-Lewis et al. Pathology. 2021 Jun.

Abstract

We conducted a multicentre cross sectional observational study of laboratory, public health and hospitalisation data for PCR-confirmed COVID-19 cases within the New Zealand Northern Region, between 12 February and 8 June 2020. The aim of this study was to describe population level SARS-CoV-2 upper respiratory tract (URT) viral load dynamics by stratifying positivity rates and polymerase chain reaction (PCR) cycle threshold (Ct) values of URT samples from COVID-19 cases by days since symptom onset, and to explore utility of Ct values in determining length of time post-infection and thus potential infectivity. Of 123,124 samples tested for SARS-CoV-2 by PCR, 579 samples (407 positive and 172 negative) from 368 symptomatic non-hospitalised individuals with PCR-confirmed infection were included. Sample positivity rate was 61.5% (8/13) for pre-symptomatic samples, rising to 93.2% (317/340) for samples collected during the purported symptomatic infectious period (days 0-10 post-symptom onset), and dropping to 36.3% (82/226) for post-infectious period samples (day 11 onwards). URT viral load peaked shortly after symptom onset, with median Ct values ranging 20.00-29.99 until 15 days post-symptom onset, and >30.00 after this time. Of samples with a Ct value of <20.00, 96.1% were collected during the symptomatic infectious period. However, of samples with a Ct value ≥30.00 and ≥35.00, 46.9% and 18.5%, respectively, were also collected during the symptomatic infectious period. The findings of this study indicate that at or soon after symptom onset represents the optimum time to test for SARS-CoV-2 in the URT, with median Ct values suggesting the useful testing window extends until around 15 days post-symptom onset. In asymptomatic individuals or those with unknown dates of symptom onset, Ct values <20.00 imply recent onset/potential infectivity, but Ct values ≥30.00 or ≥35.00 do not exclude recent onset/potential infectivity. Individual sample Ct values should not be used as an absolute marker of length of time post-infection or to exclude infectivity where date of symptom onset is unavailable.

Keywords: COVID-19; New Zealand; PCR; SARS-CoV-2; cycle threshold.

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Figures

Fig. 1
Fig. 1
Summary of samples included in the study. LRT, lower respiratory tract.
Fig. 2
Fig. 2
Raw cycle threshold (Ct) values by days since symptom onset for included positive and negative samples from symptomatic non-hospitalised individuals with PCR-confirmed SARS-CoV-2 infection (n=579), with LOESS (locally weighted smoothing) curves fitted to visualise viral load dynamics over time. Day 0 = day of symptom onset. Dashed vertical line represents end of symptomatic infectious period (after day 10 post-symptom onset). A Ct value of 40.00 indicates a negative sample.
Fig. 3
Fig. 3
(A–J) Cycle threshold (Ct) values by days since symptom for individuals with five samples or more included in the study (n=10). Day 0 = day of symptom onset. A Ct value of 40.00 indicates a negative sample.

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References

    1. Baker M., Kvalsvig A., Verrall A.J., et al. New Zealand's elimination strategy for the COVID-19 pandemic and what is required to make it work. N Z Med J. 2020;133:10–14. - PubMed
    1. Song F., Zhang X., Zha Y., et al. COVID-19: recommended sampling sites at different stages of the disease. J Med Virol. 2020;92:1383–1385. - PMC - PubMed
    1. Wishaupt J.O., Ploeg T.V., Smeets L.C., et al. Pitfalls in interpretation of CT-values of RT-PCR in children with acute respiratory tract infections. J Clin Virol. 2017;90:1–6. - PMC - PubMed
    1. Reichler M.R., Bruden D., Thomas H., et al. Ebola patient virus cycle threshold and risk of household transmission of Ebola virus. J Infect Dis. 2020;221:707–714. - PMC - PubMed
    1. Walsh K.A., Jordan K., Clyne B., et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection. J Infect. 2020;81:357–371. - PMC - PubMed

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