Alert: Patients with Less Severe COVID-19 Symptoms May Be a Significant Threat

Recently, we shared new data published in the Journal of Pediatrics indicating that nonsympomatic children are more than capable of infecting others with COVID-19. It turns out the same may be true in adults. A study published in The American Journal of Pathology reveals that nonhospitalized adults with less-severe symptoms of COVID-19 can actually have a higher SARS-CoV-2 viral load than hospitalized patients with more severe symptoms. The study population included 205 patients treated at a tertiary care center in New York City who were tested using both qualitative RT-PCR and quantitative RT-PCR to obtain diagnostic SARS-CoV-2 viral load at initial presentation. Paradoxically, higher viral load was found to be associated with shorter duration of symptoms in all patients. In fact, higher viral load was also associated with shorter duration of symptoms in hospitalized patients. The nonhospitalized patients tended to be younger (median age 45). Median duration of symptoms was 5 days for the hospitalized group, compared with 3 days for the nonhospitalized patients. The authors concluded that patients “with mild COVID-19 symptoms may represent the most important ‘overlooked’ source of shedding given the higher viral load.” The implications of this as schools and businesses start to reopen around the country could be significant, as many people rationalize that if they “don’t feel sick” they don’t need to take precautions such as social distancing and wearing a mask around others. Encourage patients (and staff) to continue using protective measures for their own safety and that of those around them.