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Review 3: "Is Higher Viral Load in SARS-CoV-2 Associated With Death?"

This study is potentially informative but the results should be approached with caution. The claim that high viral load indicates higher mortality is not fully supported. Multiple confounding variables have not been taken into account.

Published onSep 03, 2020
Review 3: "Is Higher Viral Load in SARS-CoV-2 Associated With Death?"

RR:C19 Evidence Scale rating by reviewer:

  • Potentially informative. The main claims made are not strongly justified by the methods and data, but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt. Decision-makers should consider this evidence only with a thorough understanding of its weaknesses, alongside other evidence and theory. Decision-makers should not consider this actionable, unless the weaknesses are clearly understood and there is other theory and evidence to further support it.

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Review:

General: The authors report viral load data of RT-PCR nasopharyngeal swabs in 857 individuals in Sao Paulo (Brazil) on admission, categorized into a low and high viral load (>/< 24 cycle thresholds) and patients with mild (no hospitalization), moderate (hospitalization in the ward) and severe disease (ICU treatment).

Should this preprint be published? Yes, with probably a minor revise. Can mortality data of subgroups outside/in-hospital be added or presented as well ? (optional):

Referring to the Results section (last paragraph and Figure 3):
The authors evaluate mortality data of high and low viral load and present the common data (46% and 22%) of the group in this section. They continue to speak about “in-hospital mortality” in this section and about “outside” in Fig. 3, but do not present the mortality data of these subgroups, only CI/OR. Do they have these data, if yes, they should present as well.

The study is potentially informative. Reason for this (comparable low) scale is not within the manuscript, but within the data: e.g. how long is the period from first symptom until admission in this setting (not reported), other risk factors (obesity, COPD, hypertension) and local circumstances, which limit the conclusions. But again, this is not a topic of the manuscript.

Conclusions are supported by the results, the data are discussed well in the context of present data. The data present valuable information about the present and further development of the virulence and further mortality rates during the ongoing pandemic in different areas and at different time points.

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