ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2024
The New Normal: Delayed Peak SARS-CoV-2 Viral Loads Relative to Symptom Onset and Implications for COVID-19 Testing Programs.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed, 42 citations in OpenAlex.
- Assessing the Potential of an Enzymatically Liberated Salmon Oil to Support Immune Health Recovery from Acute SARS-CoV-2 Infection via Change in the Expression of Cytokine, Chemokine and Interferon-Related Genes.International journal of molecular sciences · 2024Trial
- Peak Nasal SARS-CoV-2 and Influenza Viral Loads Relative to Symptom Onset, 2022-2025: Impact of Vaccination and Implications for Multiplexed Testing.The Journal of infectious diseases · 2026Article
- A Multi-Provincial Clinical Evaluation of the PANBIO™ COVID-19 Antigen Rapid Test Device in South Africa.Diagnostics (Basel, Switzerland) · 2026Article
- Quantifying Epidemiological Risk Transitions of COVID-19 in the Brazilian State of Ceará (2020-2023): A Generalized Linear Modeling Approach.Epidemiologia (Basel, Switzerland) · 2026Article
- Why Andes hantavirus is not the next SARS-CoV-2: contrasting viral shedding, transmissibility and genomic patterns.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2026Article
- Independent Testing to Accelerate the Development of Lateral Flow Assays for Influenza A, Influenza B and SARS-COV-2.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Antigenic remodeling of the SARS-CoV-2 Spike N-terminal domain links sequence variability to structural reorganization of a neutralizing antibody supersite.Frontiers in cellular and infection microbiology · 2026Article
- Peak Nasal SARS-CoV-2 and Influenza Viral Loads Relative to Symptom Onset, 2022-2025: Impact of Vaccination and Implications for Multiplexed Testing.medRxiv : the preprint server for health sciences · 2025Article
- Quantum-enhanced nanodiamond rapid test advances early SARS-CoV-2 antigen detection in clinical diagnostics.Nature communications · 2025Article
- A composite symptoms severity score based on survey self-reports as a predictor of SARS-CoV-2 infection and viral load.BMC infectious diseases · 2025Article
- Saliva Has High Sensitivity and Specificity for Detecting SARS-CoV-2 Compared to Nasal Swabs but Exhibits Different Viral Dynamics from Days of Symptom Onset.Diagnostics (Basel, Switzerland) · 2025Article
- The effect of COVID-19 vaccination on viral load among health care workers: a retrospective cohort study.Clinical and experimental vaccine research · 2025Article
- Diagnostic Performance of a Combined Rapid Antigen Test for Detecting SARS-CoV-2, Influenza Virus, and Respiratory Syncytial Virus in Symptomatic Patients in Tertiary Care.Journal of medical virology · 2025Article
- Management of SARS-CoV-2 Infection-Clinical Practice Guidelines of the Polish Association of Epidemiologists and Infectiologists, for 2025.Journal of clinical medicine · 2025Review
- Modeling suggests SARS-CoV-2 rebound after nirmatrelvir-ritonavir treatment is driven by target cell preservation coupled with incomplete viral clearance.Journal of virology · 2025Article
- Terminating pandemics with smartwatches.PNAS nexus · 2025Article
- Relationship Between Acute SARS-CoV-2 Viral Clearance and Long COVID-19 (Long COVID) Symptoms: A Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Factors Influencing COVID-19 Viral Clearance: Implications for Vaccination and Antiviral Therapy.Infection and drug resistance · 2025Article
- Associations of SARS-CoV-2 PCR positivity with clinical symptoms and race/ethnicity: The household transmission study.PloS one · 2025Article
- Trends in Testing for SARS-CoV-2 Among Healthcare Workers in a Canadian Cohort Study During the COVID-19 Pandemic, June 2020 to November 2023.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2025Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundEarly in the coronavirus disease 2019 (COVID-19) pandemic, peak viral loads coincided with symptom onset. We hypothesized that in a highly immune population, symptom onset might occur earlier in infection, coinciding with lower viral loads.
methodsWe assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A viral loads relative to symptom duration in symptomatic adults (≥16 years) presenting for testing in Georgia (4/2022-4/2023; Omicron variant predominant). Participants provided symptom duration and recent testing history. Nasal swabs were tested by Xpert Xpress SARS-CoV-2/Flu/RSV assay and cycle threshold (Ct) values recorded. Nucleoprotein concentrations in SARS-CoV-2 polymerase chain reaction (PCR)-positive samples were measured by single molecule array. To estimate hypothetical antigen rapid diagnostic test (Ag RDT) sensitivity on each day after symptom onset, percentages of individuals with Ct value ≤30 or ≤25 were calculated.
resultsOf 348 newly-diagnosed SARS-CoV-2 PCR-positive individuals (65.5% women, median 39.2 years), 317/348 (91.1%) had a history of vaccination, natural infection, or both. By both Ct value and antigen concentration measurements, median viral loads rose from the day of symptom onset and peaked on the fourth/fifth day. Ag RDT sensitivity estimates were 30.0%-60.0% on the first day, 59.2%-74.8% on the third day, and 80.0%-93.3% on the fourth day of symptoms.In 74 influenza A PCR-positive individuals (55.4% women; median 35.0 years), median influenza viral loads peaked on the second day of symptoms.
conclusionsIn a highly immune adult population, median SARS-CoV-2 viral loads peaked around the fourth day of symptoms. Influenza A viral loads peaked soon after symptom onset. These findings have implications for ongoing use of Ag RDTs for COVID-19 and influenza.
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