Viral load of SARS-CoV-2 in adults during the first and second wave of COVID-19 pandemic in Houston, TX: the potential of the super-spreader

Avadhanula, Vasanthi; Nicholson, Erin G; Ferlic-Stark, Laura; Piedra, Felipe-Andres; Blunck, Brittani N; Fragoso, Sonia; Bond, Nanette L; Santarcangelo, Patricia L; Ye, Xunyan; McBride, Trevor J; Aideyan, Letisha O; Patel, Kirtida D; Maurer, Lauren; Angelo, Laura S; Piedra, Pedro A

BACKGROUND: During the COVID-19 pandemic, a minority of index cases are associated with a majority of secondary cases suggesting that super-spreaders could drive the pandemic. We identified a phenotype in individuals with extremely high viral load who could act as super-spreaders. METHODS: Data were analyzed from individuals tested for SARS-CoV-2 from March 18 through August 15, 2020. Outcomes were compared using contingency table and quantile regression to test the equality of medians between the pandemic waves and by viral load groups. RESULTS: Of the 11,564 samples tested, 1,319 (11.4%) were positive for SARS-CoV-2. An increase in weekly median viral load occurred in the second wave of the SARS-CoV2 pandemic. This population was more likely to be women, outpatients, symptomatic and have an extremely high or high viral load. In patients with multiple RT-PCR positive tests, the duration of viral shedding was comparable between individuals with asymptomatic/mild and mild/moderate illness severity. CONCLUSIONS: We detected a small group of individuals with extremely high SARS-CoV-2 viral load with mild illness. We believe that these individuals’ characteristics could be consistent with the super-spreader phenomenon and that greater awareness of the social dynamics of these individuals is needed to understand the spread of SARS-CoV-2.