Potency and timing of antiviral therapy as determinants of duration of SARS CoV-2 shedding and intensity of inflammatory response

Ashish Goyal; E. Fabian Cardozo-Ojeda; Joshua T Schiffer

We used four datasets of SARS CoV-2 shedding in the absence of effective treatment to develop and validate a mathematical model. This data included 25 infected people: 11 from Singapore (7), 9 from Germany (8), one from Korea (9) , and 4 from France (10) (Fig 1) . Notably, sampling techniques differed across studies. In Singapore, Korea and France, samples were obtained with nasopharyngeal swabs, whereas in Germany viral loads were measured directly from sputum. Shedding was notable for an early peak, followed by three phases of viral decay including a rapid initial decline from peak, a slower period of decay of variable length, followed by a third abrupt elimination of the low levels of remaining virus. Of note, we only captured the viral peak as well as the final rapid clearance phase in a subset of study participants. There was one example of substantial, transient viral re-expansion (G7 in Fig 1) .