Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly, causing in COVID-19 being declared a global pandemic by the World Health Organization. The key variants include alpha, beta, gamma, and delta; these exhibit high viral transmission, pathogenicity, and immune evasion mechanisms. The delta variant, first confirmed in India, was detected in the majority of COVID-19 patients at the recent wave in the Republic of Korea. Here, the features of the delta variant were compared to the earlier waves, with focus on increased transmissibility. The viral load, from the initial days of infection to 14 days later, was compared based on epidemiological data collected at the time of confirmed diagnosis. The increased viral load observed in the delta variant-led infections influences the scale of the wave, owing to the increased rate of transmission. Infections caused by the delta variant increases the risk of hospitalization within 14 days after symptom onset, and the high viral load correlates with COVID-19 associated morbidity and mortality. Therefore, the future studies should compare the trend of disease severity caused by the high viral load of delta variant with previous waves and analyze the vaccine effects in light of the delta variant of fourth wave.

Highlights

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), was first detected in China in December 2019

  • We investigated SARS-CoV-2 viral load as potential factor contributing to the increased in delta variant infections during the fourth wave in 2021 by comparing it with those observed during the first, second, and third wave in the Republic of

  • The initial viral load of the delta variant within 4 days after symptom onset was approximately 30– 371-fold higher than that during the first wave caused by the S, L, and V clades, including early COVID-19 cases in Wuhan, and was approximately 5–27-fold higher compared to that during the second and third waves, which were mainly caused by the GH clade

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Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), was first detected in China in December 2019. The initial symptoms of COVID19 were fever, cough, and sore throat, followed by reports of pneumonia with an unidentified cause that developed into severe disease (Huang et al, 2020; Zhou et al, 2020; Zhu et al, 2020). After the rapid spread of SARS-CoV-2, the World Health Organization [WHO] (2020) declared COVID19 as a global pandemic on January 30, 2020. As of October 25, 2021, the number of confirmed COVID-19 patients worldwide was 243,260,214, with 4,941,039 deaths, giving a mortality rate of 2.03% (WHO). In the Republic of Korea, 354,355 patients tested positive and 2,788 deaths occurred, resulting in a mortality rate of 0.79%. COVID-19 infections surged in the Republic of Korea during

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