Abstract
The correlation between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load and risk of disease severity in cancer patients is poorly understood. Given the fact that cancer patients are at increased risk of severe coronavirus disease 2019 (COVID-19), analysis of viral load and disease outcome in COVID-19-infected cancer patients is needed. Here, we measured the SARS-CoV-2 viral load using qPCR cycle threshold (Ct) values collected from 120 noncancer and 64 cancer patients’ nasopharyngeal swab samples who are admitted to hospitals. Our results showed that the in-hospital mortality for high viral load cancer patients was 41.38%, 23.81% for medium viral load and 14.29% for low viral load patients (p < −0.01). On the other hand, the mortality rate for noncancer patients was lower: 22.22% among patients with high viral load, 5.13% among patients with medium viral load, and 1.85% among patients with low viral load (p < 0.05). In addition, patients with lung and hematologic cancer showed higher possibilities of severe events in proportion to high viral load. Higher attributable mortality and severity were directly proportional to high viral load particularly in patients who are receiving anticancer treatment. Importantly, we found that the incubation period and serial interval time is shorter in cancer patients compared with noncancer cases. Our report suggests that high SARS-CoV-2 viral loads may play a significant role in the overall mortality and severity of COVID-19-positive cancer patients, and this warrants further study to explore the disease pathogenesis and their use as prognostic tools.
Highlights
Individuals who are infected with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2; coronavirus disease 2019 (COVID-19)] demonstrate a heterogeneous presentation of symptoms and severity depending on the history of active malignancies
Our study demonstrated that the differences in SARS-CoV-2 viral load in COVID-19-positive cancer and noncancer patients may play a role in the prediction of mortality and the extent of disease severity
Cancer patients with active COVID-19 infection showed shorter incubation period and serial interval time when compared with noncancer patients
Summary
Individuals who are infected with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2; coronavirus disease 2019 (COVID-19)] demonstrate a heterogeneous presentation of symptoms and severity depending on the history of active malignancies. Individuals with a history of cancer are more susceptible to COVID-19 infection and have been identified as having an increased risk of mortality and morbidity due to overall poor health status and systemic immunosuppressive conditions [1, 2]. Cancer was identified as a susceptible group and have been identified as having an increased risk of infection with COVID-19 with increased risk of death and severe outcomes These severe phenotypes require special attention with higher intensive care, correlating with rapidly deteriorating patient conditions and increased risk of death [5,6,7] with a clear contrast between the patients with and without cancer. The clinical phenotypes of patients with cancer and the effects of anticancer treatment greatly influence the outcome of the patient’s severity and survival [2, 8]
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