Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study
Open accessAbstract
Summary Background We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). Methods We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. Findings Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. Interpretation The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage. Published online May 9, 2003 http://image.thelancet.com/extras/03art4432web.pdf
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The latent period would be at least as long as the incubation period.
“Thus, the latent period would be at least as long as the incubation period.80,124”
From Severe acute respiratory syndrome (SARS) mathematical models and disease parameters: a systematic review (2025) · cites this paper as [80]
The Results report viral RNA detection and viral loads measured after symptom onset, but give no comparison between the latent and incubation periods. A search for presymptomatic infectiousness and incubation found no passage establishing that the latent period is at least as long as the incubation period. Page numbers were not available in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measuredVery little evidence was found for asymptomatic transmission of SARS-CoV-1, suggesting that most individuals with SARS-CoV-1 infection were symptomatic and that their infectiousness started after presenting with symptoms.
“Although not a focus of our systematic review, very little evidence was found for asymptomatic transmission of SARS-CoV-1, suggesting that most individuals with SARS-CoV-1 infection were symptomatic and that their infectiousness started after presenting with symptoms.”
From Severe acute respiratory syndrome (SARS) mathematical models and disease parameters: a systematic review (2025) · cites this paper as [80]
The Discussion describes a cohort of symptomatic patients admitted soon after symptom onset, and the Results measure viral RNA only after onset. Our copy does not assess asymptomatic transmission, the proportion of all infected people who were symptomatic, or whether infectiousness began only after symptoms appeared (searched: asymptomatic transmission and infectiousness before symptom onset). (LLM, conf=0.78)
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- Authors
- Peiris, J., Chu, C., Cheng, V., Chan, K., Hung, I., Poon, L., Law, K., Tang, B., Hon, T., Chan, C., Chan, K., Ng, J., Zheng, B., Ng, W., Lai, R., Guan, Y., & Yuen, K.
- Affiliations
- Queen Mary Hospital (CN)
- United Christian Hospital (CN)
- ORCID
- Guan, Y
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2003-05
- Volume
- 361
- Issue
- 9371
- Pages
- 1767-1772
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC7112410
- OpenAlex
- W2129542667
- Semantic Scholar
- a6f1a703194e8a959fef81aac5d26499a3dadf1e
- Cited by
- 2,375
- References
- 17
- Citations by year
- 2026: 14 · 2025: 24 · 2024: 38 · 2023: 101 · 2022: 138 · 2021: 335 · 2020: 681 · 2019: 16 · 2018: 3 · 2017: 14 · 2016: 27 · 2015: 32 · 2014: 28 · 2013: 30 · 2012: 28
- FWCI
- 128.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- Queen Mary University of London
- Wellcome Trust
- Hong Kong Government
- U.S. Public Health Service (A195357)
- National Institute of Allergy and Infectious Diseases
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- SARS, SARS-associated coronavirus, clinical progression, viral load, community outbreak, acute respiratory distress syndrome, pneumomediastinum, recurrent fever, diarrhea, radiographic progression, quantitative RT-PCR, nasopharyngeal aspirates, seroconversion, chronic hepatitis B, lamivudine, ribavirin, corticosteroids, immunopathology
- MeSH terms
- Administration, Oral, Adult, Aged, Disease Outbreaks, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Length of Stay, Lung, Male, Middle Aged, Pregnancy, Pregnancy Complications, Infectious, Radiography, Ofloxacin, Survival Rate, Disease Progression, Viral Load, Amoxicillin-Potassium Clavulanate Combination, Pulse Therapy, Drug, Severe Acute Respiratory Syndrome, Severe acute respiratory syndrome-related coronavirus
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