Patients (of any age) infected with COVID-19 with information on either viral load or detection during infection (including in the pre-symptomatic phase) and/or duration of infectivity. 8 The findings of the research question were synthesised narratively due to the heterogeneity of study designs and data. case series, modelling studies), a de-novo tool, adapted from related tools, was used. 11 For study designs where no universally accepted quality appraisal tool existed (e.g. Cochrane Risk of Bias (RoB) tool for Randomized Controlled Trials 10 and Risk Of Bias In Non-randomized studies of Interventions tool (ROBINS-I)). Various validated risk of bias tools were used for quality appraisal of included studies, where appropriate (e.g. For each included study, data on the study design, participant demographics and clinically relevant data were extracted. Any study (regardless of design) that addressed the research question and met the inclusion criteria ( Table 1 8Īll potentially eligible papers, including non-peer-reviewed pre-prints, were exported to Endnote X8.2 and screened for relevance. The protocol, which is available online, contains the detailed search strategies.
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The last update for this rapid review was conducted on. Only articles including human subjects were included. The search combined terms for COVID-19 with terms for viral load, detection and infectivity. Hence, we conducted a systematic literature search of PubMed, Europe PubMed Central and EMBASE from 30 December 2019. Due to the proliferation of COVID-19 literature, the vast majority of which were not relevant to our research question, we employed a more specific search strategy from 27 March 2020 onwards. The purpose of the initial broad search was to identify all COVID-19 scientific and medical literature to answer a range of research questions. 9 Initially, we conducted a systematic literature search of electronic databases (PubMed, EMBASE, Science Direct, Cochrane, National Health Service Evidence, and Infectious Diseases Society of America search of infectious disease journals) and pre-print servers (medRxiv, bioRxiv and Health Research Board Open) using COVID-19 search terms. We conducted rapid reviews for a broad range of public health topics related to COVID-19 following a standardised protocol, 8 in keeping with Cochrane rapid review methodology guidance. For this current article, we summarise the available evidence to address the following two research questions: We defined viral load as the quantity (or titre) of virus in a volume of fluid at a given time. undetectability) of the virus in a sample at a given time. We defined detection as the presence (i.e. Furthermore, information pertaining to the duration of infectivity will help inform public health protocols for quarantine, isolation and contact tracing. Information relating to SARS-CoV-2 detection and viral load at different time points of an infection, including in those without any symptoms, will aid with the clinical interpretation of real-time reverse transcriptase polymerase chain reaction (rRT-PCR) test results. detection and viral load) in patients and how this relates to infectivity and disease severity. 7 As SARS-CoV-2 is a novel virus in the human population, there is substantial uncertainty regarding virological levels (i.e. Understanding the trajectory of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the duration of infectivity is of critical importance to controlling the pandemic. Hence, the findings of these reviews have informed the national response to the COVID-19 pandemic in Ireland, 6 and have implications for international health policy as well as clinical and public health guidance. The rapid reviews arose directly from questions posed by policy makers and expert clinicians supporting the Irish National Public Health Emergency Team (NPHET).
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5 Our team at the Health Information and Quality Authority (HIQA) of Ireland has conducted a series of rapid reviews on various public health topics relating to COVID-19. 3, 4 Much remains unknown about COVID-19 however, evidence is emerging at a fast pace. 1, 2 COVID-19 presents an unprecedented challenge to governments worldwide due to the transmissibility of the virus, the scale of its impact on morbidity and mortality, the uncertainty regarding the development of long-term immunity in those infected, the current lack of vaccine or treatment options, and the impact on healthcare systems, economies and society. The Coronavirus Disease 2019 (COVID-19) pandemic is a public health emergency of international concern causing a substantial number of cases and deaths globally.
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