Abstract：
SARS-CoV-2 is recently emerged virus, which caused millions of deaths, all over the world. To tackle COVID-19 pandemic, there is an utmost need for in-depth analysis of viral replication. We aimed to examine viral load in SARS-CoV-2 patients during first two waves of COVID-19 in Pakistan. 225,615 suspected subjects from 75 different regions of Pakistan were selected in the study. SARS-CoV-2 RNAs were detected via real time PCR. During first wave (period of June-July, 2020) of COVID-19 the prevalence of SARS-CoV-2 was 20.38%. However, during second wave (period of November-December, 2020) of COVID-19, the rate of prevalence was 9.41%. During first wave of COVID-19 96.31% of participants remained PCR positive for 14 to 21 days, 3.39% of subjects showed positive results for 22 to 35 days, while delayed Ct values were observed among 0.26% of participants for 36 to 49 days. However, during second wave of COVID-19 89.31% of the subjects exhibited symptoms and showed real-time PCR positive results for 14 to 21 days, 9.42% showed positive results for 22 to 35 days, while significantly delayed Ct value results were observed among 1.026% of participants for 36 to 63 days (3.95 times higher than first wave). In contrast to first wave of COVID-19, the factors that were different in second wave were neither viral (different strains) nor host (same population). But treatment factors changed significantly. As during second wave besides azithromycin, corticosteroid dexamethasone consumption was increased consequently causing delayed Ct value negativity. This suggests that corticosteroid treatment might be linked with delayed Ct value or viral clearance. This study is crucial for re-considering effective therapeutic options against COVID-19.
摘要：
SARS-CoV-2是最近出现的病毒，造成数百万人死亡，全世界.为了应对COVID-19大流行，最需要对病毒复制进行深入分析。我们的目的是检查巴基斯坦前两波COVID-19期间SARS-CoV-2患者的病毒载量。研究中选择了来自巴基斯坦75个不同地区的225,615名可疑受试者。通过实时PCR检测SARS-CoV-2RNA。在第一波(6月至7月期间，2020年）在COVID-19中，SARS-CoV-2的患病率为20.38%。然而,在第二波(11月至12月期间，2020年）COVID-19的患病率为9.41%。在第一波COVID-19中，96.31%的参与者在14到21天内保持PCR阳性，3.39%的受试者在22至35天内显示阳性结果，而在0.26%的参与者中观察到36~49天的延迟Ct值。然而,在COVID-19的第二波中，89.31%的受试者出现症状，并在14至21天内显示实时PCR阳性结果，9.42％的人在22至35天内显示阳性结果，而在1.026%的参与者中,Ct值结果显著延迟36~63天(比第一波高3.95倍).与第一波COVID-19相反，第二波中不同的因素既不是病毒(不同的毒株)也不是宿主(相同的群体)。但治疗因素发生了显著变化。除了阿奇霉素，在第二波中，因此,皮质类固醇地塞米松消耗量增加导致Ct值阴性延迟.这表明皮质类固醇治疗可能与延迟的Ct值或病毒清除有关。这项研究对于重新考虑针对COVID-19的有效治疗选择至关重要。
