BibTex format
@article{Hakki:2026,
author = {Hakki, S and Madon, KJ and Nevin, S and Fenn, J and Jonnerby, J and Kundu, R and Conibear, E and Koycheva, A and Derqui, N and Baldwin, S and Houston, H and Pillay, TD and Sam, Narean J and Varro, R and Luca, C and Evetts, S and Ahmad, S and Zambon, M and Dunning, J and Lalvani, A},
journal = {International Journal of Infectious Diseases},
title = {Symptoms predicting the onset and duration of SARS-CoV-2 infectiousness: a community cohort study},
year = {2026}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - IntroductionUpper respiratory tract (URT) SARS-CoV-2 viral load (VL) kinetics influence the clinical course of COVID-19, but their relationship to symptoms remains poorly understood. We hypothesised that VL kinetics affect the timing, intensity, and duration of symptoms in community cases.MethodsOur prospective community cohort provided daily URT swabs for VL quantification for 2 weeks and symptom diaries for 28 days post-recruitment. Symptom data were summarised using a composite Symptom Burden Score (SBS) incorporating symptom presence and severity. Only cases who enrolled sufficiently early post-exposure to discern peak (p)VL were included (n=89). Infectious viral shedding was assessed in a subset (n=37) through quantitative viral culture.ResultsThe day of pVL correlated with the day of peak symptom burden score (pSBS) (p<0.001, n=89). Very high pVL (>170,000,000 RNA copies/ml) was linked to prolonged illness, with a subset experiencing symptoms ≥3 weeks (p<0.001). Cases reported more symptoms, as well as an increase in URT symptom burden, on the first day of virus cultivability compared to the preceding day (p<0.001 and p=0.005, n=31). Peak systemic symptom score, and specifically muscle aches, significantly associated with prolonged infectious viral shedding (p=0.012 and p=0.033, n=34). URT symptoms such as rhinitis, sore throat, and hoarse voice showed the steepest increase at infectiousness onset.ConclusionsThe timing of pSBS aligns with pVL, and pVL above 170,000,000 RNA copies/ml predicts prolonged symptom duration. URT symptom escalation often marks the onset of infectiousness, while systemic symptoms, particularly muscle aches, signal prolonged infectiousness. These findings identify symptom-based markers of infectiousness with implications for testing strategies. They also highlight the importance of collecting early, frequent longitudinal symptom and virological data as a core element of the public health response to novel pathogens and f
AU - Hakki,S
AU - Madon,KJ
AU - Nevin,S
AU - Fenn,J
AU - Jonnerby,J
AU - Kundu,R
AU - Conibear,E
AU - Koycheva,A
AU - Derqui,N
AU - Baldwin,S
AU - Houston,H
AU - Pillay,TD
AU - Sam,Narean J
AU - Varro,R
AU - Luca,C
AU - Evetts,S
AU - Ahmad,S
AU - Zambon,M
AU - Dunning,J
AU - Lalvani,A
PY - 2026///
SN - 1201-9712
TI - Symptoms predicting the onset and duration of SARS-CoV-2 infectiousness: a community cohort study
T2 - International Journal of Infectious Diseases
ER -