SARS-Cov-2 Clearance in Term of Cycle Threshold (Ct) During First Two Waves of COVID-19 in Pakistan: A Phenomenon of Delayed Viral Clearance Post- Corticosteroid Treatment.

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.

The Mucormycosis Crisis: An Epidemic Within a Pandemic

“…21 A study in Pakistan revealed that the majority of the population in the second wave of COVID-19 consumed corticosteroids like dexamethasone as an early treatment of SARS-CoV-2 which resulted in delayed viral clearance. 22 This may also explain the CAM outbreak in the country following the second wave. 12 Another plausible factor is that mucormycosis is complex to diagnose in its early stages and requires aggressive diagnostic strategies, posing great challenges for physicians.…”

The risk of cutaneous mucormycosis associated with COVID‐19: A perspective from Pakistan

“…Furthermore, it was reported that an increasing majority of COVID-19 patients took corticosteroid medications especially during the second COVID-19 wave in Pakistan, which explains the recent increment in mucormycosis cases in the country. 9 Additionally, severe COVID-19 disease leads to increased levels of pro-inflammatory markers, including IL-1, IL-6 and tumor necrosis alpha, and decreased levels of CD4 interferon-gamma, CD4 and CD8 cells; which augments the chances of microbial infections including mucormycosis. Usage of low-quality industrial-grade oxygen cylinders, unclean and humid environment of the hospital facility, tap water in humidifiers and antibiotic overuse may also trigger the mucormycosis infection.…”