Investigation of Initial Viral Loads and Patient Characteristics as Predictors of COVID-19 Outcomes: A Retrospective Cohort Study

Round 1

Reviewer 1 Report

In this study, Yusri has investigated if measuring viral load during the first visit can be used as a predictor of disease severity in SARS-CoV-2 infected patients. With this retrospective study, the author has established an association between low viral load with disease progression and poor outcomes in COVID-19 patients. Several studies are performed to determine the relationship between the initial viral load and disease outcome in COVID-19 patients but with varied results. The findings of this study support some of these studies. However, there are a few points that need to be clarified as they might affect the study’s findings.

 

Are there any exclusion criteria used for screening these patients for this specific purpose?  For example, excluding those patients who already started any medication before giving clinical samples for viral load estimation or something else. Please include both inclusion and exclusion criteria for patient selection in methods.

 

As the extent of viral load in clinical samples also varies with the duration of symptoms onset. It is also important to consider at what time point following symptom onset, the viral load was determined in these patients. This information is missing in this study.

 

It is mentioned in the results “Slightly higher rates of COVID-19 severity were reported among the moderate group (106, 28.42%) compared to other severity groups.” I think this statement must be the “higher number of cases were reported in the moderate group of COVID-19 patients.

 

The author has mentioned the frequency of females affected by COVID-19 in the abstract but no clinical and vial load characteristics are discussed in the results.

 

 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Overall the author has good knowledge related to topic. I suggested to change the title because title is not scientific. Moreover, I also suggested to add the studies of low-income countries and compare the data in form of table. In abstract, mentioned significant value and use statistics. Introduction fine method is adequate. In discussion, add some significant facts. I found missing facts and also discuss data with concrete justification.Overall paper is good.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments to the corresponding author:

 

1)      The main criticism which impairs the quality of this manuscript is that the SARS-CoV-2 genotype has not been identified.

 

2)      Another major concern is that a power calculation should be done to derive at the appropriate sample size.

 

3)      The relationship between initial viral load of SARS-CoV-2 and parents’ clinical outcome has been extensively studied in several previous studies.

 

4)      The manuscript doesn’t address a specific gap in the field.

 

5)      The manuscript doesn’t add to the subject area compared with other published
material.

 

6)      The study design is improper.

 

7)      The authors should consider the two study groups (LIVL, Ct > 20 and HIVL, Ct ≤ 20) as separate entities when performing the statistical analyses.

 

8)      I do not believe that the scope of the present study is sufficient to arrive at the strong conclusion that would make the study of wider interest to the journal’s readers. 

Minor editing of English language required

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

None