Our results show a direct link between nasopharyngeal viral load and hypoxemia, as well as worse disease outcomes in admitted patients with COVID-19. Previous studies tested the association between viral load and survival. In agreement with our results, a study of 678 admitted patients in New York found that 35.0% of patients with a high viral load on admission died, compared to 6.2% of patients with low viral loads [
1]. In an older age cohort (
n = 48, age 67–97) from Belgium, clinical frailty scale, LDH, and viral load predicted survival [
2]. Intensive care unit (ICU) admission also positively correlated with detectable viral RNA in anal swabs [
3]. In contrast, a Swiss study found no correlation between viral load and disease outcome. The study compared the viral load of patients admitted to the ICU (
n = 48) to patients treated in a screening unit (
n = 723) [
4]. It is not clear, however, whether these patients were later admitted, intubated, or survived. A different New York study (
n = 205) found no association between viral load and disease severity parameters. However, this study mainly compared non-hospitalized to hospitalized patients [
5]. Several markers were associated with COVID-19 severity, the most accepted is IL-6 [
6]. However, IL-6 is not routinely tested at admission and might reflect other inflammatory conditions. Thus, in spite of differences in test kits and procedures between different laboratories and institutions, viral load might provide a rapid screening tool for COVD-19 severity among admitted patients.