Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19

Abstract

on behalf of Gemelli Against COVID-19 Post-Acute Care Team Introduction: As an emerging infectious disease, the clinical and virologic course of COVID-19 requires better investigation. The aim of this study is to identify the potential risk factors associated with persistent positive nasopharyngeal swab real-time reverse transcription-polymerase chain reaction tests in a large sample of patients who recovered from COVID-19. Methods: After the acute phase of SARS-CoV-2 epidemic infection, the Fondazione Policlinico A. Gemelli IRCSS of Rome established a post-acute care service for patients discharged from the hospital and recovered from COVID-19. Between April 21 and May 21, 2020, a total of 137 individuals who officially recovered from COVID-19 were enrolled in this study. All patients were tested for the SARS-CoV-2 virus with nucleic acid RT-PCR tests. Analysis was conducted in June 2020. Results: Of the 131 patients who repeated the nasopharyngeal swab, 22 patients (16.7%) tested positive again. Some symptoms such as fatigue (51%), dyspnea (44%), and coughing (17%) were still present in a significant percentage of the patients, with no difference between patients with a negative test and those who tested positive. The likelihood of testing positive for SARS-CoV-2 infection was significantly higher among participants with persistent sore throat (prevalence ratio=6.50, 95% CI=1.38, 30.6) and symptoms of rhinitis (prevalence ratio=3.72, 95% CI=1.10, 12.5). Conclusions: This study is the first to provide a given rate of patients (16.7%) who test positive on RT-PCR test for SARS-CoV-2 nucleic acid after recovering from COVID-19. These findings suggest that a significant proportion of patients who have recovered from COVID-19 still could be potential carriers of the virus. In particular, if patients continue to have symptoms related to COVID-19, such as sore throat and rhinitis, it is reasonable to be cautious by avoiding close contact, wearing a face mask, and possibly repeating a nasopharyngeal swab.

A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

“…During the second hospitalization, no RP patients showed any new symptoms, 78·31% showed further improved on chest CT scan compared with the first discharge. None of the close contacts developed COVID-19 Peng et al [117] China Case series 9 5 7·2 ± 4·8 14/38 – positive positive – positive Family cluster infection, higher WBC count, and longer plasma prothrombin time (PT) are the early risk factors for RP in recovered COVID‐19 children Landi et al [115] Italy Case series 10 12 56·4 ± 15·7 22/131 14 d positive – – – Persistent sore throat (prevalence ratio=6·50, 95% CI 1·38, 30·6) and symptoms of rhinitis (prevalence ratio=3·72, 95% CI 1·10, 12·5) were risk factors for retesting positive for SARS-CoV-2 Zhou et al [121] China Case series 16 7 51·0(42–58) 23/368 14 d positive – – – Using multivariate Cox regression analysis, risk factors associated with RP included a higher ratio of lymphocyte/white blood cell on admission, lower peak temperature during hospitalization, and the presence of comorbidities, particularly hypertension or chronic respiratory system diseases. Antivirus treatment with arbidol was associated with a lower likelihood of RP Huang et al [114] China Case series 41 28 – 69/417 14 d positive – – …”

“…Nineteen studies ( n = 101) [ 16 , 18 , 22 – 25 , 32 , 35 , 36 , 49 – 51 , 59 , 73 , 76 , 97 , 104 , 107 , 115 ] showed that discharged patients had no symptoms when the nucleic acid test was positive. Among 55 studies, 1054 RP patients had symptoms, cough (19·82%) [ 20 , 26 , 29 – 31 , 34 , 38 , 42 , 44 , 49 , 52 , 60 , 62 , 63 , 66 , 67 , 69 , 71 , 74 , 78 , 81 , 83 – 85 , 88 , 89 , 91 , 94 , 95 , 98 , 101 , 103 , 106 , 108 , 110 , 119 , 121 , 125 , 127 , 130 ] and fever (14·99%) [ 20 , 28 , 29 , 41 , 44 , 46 , 49 , 52 , 67 ,…”

“…Based on the results of included studies [ 83 , 98 , 99 , 107 , 110 , 112 , 115 , 117 , 118 , 121 , 129 ], we found that patients classified with a severe first episode [112] , aged 60 years and above [98] , and co-morbidities were more likely to be RP after discharge [ 99 , 121 ], especially those having hypertension or chronic respiratory diseases [121] .…”

“…When compared with the patients without RP results, the RP patients had a higher level of fever [ 107 , 129 ], a higher proportion with symptoms like diarrhea [118] , sore throat, and rhinitis [115] , and a higher level of some laboratory indices such as serum IL-6 [83] , ALT, AST [110] , erythrocyte sedimentation rate, D -dimer [129] , lymphocyte ratio [121] than those at the first hospitalization. However, neutrophil counts were comparatively lower [107] .…”

Post-COVID-19 Syndrome and the Potential Benefits of Exercise

“…There are few prospective studies with assessments beyond 12 weeks [31,[35][36][37][38][39] fulfilling the NHS current criteria for post-COVID-19 syndrome. [40][41][42][43][44][45][46][47][48][49][50] or outpatients [51][52][53][54][55][56], evaluated between 4 and 12 weeks after diagnosis. The mean of the presentation of symptoms appears considering all the studies that contribute.…”