Recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients during medical isolation observation

Abstract

Recently, the recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients is receiving more attention. Herein we report a cohort study on the follow-up of 182 recovered patients under medical isolation observation. Twenty (10.99%) patients out of the 182 were detected to be SARS-CoV-2 RNA positive (re-positives), although none showed any clinical symptomatic recurrence, indicating that COVID-19 responds well to treatment. Patients aged under 18 years had higher re-positive rates than average, and none of the severely ill patients re-tested positive. There were no significant differences in sex between re-positives and non-re-positives. Notably, most of the re-positives turned negative in the following tests, and all of them carried antibodies against SARS-CoV-2. This indicates that they might not be infectious, although it is still important to perform regular SARS-CoV-2 RNA testing and follow-up for assessment of infectivity. The findings of this study provide information for improving the management of recovered patients, and for differentiating the follow-up of recovered patients with different risk levels. The current pneumonia epidemic (COVID-19), caused by the SARS-CoV-2 coronavirus has spread to more than 200 countries. There have been more than 8 million confirmed cases and up to 440,000 deaths (as of June 18, 2020) 1 , raising a high level of concern all over the world. Previous studies have mainly focused on the clinical and epidemiological characteristics of patients infected with SARS-CoV-2 2-4. With the increase in the number of recovered patients, follow-up and detection are particularly important. Previous studies have found that patients who have recovered from COVID-19 are still testing positive for SARS-CoV-2 5-7. A single center study reported that 7.41% of COVID-19 patients re-tested positive for SARS-CoV-2 RNA by real-time reverse transcriptase polymerase chain reaction (RT-PCR) test after discharge 8 , and this finding has challenged the current hospital discharge criteria for containing the pandemic. The present study analyzed the SARS-CoV-2 viral RNA test results in all 182 recovered COVID-19 patients in Shenzhen before April 21st during a 14-day medical isolation observation period, to provide more reference for containing the pandemic more effectively. Results Patients under 18 years old, and mild and moderately patients have a higher risk of re-testing positive. Among all the recovered and isolated patients, 182 of them satisfied the inclusion criteria of this study. They were all re-tested at least once. Eighty-four (46.2%) were males and 98 (53.8%) were females, and the average age was 46.4 ± 17.1 years (median 49 years, range 1-81 years). Thirty-nine (21.4%) had severe symptoms, and 143 (78.6%) had mild and moderate symptoms (Table 1). A few of them showed different symptoms (mild flu, allergic rhinitis, smoking-induced sore throat) during medical isolation, although COVID-19 symptoms did not recur. Twenty patients out of the 182 re-tested positive (13 females, seven m...

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