Recurrence of SARS-CoV-2 PCR positivity in COVID-19 patients: a single center experience and potential implications

Abstract

IMPORTANCE How to appropriately care for patients who become PCR-negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still not known.Patients who have recovered from coronavirus disease 2019 (COVID-19) could profoundly impact the health care system if a subset were to be PCR-positive again with reactivated SARS-CoV-2.OBJECTIVE To characterize a single center COVID-19 cohort with and without recurrence of PCR positivity, and develop an algorithm to identify patients at high risk of retest positivity after discharge to inform health care policy and case management decision-making. DESIGN, SETTING, AND PARTICIPANTSA cohort of 414 patients with confirmed SARS-CoV-2 infection, at The Second Affiliated EXPOSURES Polymerase chain reaction (PCR) and IgM-IgG antibody confirmed SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES Univariable and multivariable statistical analysis of the clinical, laboratory, radiologic image, medical treatment, and clinical course of admission/quarantine/readmission data to develop an algorithm to predict patients at risk of recurrence of PCR positivity.RESULTS 16.7% (95CI: 13.0%-20.3%) patients retest PCR positive 1 to 3 times after discharge, despite being in strict quarantine. The driving factors in the recurrence prediction model included: age, BMI; lowest levels of the blood laboratory tests

A compromised specific humoral immune response against the SARS-CoV-2 receptor-binding domain is related to viral persistence and periodic shedding in the gastrointestinal tract

“…Active SARS-CoV-2 viral replication in the gastrointestinal tract Since strict home quarantine measures precluded the possibility of a new infection, the virus detected in the positive retest was epidemiologically postulated to have been derived from the initial virus infection. 6,[8][9][10][11] However, experimental evidence directly supporting that conclusion has been lacking. We sequenced the viruses obtained from 42 throat and anal samples from 16 patients.…”

“…This causes public health concerns, such as the origin of the virus in such patients, whether the virus is transmissible, and which patients will have positive retest results. Positive detection of SARS-CoV-2 in discharged patients during follow-up is usually regarded as a recurrence of the original virus after the epidemiological exclusion of a new infection 6,[8][9][10][11] based on the fact that the discharged patients underwent a 14-day home quarantine according to the Chinese government treatment guidelines. However, this postulation has seldom been experimentally supported.…”

Pre-existing conditions are associated with COVID patients’ hospitalization, despite confirmed clearance of SARS-CoV-2 virus

“…Data on the long-term outcomes among cleared SARS-CoV-2 patients has been thus far limited and often poorly defined. Some patients labeled as cleared have been shown to have a new positive test after documented negative tests, a positive test after a period of quarantine, or develop new symptoms requiring hospitalization after documented negative tests [2][3][4][5][6] . The former case is most narrowly suggestive of delayed viral shedding, false positives, or re-infection while the latter case allows for a more broader interpretation of possible outcomes after clearance to also include delayed complications of the index hospitalization and manifestations of a systemic inflammatory response 7 .…”

“…A recent case series 8 reported four patients with apparent SARS-CoV-2 reinfection after an index hospitalization, despite resolution of symptoms and radiographic abnormalities and two consecutive negative tests separated by a day. A single center cohort study of 414 patients with SARS-CoV-2 reported a reinfection rate of 16.7% among cleared patients 5 , while a second cohort study of 262 patients with SARS-CoV-2 reported a reinfection rate of 14.5% among cleared patients 4 . To date, details on the outcomes of patients who require hospitalization after documented clearance of SARS-CoV-2, however, remain unknown.…”

Heparin-binding Peptides as Novel Therapies to Stop SARS-CoV-2 Cellular Entry and Infection

“…The emerging COVID-19 pandemic caused an unexpected and large number of infections leading to significant mortality globally. Due to mandatory quarantine strategy, the rate of viral transmission has been slowed down, but there is still an urgent need to find a therapeutic agent to treat or prevent the transmission of the virus, especially in the light of possible reinfection after recovery (ALIZARGAR, 2020;ZHENG;HAO et al, 2020). SAMULSKI, 2012).…”