Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review

Abstract

As the pandemic continues, individuals with re-detectable positive (RP) SARS-CoV-2 viral RNA among recovered COVID-19 patients have raised public health concerns. It is imperative to investigate whether the cases with re-detectable positive (RP) SARS-CoV-2 might cause severe infection to the vulnerable population. In this work, we conducted a systematic review of recent literature to investigate reactivation and reinfection among the discharged COVID-19 patients that are found positive again. Our study, consisting more than a total of 113,715 patients, indicates that the RP-SARS-CoV-2 scenario occurs plausibly due to reactivation, reinfection, viral shedding, or testing errors. Nonetheless, we observe that previously infected individuals have significantly lower risk of being infected for the second time, indicating that reactivation or reinfection of SARS-CoV-2 likely have relatively less impact in the general population than the primary infection.

Systematic Genomic and Clinical Analysis of Severe Acute Respiratory Syndrome Coronavirus 2 Reinfections and Recurrences Involving the Same Strain

“…Not all re-positive cases >3 months after first infection should be assumed to correspond to reinfection. In our study, of the 4 recurrences identified that involved the same strain, 2 also occurred within this period, whereas the remaining 2 occurred 55 and 77 days after the first episode, beyond the threshold proposed as highly suggestive of nonreinfections ( 25 , 30 ).…”

“…Other studies have tried to go beyond the reporting of single cases by offering data on the frequency of SARS-CoV-2 reinfections in different countries; results range from 0.14 to 2.11% ( 19 – 24 ). However, in all these studies, the assignment of reinfections was supported only by sequential positive RT-PCR results, which means that, strictly speaking, these re-positive SARS-CoV-2 infections were considered suspected reinfections ( 22 ) without determining whether they were recurrences involving the same strain, reinfections, persistent cases, or testing errors ( 25 ). Assigning re-positive cases to 1 of the above categories is only possible when whole sequencing data are also included in the analysis.…”

“…A systematic review ( 25 ) concluded that reinfections were more likely to correspond to re-positive cases with a second positive RT-PCR >3 months after the first episode. Our reinfection data are consistent with this observation, because the time between episodes ranged from 116 to 346 days.…”

The Heterogeneous Severity of COVID-19 in African Countries: A Modeling Approach

“…We also observed that most of the top 12 African countries with the most COVID-19 deaths reported their first COVID-19 case(s) between February and March 2020 (see Supplementary Table S1), which indicates that most of the stringency index policies are similar in most countries in Africa. Future work plans to extend the current study by incorporating possible reinfection or vertical transmission in the model to explore its impact on the overall transmission dynamics in African countries (Tang et al 2021 ; Musa et al 2021c ).…”

Epidemiological Assessment of Sars-Cov-2 Reinfection

“…The rate of reinfections has been persistently low throughout the literature. A systemic review on reinfection involving 113,715 patients highlighted that most reports quote a low reinfection rate of 1% amongst populations 20 . These ndings suggest that the risk of reinfection to the public health is low.…”