Case reports of patients with coronavirus disease-2019 (COVID-19) who have been discharged and subsequently report positive reverse transcriptionpolymerase chain reaction again (hereafter referred as "re-positive") do not fully describe the magnitude and significance of this issue. To determine the repositive rate (proportion) and review probable causes and outcomes, we conduct a retrospective study of all 119 discharged patients in Brunei Darussalam up till April 23. Patients who were discharged are required to self-isolate at home for 14 days and undergo nasopharyngeal specimen collection postdischarge. Discharged patients found to be re-positive were readmitted. We

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We read with interest the article by Morrison et al. on acute hypertriglyceridemia secondary to tocilizumab in patients with severe coronavirus disease . 1 One patient also had pancreatitis, a dreaded complication of hypertriglyceridemia.Both patients were already on lopinavir/ritonavir before tocilizumab (added day 9 and 13) was added. Propofol was briefly used.We recently had two out of 47 patients with moderate/severe COVID-19 who were treated with lopinavir/ritonavir and developed significant hypertriglyceridemia resulting in lipemic serum. The first patient (51-year-old man) with undiagnosed stage II chronic kidney disease (estimated glomerular filtration rate 61.12 mL/min) and no history of lipid disorder or diabetes mellitus was started on lopinavir/ritonavir (400 and 100 mg twice daily for 14 days) on the 10th day of admission. Blood serum became lipemic on the 10th day of treatment (Figure 1). Serum triglyceride levels ranged between 921.2 and 1071.7 mg/dL (normal range <150 mg/dL). His serum amylase was normal. He was started on bezafibrate and the lipemic serum settled. The second patient (45-year-old man) with hypertension, dyslipidemia and uncontrolled diabetes mellitus was started lopinavir/ritonavir monotherapy on the 4th day of admission. His blood was reported to be lipemic on the 11th day of treatment despite being on atorvastatin. Fortunately he completed treatment without any complications. Follow-up showed no recurrence of lipemic serum in both patients. The second patient had risk factors for hypertriglyceridemia.Lopinavir/ritonavir is known to be associated with lipid abnormality, 2,3 more so than tocilizumab. One study showed that at 12 weeks of treatment of lopinavir/ritonavir in patients with human immunodefieciency virus, small but significant increase from baseline in the fasting total cholesterol and triglyceride was observed. 2 Our patients developed lipemic serum within 2 weeks of treatment. In Morrison's cases, it is possible that the lopinavir/ ritonavir had contributed to or even caused the hypertriglyceridemia. Therefore it is important for clinicians to be aware and monitor for complications given that the COVID-19 pandemic will continue and these two medications continue to be used until better treatment options become available.

We report findings of a national study in Brunei Darussalam indicating that one in five recovered patients subsequently test positive again for SARS-CoV-2-this risk is nearly three times higher in older patients (age 53 and above) than younger ones (below age 53). Review of clinical and epidemiological records do not support reinfection or reactivation as likely causes of the 're-positive' observation. Instead, prolonged but intermittent viral shedding is the most probable explanation. We discuss the implications of these findings for infection control and clinical practice.

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