Clinical characteristics of the recovered COVID-19 patients with re-detectable positive RNA test

Abstract

Background It has been reported that several cases recovered from COVID-19 tested positive for SARS-CoV-2 after discharge (re-detectable positive, RP), however the clinical characteristics, significance and potential cause of RP patients remained elusive.Methods A total of 262 COVID-19 patients were discharged from January 23 to February 25, 2020, and were enrolled for analysis of their clinical parameters. The RP and non-RP (NRP) patients were grouped according to the disease severity during their hospitalization period. The clinical characterization at re-admission to the hospital was analyzed. SARS-CoV-2 RNA and plasma antibody levels were detected using high-sensitive detection methods.Findings Up to March 10, 2020, all of patients were followed up for at least 14 days, and 38/262 of RP patients (14.5%) were present. The RP patients were characterized by being less than 14-years old and having mild and moderate conditions as compared to NRP patients, while no severe patients became RP.Retrospectively, the RP patients displayed fewer symptoms, more sustained remission of CT imaging and earlier RNA negative-conversion but similar plasma antibody levels during their hospitalization period as compared to those NRP patients. When re-admitted to the hospital, these RP patients showed no obvious clinical symptoms or disease progression indicated by normal or improving CT imaging and inflammatory cytokine levels. All 21 close contacts of RP patients were tested negative for SARS-CoV-2 RNA, and no suspicious clinical symptoms were reported. However, 18/24 of RNA-negative samples detected by the commercial kit were tested to be positive for virus RNA using a hyper-sensitive method, suggesting the carrier status of virus possibly existed in patients recovered from COVID-19.Interpretation Our results showed that young and mild COVID-19 patients seem to be RP patients after discharge, who show no obviously clinical symptoms and disease progression upon re-admission. More sensitive RNA

Probable causes and risk factors for positive SARS-CoV-2 test in recovered patients: Evidence from Brunei Darussalam

“…1 While there are reports of patients who have been discharged and subsequently report positive RT-PCR, no study has attempted to describe the magnitude and significance of this issue at the country level. 2,3,4,5 This phenomenon which we term 're-positive' could complicate the management of COVID-19 patients.…”

MINERVA: A facile strategy for SARS-CoV-2 whole genome deep sequencing of clinical samples

“…New variants will likely continue to emerge as the virus mutates, and to uncover them requires deep, complete coverage of viral genomes from a large number of patients. With the existence of asymptomatic carriers( 13 ) and possible recurrent infections in the same individual( 14 ), longitudinal re-sampling of patients is also important to uncover intra-host viral heterogeneity, but as viral load decreases with time( 15 ), the sensitivity of the sample processing method becomes critical. These studies all require processing large volumes of clinical samples with a highly robust and scalable method that does not compromise on sensitivity.…”

COVID‐19: Herd immunity and convalescent plasma transfer therapy

“…Some health officials also considered it to be the cases of re-activation of latent COVID-19 9 . In China, nearly 14 % patients checked for 14 days after resolution of all symptoms, showed the positive RNA test 10 . The possibility of a mutation and emergence of a new strain of a virus cannot be ruled out and it can make herd immunity ineffective 8 .…”