Persistent SARS-COV-2 RNA positivity in a patient for 92 days after disease onset

Abstract

Rationale: Recently, patients with COVID-19 who showed persistently positive SARS-CoV-2 nucleic acid test results despite resolved clinical symptoms have attracted a lot of attention. We report the case of a patient with mild symptoms of coronavirus disease (COVID-19), who achieved clinical recovery but showed persistently positive SARS-CoV-2 nucleic acid test results until Day 92 after disease onset. Patient concerns: The patient is a 50-year-old man with mild symptoms of coronavirus disease (COVID-19). Diagnoses: COVID-19 pneumonia. Interventions: The patient was quarantined for 105 days. Of these, inpatient quarantine lasted for 75 days. When the nucleic acid test results were negative for 3 consecutive days, the patient was discharged at Day 75 after disease onset. During this period, multiple samples were collected from the patient's body surface, the surrounding environment, and physical surfaces, but none of these tested positive for SARS-CoV-2. These samples included those from anal swabs, hands, inner surface of mask, cell phone, bed rails, floor around the bed, and toilet bowl surface. However, nucleic acid retest results on Day 80 and Day 92 after disease onset were positive for SARS-CoV-2 nucleic acids. Outcomes: The patient continued with quarantine and observation at home. After the test results on Days 101 and 105 after disease onset were negative, quarantine was terminated at last. Lessons: Per our knowledge, this is the longest known time that a patient has tested positive for SARS-CoV-2 nucleic acids. No symptoms were observed during follow-up. During hospitalization, the SARS-CoV-2 nucleic acid positivity was not observed in samples from the body surface and surrounding environment, and no verified transmission event occurred during the quarantine at home. After undergoing clinical recovery a minority of patients with COVID-19 have shown long-term positive results for the presence of the SARS-CoV-2 nucleic acid. This has provided new understanding and research directions for coronavirus infection. Long-term follow-up and quarantine measures have been employed for such patients. Further studies are required to analyze potential infectivity in such patients and determine whether more effective antiviral drugs or regimens to enable these patients to completely clear viral infection should be researched.

Understanding the outcomes of COVID-19 – does the current model of an acute respiratory infection really fit?

“…While an acute, resolving pattern of infection is frequently observed, an analysis of cohort studies and case reports investigating durations of shedding of SARS-CoV-2 from the respiratory tract casts severe doubt on the broader applicability of this model. Published reviews report mean durations of SARS-CoV-2 shedding for acute infection of 17–18 days () [1, 2], and 20 days in severe cases [2], with numerous individual case reports of immunocompetent subjects remaining PCR-positive for longer than 50 days, and in some cases shedding virus for up to 104 days [3–6]. These durations of shedding are systematically and substantially longer than the mean shedding durations of 9.5 and 5.7 days determined by PCR-based follow-up of immunocompetent adults and children infected with RSV [1, 7–10] and IAV [1, 11–14], respectively.…”

SARS‐CoV‐2 re‐infection versus prolonged shedding: A case series

“…4,5 However, detailed SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction (RT-PCR) kinetics data appear to describe a cessation of viral RNA shedding after 70 days in the majority of individuals (though exceptions have been described). [6][7][8] In this brief report, we describe the clinical characteristics and laboratory results of individuals with multiple positive SARS-CoV-2 RT-PCR results that extend beyond 70 days.…”

Persistence of COVID-19 Symptoms after Recovery in Mexican Population

“…For which it is necessary to known the short, medium and long-term scope of the possible physical and psychological consequences post-COVID, including in these questions, if the times set for social isolation are sufficient [ 16 , 54 ], also about the possible complications, when patients are discharged, that possibly require specific rehabilitative care. It is also in the interest of public health to design strategies that make it possible to face both the problems of the active pandemic and, at the same time, treat recovered cases, but which present complications, to prevent them from becoming chronic and avoid repercussions on the quality of life.…”