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

Abstract

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.

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.…”

Analysis of Risk Factors on Readmission Cases of COVID-19 in the Republic of Korea: Using Nationwide Health Claims Data

“…In addition, the finding is consistent with a report from New York City that revealed that 3.3% of 676 admitted patients aged 65 and over required re-hospitalization, confirming that the risk of readmission is higher in elderly patients than in other age groups [ 16 ]. In the elderly, the response of immune cells against the virus is reduced, so the virus can last longer in the body [ 17 ]. Therefore, there is a possibility that the patients were readmitted because the virus, which remained in the body [ 8 ], could have manifested again with symptoms or been redetected in RT-PCR [ 18 ].…”

“…Therefore, the high rate of readmission in the lopinavir/ritonavir group, as indicated above, suggests that the probability of readmission is higher in patients who are older and have underlying diseases. In addition, the high risk of readmission in the lopinavir/ritonavir treatment group, although not statistically significant, has been reported in other studies [ 17 , 31 ], so it is necessary to discuss whether lopinavir/ritonavir is effective in COVID-19 treatment [ 32 ].…”

ACE2, TMPRSS2 distribution and extrapulmonary organ injury in patients with COVID-19

“…In a cohort form Guangdong, China, 14.5 % (38/262) of convalescent patients from COVID-19 were re-detected to be positive for SARS-CoV-2 during their followed-up period [ 139 ]. Similarly, the data from Brunei Darussalam showed that 19.8 % (21/106) recovered patients were found to be re-positive for SARS-CoV-2 detection [ 140 ]. The re-detectable positive patients were confirmed by RT-PCR tests on anal or nasopharyngeal swabs.…”