Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis

Armstrong, Jillian N.; Campbell, Lauren; Rabatsky-her, Terry; Leung, Vivian; Parikh, Sunil

doi:10.1016/j.lana.2021.100054

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…Of the 3282 papers initially retrieved, we included 91 cohort studies evaluating the onset of reinfection, severe and very severe/lethal COVID‐19 among 15,034,624 previously infected subjects (Figure 1), either among health care workers (27 publications; n = 37,598 2,8,9,15,17,24,36,38,42–59 ) or in the general population (67 publications; n = 14,997,026 3–7,10,12,16–23,25–27,43,49,60–106 ).…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Table S1, most of the included studies ( n = 43) were carried out in Europe, 2,4–10,12,15,17,18,21,24,26,36,38,44,46–51,58,66,69,71,72,75,81,85–88,91–93,95,99,102 24 in the USA, 20,22,23,25,42,43,57,59,63,67,77,79,82–84,89,90,97,98,103,105–107 18 in Asia 3,16,19,27,45,52–54,56,60,62,64,65,70,73,74,100,101 and the remaining six in South America or South Africa 61,68,80,94,96,104 . The mean age of the participants ranged from 15 to 87 years, and the average follow‐up ranged from 29 to 371 days.…”

Section: Resultsmentioning

confidence: 99%

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Risk of reinfection and disease after SARS‐CoV‐2 primary infection: Meta‐analysis

Flacco

Martellucci

Baccolini³

et al. 2022

Eur J Clin Investigation

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Introduction A precise estimate of the frequency and severity of SARS‐CoV‐2 reinfections would be critical to optimize restriction and vaccination policies for the hundreds of millions previously infected subjects. We performed a meta‐analysis to evaluate the risk of reinfection and COVID‐19 following primary infection. Methods We searched MedLine, Scopus and preprint repositories for cohort studies evaluating the onset of new infections among baseline SARS‐CoV‐2‐positive subjects. Random‐effect meta‐analyses of proportions were stratified by gender, exposure risk, vaccination status, viral strain, time between episodes, and reinfection definition. Results Ninety‐one studies, enrolling 15,034,624 subjects, were included. Overall, 158,478 reinfections were recorded, corresponding to a pooled rate of 0.97% (95% CI: 0.71%–1.27%), with no substantial differences by definition criteria, exposure risk or gender. Reinfection rates were still 0.66% after ≥12 months from first infection, and the risk was substantially lower among vaccinated subjects (0.32% vs. 0.74% for unvaccinated individuals). During the first 3 months of Omicron wave, the reinfection rates reached 3.31%. Overall rates of severe/lethal COVID‐19 were very low (2–7 per 10,000 subjects according to definition criteria) and were not affected by strain predominance. Conclusions A strong natural immunity follows the primary infection and may last for more than one year, suggesting that the risk and health care needs of recovered subjects might be limited. Although the reinfection rates considerably increased during the Omicron wave, the risk of a secondary severe or lethal disease remained very low. The risk–benefit profile of multiple vaccine doses for this subset of population needs to be carefully evaluated.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk of reinfection and disease after SARS‐CoV‐2 primary infection: Meta‐analysis

Flacco

Martellucci

Baccolini³

et al. 2022

Eur J Clin Investigation

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“…Sample collection (20th October to 8 Th December 2020) was undertaken as a service evaluation to see if samples could be processed from the respiratory tract and virus measured as an alternative to qRT-PCR. Subsequently, ethical approval was given via the COVID- 19…”

Section: Ethics Statementmentioning

confidence: 99%

Mechanically ventilated patients shed high titre live SARS-CoV2 for extended periods from both the upper and lower respiratory tract

Saud

Ponsford

Bentley

et al. 2021

Preprint

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Background SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection control measures both within healthcare settings and the public domain. Methods We examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit of the University Hospital of Wales. Samples were taken from the oral cavity (saliva), oropharynx (sub-glottic aspirate), or lower respiratory tract (non-directed bronchoalveolar lavage (NBL) or bronchoalveolar lavage (BAL)) and analyzed by both qPCR and plaque assay. Results 117 samples were obtained from 25 patients. qPCR showed extremely high rates of positivity across all sample types, however live virus was far more common in saliva (68%) than in BAL/NBAL (32%). Average titres of live virus were higher in subglottic aspirates (4.5x10^7) than in saliva (2.2x10^6) or BAL/NBAL (8.5x10^6), and reached >10^8 PFU/ml in some samples. The longest duration of shedding was 98 days, while the majority of patients (14/25) shed live virus for 20 days or longer. Conclusions Intensive care unit patients infected with SARS-CoV-2 can shed high titres of virus both in the upper and lower respiratory tract, and tend to be prolonged shedders. This information is important for decision making around cohorting patients, de-escalation of PPE, and undertaking potential aerosol generating procedures.

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“…Although most patients clear infectious virus within nine days, and viral RNA ceases to be detectable between 14 and 17 days [50,51], emerging evidence suggests that subsets of patients could have persistent infection. Extended duration of viral RNA detectable in the respiratory tract and feces of several months has been described [50,[52][53][54], as have intermittent polymerase chain reaction (PCR) negative and positive tests, including in patients with PASC [55][56][57]. However, without sequential viral sequencing, it is unclear if this represents the CNS has been reported, including in neurons, which can also contribute to neurodegeneration.…”

Section: Persistent Virusmentioning

confidence: 99%

The pathogenesis of neurologic symptoms of the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection

Johnson

2022

Current Opinion in Neurology

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Purpose of reviewThe coronavirus disease 2019 (COVID) pandemic has resulted in significant mortality and morbidity globally. Patients who survive infection may develop continuing disease collectively known as the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC), which includes neurologic symptoms especially fatigue and cognitive impairment. The pathogenic mechanisms driving PASC are unknown although a postinfectious process, persistent infection, or lasting pathophysiological changes that occur during acute infection are all suspected to contribute.Recent findingsHere we review the current evidence underlying potential pathogenic mechanisms of the neurological complications of PASC with particular emphasis on the evidence for postinfectious immune processes and viral persistence.SummaryImmune dysregulation favoring persistent inflammation, including neuroinflammation and enhanced autoimmunity, are present in patients with COVID and likely contribute to the development of PASC. Limited evidence of viral persistence exists but may explain the ongoing inflammatory processes and affinity maturation observed in some patients recovering from COVID infections. No specific studies to date have tied persistent infection to PASC. CNS trauma, in particular hypoxic changes in the CNS, and psychiatric complications occur with greater frequency in patients with COVID and may contribute to the development of PASC. Future research is needed to fully understand the pathophysiological mechanisms driving PASC.

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Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis

Cited by 9 publications

References 28 publications

Risk of reinfection and disease after SARS‐CoV‐2 primary infection: Meta‐analysis

Risk of reinfection and disease after SARS‐CoV‐2 primary infection: Meta‐analysis

Mechanically ventilated patients shed high titre live SARS-CoV2 for extended periods from both the upper and lower respiratory tract

The pathogenesis of neurologic symptoms of the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection

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