The Issue of Recurrently Positive Patients Who Recovered From COVID-19 According to the Current Discharge Criteria: Investigation of Patients from Multiple Medical Institutions in Wuhan, China

Abstract

The current discharge criteria for COVID-19 require that patients have two consecutive negative results for RT-PCR detection. Here, we observed that recurrently positive RT-PCR test results in patients with three consecutive negative results (3xNegRPos, 5.4%) were significantly decreased compared with those in patients with two consecutive negative results (2xNegRPos, 20.6%); such patients reported positive RT-PCR test results within 1 to 12 days after meeting the discharge criteria. These results confirmed that many recovered patients could show a positive RT-PCR test result, and most of these patients could be identified by an additional RT-PCR test prior to discharge.

A systematic review on the recurrence of SARS-CoV-2 virus: frequency, risk factors, and possible explanations

“…Reviewing cohort studies, case series, and case reports led to finding a total number of 1128 patients with the recurrence of SARS-CoV-2; 957 in cohort studies [ 1 , 13–28 ], 142 in case series [ 3 , 17 , 29–45 ] and 29 in case report studies [ 46–74 ]. The recurrence rate, which has been defined as positive SARS-CoV-2 RNA detection by RT-PCR test in patients who were recovered (showed negative RT-PCR test), was reported between 2.3% and 21.4% in cohort studies [ 1 , 13–19 , 21–28 , 75 ]. As an exception, a cohort study on paediatrics reported that seven patients out of 14 (50%) experienced recurrence [ 20 ].…”

“…As an exception, a cohort study on paediatrics reported that seven patients out of 14 (50%) experienced recurrence [ 20 ]. Regardless of study type, based on 57 studies with available data (1019 patients), the first detection of recurrence of SARS-CoV-2 had been reported within a mean of 20 days, with a range of 1–140 days after meeting criteria for discharge [ 3 , 13 , 15–17 , 19–23 , 26–33 , 35–39 , 41–74 ].…”

“…Within the first admission, considering 1064 patients, the majority of re-positive cases ( n = 987; 92.7%) were asymptomatic or had mild to moderate symptoms [ 1 , 3 , 13 , 14 , 16 , 17 , 19 , 21–24 , 26–28 , 30–33 , 36–45 , 47 , 48 , 50–52 , 54 , 56 , 58 , 59 , 61 , 62 , 64–67 , 69–73 , 75 , 77 ], but some of them had severe or critical disease ( n = 77, 7.3%) [ 1 , 13 , 18 , 21 , 23 , 24 , 27 , 30 , 31 , 35 , 36 , 39 , 42 , 43 , 46 , 49 , 55 , 60 , 63 , 68 , 74 ]. To compare the severity of disease during the first and second courses of illness in re-positive patients, 57 studies including 858 re-positive patients, it was reported that the disease severity decreased or remained unchanged in 835 cases (97.3%) [ 13 , 15–20 , 23 , 24 , 26 , 28–31 , 33 , 36–48 , 50 , 52–54 , 58–61 , 65–68 , 70 , 71 , …”

Prolonged shedding of severe acute respiratory syndrome coronavirus 2 in patients with COVID-19

“…Typically, patients with COVID-19 recover from infection within two weeks, particularly those with mild cases 2,3 . However, several reports have shown the prolonged presence of viral nucleotides (nts) in the upper or lower respiratory tract, lung tissues, or intestinal tract (fecal matter) in recovered patients [4][5][6][7] . Likewise, an estimated range of 10-20% recurrent positivity for viral nt was also reported 7 .…”

“…However, several reports have shown the prolonged presence of viral nucleotides (nts) in the upper or lower respiratory tract, lung tissues, or intestinal tract (fecal matter) in recovered patients [4][5][6][7] . Likewise, an estimated range of 10-20% recurrent positivity for viral nt was also reported 7 . SARS-CoV-2 RNA was still detected in nasopharyngeal swabs approximately 51 days after the onset of symptoms in a clinically recovered patient 5 .…”