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For unknown reasons, about 1 in 6 people who recovered from COVID-19 then tested positive again at least 2 weeks later, researchers reported in a study in Italy.
Sore throat and rhinitis were the only symptoms associated with a positive result. “Patients who continued to have respiratory symptoms, in particular, were more likely to have a new positive test result,” said lead author Francesco Landi, MD, PhD. Medscape Medical News.
“This suggests that the persistence of respiratory symptoms should not be underestimated and should be properly assessed in all patients considered to have recovered from COVID-19,” he said.
“The results of the study are interesting,” said Akiko Iwasaki, PhD, an immunobiologist at Yale University and Howard Hughes Medical Institute. Medscape Medical News. “There are other reports of RNA detection after discharge, but this study … found that only two symptoms out of many – sore throat and rhinitis – were higher in people with PCR status. positive.”
The study was published online September 18 in the American Journal of Preventive Medicine.
The findings could have important implications for people who continue to be symptomatic. “It is reasonable to be cautious and avoid close contact with others, wear a face mask and possibly have an additional nasopharyngeal swab,” said Landi, associate professor of internal medicine at the Catholic University of the Sacred -Heart of Rome, Italy.
“One of the most interesting findings is that persistent symptoms do not correlate with PCR positivity, suggesting that in many cases, symptoms are not due to ongoing viral replication,” Jonathan Karn , PhD, professor and chair of the Department of Molecular Biology and Microbiology at Case The Western Reserve University School of Medicine in Cleveland, Ohio, said Medscape Medical News when asked to comment.
“The key technical problem, which they discussed, is that a viral RNA signal in the PCR test does not necessarily mean that the infectious virus is present,” Karn said. He added that further comprehensive viral RNA analyzes would be needed to answer this question.
Official COVID-19 recovery
To identify risk factors and COVID-19 survivors more likely to test positive again, Landi and members of the Gemelli Against COVID-19 Post-Acute Care study group assessed 131 people after discharge from the hospital. hospital.
All of the participants met the World Health Organization’s criteria for discharge from isolation, including two negative results at least 24 hours apart, and were studied between April 21 and May 21. Only a slightly higher mean BMI of 27.6 kg / m2 in the positive group, compared to 25.9 kg / m2 in the negative group, was significant.
Although 51% of survivors reported fatigue, 44% suffered from dyspnea, and 17% coughed, the rates did not differ significantly between groups. In contrast, 18% of positive survivors and 4% of negative survivors had a sore throat (P = .04), and 27% vs 12%, respectively, reported rhinitis (P = 0.05).
People returned for follow-up visits an average of 17 days after the second negative swab test.
Asymptomatic COVID-19 carriers?
“These results indicate that a remarkable rate of cured patients with COVID-19 could still be asymptomatic carriers of the virus,” the researchers note in the article. “Even in the absence of specific guidelines, the 22 patients who tested positive for COVID-19 again were suggested to quarantine a second time.”
No family member or close contact of positive survivors reported infection with SARS-CoV-2. All patients continued to wear masks and observe social distancing recommendations, making it “very difficult to say whether these patients were really contagious,” the researchers note.
next Not
Evaluating all COVID-19 survivors to identify those who test positive again “will be a crucial contribution to a better understanding of both the natural history of COVID-19 as well as the public health implications of the shedding viral, ”write the authors.
One of the limitations of the study is that the RT-PCR test reveals specific genetic sequences of COVID-19. “It is important to stress that this is not a viral culture and cannot determine whether the virus is viable and transmissible,” note the researchers.
“In this regard, we are trying to better understand whether the persistence of a positive long-term RT-PCR test for COVID-19 really correlates with potential contagiousness,” they add.
Landi and his colleagues said their results should be considered preliminary and that larger data samples are needed to validate the results.
Landi and Karn did not disclose any relevant financial relationship. Iwasaki disclosed a research grant from Condair, a 5% or more interest in RIGImmune, and income of $ 250 or more from PureTec.
Am J Prevent Med. Published online September 18, 2020. Full text
Damian McNamara is a journalist working in Miami. It covers a wide range of medical specialties, including infectious diseases, gastroenterology and rheumatology. Follow Damian on Twitter: @MedReporter.
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