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For unknown reasons, about 1 in 6 people who recovered from COVID-19 subsequently 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, especially, 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 who are considered recovered from COVID-19,” he said.
“The results of the study are interesting,” said Akiko Iwasaki, PhD, an immunobiologist at Yale University and the 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 those with PCR positive status.”
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 have symptoms. “It is reasonable to be cautious and avoid close contact with others, wear a mask and possibly undergo an additional nasopharyngeal swab,” said Landi, associate professor of internal medicine at the Catholic University of the Sacred Heart in Rome, Italy.
“One of the most interesting findings is that persistent symptoms do not correlate with PCR positivity, suggesting that symptoms in many cases are not due to ongoing viral replication,” said Jonathan Karn, PhD, professor and Chairman of the Department of Molecular Biology and Microbiology at Case Western Reserve University School of Medicine in Cleveland, Ohio, said Medscape Medical News when asked to comment.
“The key technical problem, which they have discussed, is that a viral RNA signal in the PCR assay does not necessarily mean that infectious virus is present,” Karn said. He added that new full viral RNA analyzes would be needed to answer this question.
Official COVID-19 Recovery
To identify the risk factors and COVID-19 survivors most likely to test positive again, Landi and members of the Gemelli Against COVID-19 Post-Acute Care Study Study Group evaluated 131 people after discharge from hospital.
All participants met the World Health Organization criteria for release from isolation, including two negative test results at least 24 hours apart, and were studied between April 21 and May 21. The average age was 56 and 39% were women. 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 the survivors reported fatigue, 44% had dyspnea, and 17% were coughing, the rates did not differ significantly between the groups. In contrast, 18% of the positive survivors and 4% of the negative survivors had a sore throat (P = .04), and 27% vs 12%, respectively, reported rhinitis (P = .05).
People returned for follow-up visits a mean of 17 days after the second negative swab test.
Asymptomatic carriers of COVID-19?
“These findings indicate that a remarkable rate of recovered COVID-19 patients may 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 self-quarantine for the second time.”
No family member or close contact of the positive survivors reported SARS-CoV-2 infection. All of the patients continued to wear masks and follow social distancing recommendations, making it “very difficult to say whether these patients were really contagious,” the researchers note.
next Steps
Assessing 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 and the public health implications of viral shedding,” the authors write.
One limitation of the study is that the RT-PCR test reveals specific COVID-19 genetic sequences. “It is important to emphasize that this is not a viral culture and cannot determine if the virus is viable and transmissible,” the researchers note.
“In this sense, we are trying to better understand whether the persistence of the positive RT-PCR test for a long time for COVID-19 is really correlated with a potential contagion,” they add.
Landi and his colleagues said their findings should be considered preliminary and that larger data samples are required to validate the results.
Landi and Karn have disclosed no relevant financial relationships. Iwasaki disclosed a research grant from Condair, an equity interest of 5% or more 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 Miami-based staff journalist. Covers a wide range of medical specialties, including infectious diseases, gastroenterology, and rheumatology. Follow Damian on Twitter: @MedReporter.
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