Persistent positivity and fluctuations of SARS-CoV-2 RNA in clinically-recovered COVID-19 patients

      As the COVID-19 pandemic slowly recedes, the number of clinically recovered subjects increases steadily. To minimize the risk of viral transmission in the community, several countries worldwide are currently endorsing a “test-based” strategy for hospital discharge and discontinuation of home-isolation, which requires 2 negative results of RT-PCR for SARS-CoV-2 RNA on nasopharyngeal swabs collected ≥24 h apart.
      ECDC
      European Centre for Disease Prevention and Control. Guidance for discharge and ending isolation in the context of widespread community transmission of COVID-19, 8 April 2020. Stockholm.
      Emerging evidences are indicating that RT-PCR positivity may persist for several weeks after the resolution of symptoms,
      • Peng J.
      • Wang M.
      • Zhang G.
      • Lu E
      Seven discharged patients turning positive again for SARS-CoV-2 on quantitative RT-PCR.
      • Fu W.
      • Chen Q.
      • Wang T
      Letter to the Editor: three cases of re-detectable positive SARS-CoV-2 RNA in recovered COVID-19 patients with antibodies.
      • Woodruff A
      COVID-19 follow up testing.
      • Liu W.D.
      • Chang S.Y.
      • Wang J.T.
      • Tsai M.J.
      • Hung C.C.
      • Hsu C.L.
      • et al.
      Prolonged virus shedding even after seroconversion in a patient with COVID-19.
      while the decline in viral infectivity occurs rather quickly (i.e. within one or two weeks since symptoms onset).
      • Liu W.D.
      • Chang S.Y.
      • Wang J.T.
      • Tsai M.J.
      • Hung C.C.
      • Hsu C.L.
      • et al.
      Prolonged virus shedding even after seroconversion in a patient with COVID-19.
      • Wolfel R.
      • Corman V.M.
      • Guggemos W.
      • Seilmaier M.
      • Zange S.
      • Muller M.A.
      • et al.
      Virological assessment of hospitalized patients with COVID-2019.
      • Bullard J.
      • Dust K.
      • Funk D.
      • Strong J.E.
      • Alexander D.
      • Garnett L.
      • et al.
      Predicting infectious SARS-CoV-2 from diagnostic samples.
      Whether the persistently-positive recovered patients might still shed infectious virus is thus uncertain, and this implies the risk for many of them to remain hospitalized, or in shelter-in-place, for a much longer time than necessary, with significant social distress and economic commitment.

      Keywords

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