Recurrence of SARS-CoV-2 viral RNA in recovered COVID-19 patients: a narrative review
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REVIEW
Recurrence of SARS-CoV-2 viral RNA in recovered COVID-19 patients: a narrative review Thi Loi Dao 1,2,3 & Van Thuan Hoang 1,2,3 & Philippe Gautret 1,2 Received: 10 September 2020 / Accepted: 23 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Many studies have shown that re-positive tests for SARS-CoV-2 by RT-PCR in recovered COVID-19 patients are very common. We aim to conduct this review to summarize the clinical and epidemiological characteristics of these patients and discuss the potential explanations for recurrences, the contagiousness of re-detectable positive SARS-CoV-2 virus, and the management of COVID-19 patients after discharge from hospital. The proportion of re-positive tests in discharged COVID-19 patients varied from 2.4 to 69.2% and persisted from 1 to 38 days after discharge, depending on population size, age of patients, and type of specimens. Currently, several causes of re-positive tests for SARS-CoV-2 in recovered COVID-19 patients are suggested, including false-negative, false-positive RT-PCR tests; reactivation; and re-infection with SARS-CoV-2, but the mechanism leading to these re-positive cases is still unclear. The prevention of re-positive testing in discharged patients is a fundamental measure to control the spread of the pandemic. In order to reduce the percentage of false-negative tests prior to discharge, we recommend performing more than two tests, according to the standard sampling and microbiological assay protocol. In addition, specimens should be collected from multiple body parts if possible, to identify SARS-CoV-2 viral RNA before discharge. Further studies should be conducted to develop novel assays that target a crucial region of the RNA genome in order to improve its sensitivity and specificity. Keywords COVID-19 . SARS-CoV-2 . Recurrence . Discharge . Recovery . PCR . False-negative . False-positive
Introduction At the end of December 2019, an epidemic of acute respiratory infections broke out in Wuhan, China. It is caused by a new coronavirus, later named SARS-CoV-2. The disease is highly contagious, with the ability to spread directly through interhuman transmission by the airways, and the epidemic quickly spread globally [1]. The World Health Organization (WHO) declared it a Public Health Emergency of International Concern on 30 January 2020, and then a Global Pandemic on 11 March 2020, less than 3 months after * Philippe Gautret [email protected] 1
IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
2
IHU-Méditerranée Infection, Marseille, France
3
Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
its appearance. At the time of writing, the COVID-19 pandemic has affected 213 countries and territories worldwide and has caused 848,929 deaths out of a total of 25,318,363 people infected [2]. The pandemic is becoming more complex, and it is increasingly difficult to control
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