Recurrent-positive patients pose a low transmission risk, a relatively relaxed management of recovered COVID-19 patients is recommended.Ĭoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally to over 213 countries. Our findings suggested that an intermittent, non-stable excretion of low-level viral RNA may result in recurrent-positive occurrence, rather than re-infection. After full recovery (no longer/never recurrent-positive), 60% (98/162) patients had neutralizing antibody titers of ≥1:32. 96 close contacts and 1,200 candidate contacts of 23 recurrent-positive patients showed no clinical symptoms their viral RNA (1,296/1,296) and antibody (20/20) tests were negative. Whole genome sequencing of six specimens yielded only genomic fragments. Virus isolation of nine representative specimens returned negative results. There are generally no significant differences in antibody levels between recurrent-positive and non-recurrent-positive patients, or in recurrent-positive patients over time (before, during, or after recurrent-positive detection). The viral RNA level in recurrent-positive patients ranged from 1.8 to 5.7 log10 copies/mL (median: 3.2), which was significantly lower than the corresponding values at disease onset. After readmission, recurrent-positive patients exhibited mild (28%) or absent (72%) symptoms, with no disease progression. Of 479 recovered COVID-19 patients, 93 (19%) recurrent-positive patients were identified, characterized by younger age, with a median discharge-to-recurrent-positive length of 8 days. We performed a population-based observational study to characterize the viral RNA level and serum antibody responses in recurrent-positive patients and evaluate their viral transmission risk. Managing recovered COVID-19 patients with recurrent-positive SARS-CoV-2 RNA test results is challenging.
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