Clinical, Immunological and Virological Characterization of COVID-19 Patients that Test Re-Positive for SARS-CoV-2 by RT-PCR (preprint)

ABSTRACT

Background: COVID-19 pandemic is underway. Some COVID-19 cases re-tested positive for SARS-CoV-2 RNA after discharge raising the public concern on their infectivity. Characterization of re-positive cases are urgently needed for designing intervention strategies. Methods: Clinical data were obtained through Guangdong COVID-19 surveillance network. Neutralization antibody titre was determined using a microneutralization assay. Potential infectivity of clinical samples was evaluated after the cell inoculation. SARS-CoV-2 RNA was detected using three different RT-PCR kits and multiplex PCR with nanopore sequencing. Findings: Among 619 discharged COVID-19 cases, 87 were re-tested as SARS-CoV-2 positive in circumstance of social isolation. All re-positive cases had mild or moderate symptoms in initial diagnosis and a younger age distribution (mean, 30·4). Re-positive cases (n=59) exhibited similar neutralization antibodies (NAbs) titre distributions to other COVID-19 cases (n=150) parallel-tested in this study. No infective viral strain could be obtained by culture and none full-length viral genomes could be sequenced for all re-positive cases. Interpretation: Re-positive SARS-CoV-2 was not caused by the secondary infection and was identified in around 14% of discharged cases. A robust Nabs response and a potential virus genome degradation were detected from nearly all re-positive cases suggesting a lower transmission risk, especially through a respiratory route. Funding: This work was supported by grants from Guangdong Provincial Novel Coronavirus Scientific and Technological Project (2020111107001), Science and Technology Planning Project of Guangdong(2018B020207006), National Science and Technology Project(2020YFC0846800).Declaration of Interests All authors No reported conflicts of interest.Ethics Approval Statement This study was reviewed and approved by the Medical Ethical Committee of Guangdong Provincial Center for Disease Control and Prevention. Data collection and analysis of cases were determined by the Health Commission of Guangdong province to be part of a continuing public health outbreak investigation during the emergency response and were thus considered exempt from institutional review board approval.