Recurrent SARS-CoV-2 RNA positivity after COVID-19: A systematic review and meta analysis

ABSTRACT

BackgroundPrevious studies reported recurrent SARS-CoV-2 RNA positivity in individuals who had recovered from COVID-19 infections. However, little is known regarding the systematic review of recurrent SARS-CoV-2 RNA positivity. The current study conducted a systematic review and meta-analysis, aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity. MethodsWe searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was assessed using I2. ResultsFourteen studies of 2,568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.81% (95% confidence interval [CI] 11.44-18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.44 days (95% CI 32.65-38.24 days), and from the last negative to recurrent positive result was 9.76 days (95% CI 7.31-12.22 days). Patients with younger age (mean difference [MD]=-2.27, 95% CI -2.95 to -1.80) and a longer initial illness (MD=8.24 days; 95% CI 7.54 - 8.95; I2=98.9%) were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes (RR=0.52; 95% CI 0.30-0.90; I2=53%), severe disease (RR=0.54; 95% CI 0.35-0.84; I2=70%), and a low lymphocyte count (RR=0.58; 95% CI 0.39 - 0.86; I2=48%) were less likely to experience recurrent SARS-CoV-2 positivity. ConclusionsThe incidence of recurrent SARS-CoV-2 positivity was 14.81%. The estimated interval from disease onset to repeat positivity was 35.44 days, and the estimated interval from the last negative result to recurrent positive result duration was 9.76 days.