Probable causes and risk factors for positive SARS‐CoV‐2 test in recovered patients: Evidence from Brunei Darussalam

  1. Justin Wong
  2. Wee Chian Koh
  3. Riamiza Natalie Momin
  4. Mohammad Fathi Alikhan
  5. Noraskhin Fadillah
  6. Lin Naing

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Abstract

Case reports of patients with coronavirus disease‐2019 (COVID‐19) who have been discharged and subsequently report positive reverse transcription‐polymerase chain reaction again (hereafter referred as “re‐positive”) do not fully describe the magnitude and significance of this issue. To determine the re‐positive rate (proportion) and review probable causes and outcomes, we conduct a retrospective study of all 119 discharged patients in Brunei Darussalam up till April 23. Patients who were discharged are required to self‐isolate at home for 14 days and undergo nasopharyngeal specimen collection postdischarge. Discharged patients found to be re‐positive were readmitted. We reviewed the clinical and epidemiological records of all discharged patients and apply log‐binomial models to obtain risk ratios for re‐positive status. One in five recovered patients subsequently test positive again for severe acute respiratory syndrome coronavirus 2—this risk is more than six times higher in persons aged 60 years and above. The average Ct value of re‐positive patients was lower predischarge compared with their readmission Ct value. Out of 111 close contacts tested, none were found to be positive as a result of exposure to a re‐positive patient. Our findings support prolonged but intermittent viral shedding as the probable cause for this phenomenon. We did not observe infectivity potential in these patients.

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  1. Version published to 10.1002/jmv.26199
  2. ScreenIT

    SciScore for 10.1101/2020.04.30.20086082: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.04.30.20086082v1 on medRxiv