March 25, 2020

Recovered COVID-19 Patients are Testing Positive Again


Authorities in Hubei say they will not count patients who test positive again after discharge as fresh cases. Photo: Xinhua

Patients who test positive for coronavirus after being discharged from hospital will not be classified as fresh cases and there is no evidence that they remain infectious, according to a top health official in the central Chinese province where the pathogen was first detected.

Tu Yuanchao, deputy director of the health commission in Hubei province, said people who tested positive and showed coronavirus symptoms a second time would be sent to designated hospitals for treatment until they met discharge conditions again, the official Hubei Daily reported on Monday. They would then be observed for two weeks in isolation.

But they would not be counted as new cases, Tu was quoted as saying.

“Those who retest positive have already been reported as confirmed cases in their initial test, so they will not be repeatedly counted as new cases,” he said.

The National Health Commission said on Monday that of the 81,093 confirmed cases of Covid-19 – the disease caused by the coronavirus – more than 72,200 had recovered and been discharged from hospital.

In addition, Premier Li Keqiang declared at a task force meeting in Beijing on Monday that “local transmission [of the disease] across the country has been basically cut off but the risks of isolated cases or localised outbreak still exist”.

While there are no national numbers for those who retest positive, health authorities in Guangdong province, in the country’s south, said late last month that about 14 per cent of patients – more than a hundred at the time – who recovered from the coronavirus tested positive again after being discharged.

Wang Xinhua, president of Guangzhou Medical University, said there were usually two reasons discharged patients tested positive again for coronavirus.

“One is because they were only carrying a small amount of virus when they were discharged. More tests will need to be conducted on such patients for accuracy,” Wang said.

“The other possible situation is that the patients get reinfected. It’s not clear if they have acquired a strong immunity after recovery. [Reinfection] is not a high possibility but it is still possible.”

Peng Zhiyong, director of intensive care at Wuhan University’s Zhongnan Hospital, said that only 1 per cent of patients fell into the category.

“It is extremely rare for patients to retest positive after they recover,” Communist Party mouthpiece People’s Daily quoted Peng as saying on March 14.

“One is because they were only carrying a small amount of virus when they were discharged. More tests will need to be conducted on such patients for accuracy,” Wang said.

“The other possible situation is that the patients get reinfected. It’s not clear if they have acquired a strong immunity after recovery. [Reinfection] is not a high possibility but it is still possible.”

Peng Zhiyong, director of intensive care at Wuhan University’s Zhongnan Hospital, said that only 1 per cent of patients fell into the category.

“It is extremely rare for patients to retest positive after they recover,” Communist Party mouthpiece People’s Daily quoted Peng as saying on March 14.

In another article on Sunday, People’s Daily reported that 5 to 10 per cent of cases in “certain isolation areas in Wuhan” tested positive again after being discharged. But it did not specify the total number or locations.

Apart from Hubei and Guangdong, similar cases have been reported in Sichuan, Hunan, Tianjin and Shaanxi. However, there are no national guidelines on the definition or treatment of these patients yet.

Positive cases among discharged patients have been reported in Japan and South Korea. In late February, a tour guide in Japan tested positive for the coronavirus a second time after testing negative on February 6.

A 73-year-old woman in South Korea was diagnosed again with the virus within a week after being discharged from hospital in late February.

According to NHC treatment guidelines for Covid-19, patients qualify as recovered and can be released from hospital when their throat or nose swabs show up negative in two consecutive tests, a CAT scan indicates no lung lesions, and they have no symptoms such as fever.

Yang Nian, a doctor from Nanjing deployed to Wuhan, said he thought the negative results before discharge could be “false negatives” that failed to detect the small amounts of virus still within the patient.

Yang said a number of hospitals in Wuhan were going further than official guidelines to try to determine what kind of coronavirus antibodies were present to know what stage of recovery each patient was in.

“IgM antibodies tend to appear in early stages of infection, but the level could go down quickly in a few days. Meanwhile, IgG antibodies appear later in bodies but remain longer and can be used as an indication that patients are entering a recovery stage … Those who show low levels of IgG antibodies need to be hospitalised longer,” Yang said, adding that some patients were hospitalised for as long as 40 days for this reason.

But some internet users were not convinced by the authorities’ explanations.

“Even Guangdong has 14 per cent of people who retested positive, and you are telling me Wuhan only has 1 per cent?” one netizen said on Weibo, a Twitter-like platform.

“This is a game of words that [the government] is playing. Of course they are not ‘newly infected cases’, but the authorities should still announce the number [of people retesting positive],” another Weibo user said.

A district official in Wuhan, who declined to be named, said she had bigger worries than whether people were testing positive again.

“ The problem we face as officials are residents who are locked down at home and have no income … Hubei is a province that exports a lot of workers to the rest of the country, not all of us are sick. Discrimination [from outside the province] is the biggest concern.” Purchase the China AI Report 2020 brought to you by SCMP Research and enjoy a 20% discount (original price US$400). This 60-page all new intelligence report gives you first-hand insights and analysis into the latest industry developments and intelligence about China AI. Get exclusive access to our webinars for continuous learning, and interact with China AI executives in live Q&A. Offer valid until 31 March 2020.

Source: South China Morning Post


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