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Kinetics of SARS-CoV-2 Positivity of Infected and Recovered Patients: A Single Center COVID-19 Experience and Potential Implications

45 Pages Posted: 7 Jul 2020

See all articles by Jia Huang

Jia Huang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Le Zheng

Stanford University - Department of Cardiothoracic Surgery

Zhen Li

Stanford University - Department of Surgery

Shiying Hao

Stanford University - Department of Cardiothoracic Surgery

Fangfan Ye

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Jun Chen

Southern University of Science and Technology - National Clinical Research Center for Infectious Diseases

Hayley A. Gans

Stanford University - Department of Pediatrics

Xiaoming Yao

Sichuan University - Translational Medicine Laboratory

Jiayu Liao

University of California, Riverside (UCR) - Department of Bioengineering

Song Wang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Manfei Zeng

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Liping Qiu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Fanlan Cen

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Yajing Huang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Tengfei Zhu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Zehui Xu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Manhua Ye

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Yang Yang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Guowei Wang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Jinxiu Li

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Lifei Wang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Jiuxin Qu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Jing Yuan

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Wei Zheng

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Zheng Zhang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Chunyang Li

Sichuan University - West China Biomedical Big Data Center

John C. Whitin

Stanford University - Department of Pediatrics

Lu Tian

Stanford University - Department of Biomedical Data Science

Henry Chubb

Stanford University - Department of Pediatrics

Kuo-Yuan Hwa

The University of Hong Kong - 1Department of Medicine

Scott R. Ceresnak

Stanford University - Department of Pediatrics

Wei Zhang

Sichuan University - Biomedical Big Data Center

Ying Lu

Stanford University - Department of Biomedical Data Science

He Qing

Southern University of Science and Technology - National Clinical Research Center for Infectious Diseases

Wang Zhaoqin

Southern University of Science and Technology - Diagnosis and Treatment of Infectious Diseases Research Laboratory

Yingxia Liu

Shenzhen Third People’s Hospital - Institute of Hepatology

Yvonne A. Maldonado

Stanford University - Department of Pediatrics

Doff B. McElhinney

Stanford University - Department of Cardiothoracic Surgery

Karl G. Sylvester

Stanford University - Department of Surgery

Harvey J. Cohen

Stanford University - Department of Pediatrics

Lei Liu

Southern University of Science and Technology - Pulmonary Diseases Department Two

Xuefeng B. Ling

Stanford University - Clinical and Translational Research Program; Stanford University - Department of Surgery

More...

Abstract

BACKGROUND: Recurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive detection in infected but recovered individuals has been reported. Patients who have recovered from coronavirus disease 2019 (COVID-19) could profoundly impact the health care system if a subset were to be polymerase chain reaction (PCR)-positive again with reactivated SARS-CoV-2. We sought to define the kinetics and relevance of PCR-positive recurrence during recovery from acute COVID-19 to better understand risks for prolonged infectivity and reinfection.

METHODS: A series of COVID-19 414 patients, at The Second Affiliated Hospital of Southern University of Science and Technology in Shenzhen, China from January 11 to April 23, 2020. Univariable and multivariable statistical analysis of inpatient data were performed to develop an algorithm to predict patients at risk of recurrence of PCR positivity.

FINDINGS: 16·7% recovered patients with PCR positive recurring one to three times, despite being in strict quarantine. Younger patients with mild pulmonary respiratory syndrome had higher risk of PCR positivity recurrence. The recurrence prediction model had an area under the ROC curve of 0·786.

INTERPRETATION: This case series provides clinical characteristics of recovered COVID-19 patients with recurrent SARS-CoV-2 positivity, despite strict quarantine, at a 16·7% rate. Use of a recurrence prediction algorithm may identify patients at high risk of recurrent SARS-CoV-2 positivity and help understand reactivation and reinfection possibilities to establish protocols for health policy.

FUNDING STATEMENT: This work was supported by grants from Sanming Project of Medicine in Shenzhen (Jia Huang, No. SZSM201812065); Bill & Melinda Gates Foundations (Lei Liu); and from National Natural Science Foundation of China (Jia Huang, No. 81501651)

DECLARATION OF INTERESTS: The authors declare no competing interests.

ETHICS APPROVAL STATEMENT: This study was approved by the Ethics Committee of the Second Affiliated Hospital of Southern University of Science and Technology. Written informed consent was obtained from all patients.

Keywords: COVID-19, SARS-CoV-2, PCR positive recurrence

Suggested Citation

Huang, Jia and Zheng, Le and Li, Zhen and Hao, Shiying and Ye, Fangfan and Chen, Jun and Gans, Hayley A. and Yao, Xiaoming and Liao, Jiayu and Wang, Song and Zeng, Manfei and Qiu, Liping and Cen, Fanlan and Huang, Yajing and Zhu, Tengfei and Xu, Zehui and Ye, Manhua and Yang, Yang and Wang, Guowei and Li, Jinxiu and Wang, Lifei and Qu, Jiuxin and Yuan, Jing and Zheng, Wei and Zhang, Zheng and Li, Chunyang and Whitin, John C. and Tian, Lu and Chubb, Henry and Hwa, Kuo-Yuan and Ceresnak, Scott R. and Zhang, Wei and Lu, Ying and Qing, He and Zhaoqin, Wang and Liu, Yingxia and Maldonado, Yvonne A. and McElhinney, Doff B. and Sylvester, Karl G. and Cohen, Harvey J. and Liu, Lei and Ling, Xuefeng B., Kinetics of SARS-CoV-2 Positivity of Infected and Recovered Patients: A Single Center COVID-19 Experience and Potential Implications (5/15/2020). Available at SSRN: https://ssrn.com/abstract=3605268 or http://dx.doi.org/10.2139/ssrn.3605268

Jia Huang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease ( email )

Shenzhen 518112, Guangdong Province
China
+86-13699858655 (Phone)

Le Zheng

Stanford University - Department of Cardiothoracic Surgery

291 Campus Drive
Li Ka Shing Building
Stanford, CA 94305-5101
United States

Zhen Li

Stanford University - Department of Surgery

United States

Shiying Hao

Stanford University - Department of Cardiothoracic Surgery

291 Campus Drive
Li Ka Shing Building
Stanford, CA 94305-5101
United States

Fangfan Ye

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Jun Chen

Southern University of Science and Technology - National Clinical Research Center for Infectious Diseases

China

Hayley A. Gans

Stanford University - Department of Pediatrics

291 Campus Drive
Li Ka Shing Learning and Knowledge Center
Stanford, CA 94305-5101
United States

Xiaoming Yao

Sichuan University - Translational Medicine Laboratory

Sichuan
China

Jiayu Liao

University of California, Riverside (UCR) - Department of Bioengineering

900 University Avenue
Riverside, CA 92521
United States

Song Wang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Manfei Zeng

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Liping Qiu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Fanlan Cen

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Yajing Huang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Tengfei Zhu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Zehui Xu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Manhua Ye

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Yang Yang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Guowei Wang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Jinxiu Li

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Lifei Wang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Jiuxin Qu

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Jing Yuan

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Wei Zheng

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Zheng Zhang

Southern University of Science and Technology - National Clinical Research Center for Infectious Disease

Shenzhen 518112, Guangdong Province
China

Chunyang Li

Sichuan University - West China Biomedical Big Data Center

Sichuan
China

John C. Whitin

Stanford University - Department of Pediatrics

291 Campus Drive
Li Ka Shing Learning and Knowledge Center
Stanford, CA 94305-5101
United States

Lu Tian

Stanford University - Department of Biomedical Data Science

Stanford, CA 94305
United States

Henry Chubb

Stanford University - Department of Pediatrics

291 Campus Drive
Li Ka Shing Learning and Knowledge Center
Stanford, CA 94305-5101
United States

Kuo-Yuan Hwa

The University of Hong Kong - 1Department of Medicine

Pokfulam Road
Hong Kong, Pokfulam HK
China

Scott R. Ceresnak

Stanford University - Department of Pediatrics

291 Campus Drive
Li Ka Shing Learning and Knowledge Center
Stanford, CA 94305-5101
United States

Wei Zhang

Sichuan University - Biomedical Big Data Center

Sichuan
China

Ying Lu

Stanford University - Department of Biomedical Data Science ( email )

CA
United States

He Qing

Southern University of Science and Technology - National Clinical Research Center for Infectious Diseases

China

Wang Zhaoqin

Southern University of Science and Technology - Diagnosis and Treatment of Infectious Diseases Research Laboratory

Shenzhen
China

Yingxia Liu

Shenzhen Third People’s Hospital - Institute of Hepatology

Shenzhen 518112, Guangdong Province
China

Yvonne A. Maldonado

Stanford University - Department of Pediatrics

291 Campus Drive
Li Ka Shing Learning and Knowledge Center
Stanford, CA 94305-5101
United States

Doff B. McElhinney

Stanford University - Department of Cardiothoracic Surgery

291 Campus Drive
Li Ka Shing Building
Stanford, CA 94305-5101
United States

Karl G. Sylvester

Stanford University - Department of Surgery

United States

Harvey J. Cohen

Stanford University - Department of Pediatrics

291 Campus Drive
Li Ka Shing Learning and Knowledge Center
Stanford, CA 94305-5101
United States

Lei Liu

Southern University of Science and Technology - Pulmonary Diseases Department Two ( email )

Shenzhen
China
+86-13510333313 (Phone)

Xuefeng B. Ling (Contact Author)

Stanford University - Clinical and Translational Research Program ( email )

Palo Alto, CA
United States
650-427-9198 (Phone)
650-723-1154 (Fax)

Stanford University - Department of Surgery ( email )

Palo Alto, CA
United States
650-427-9198 (Phone)
650-723-1154 (Fax)

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