key: cord-0916612-jngjsacg authors: Peng, Jianhui; Wang, Mingke; Zhang, Gangqing; Lu, Eying title: Seven discharged patients turning positive again for SARS-CoV-2 on quantitative RT-PCR date: 2020-04-10 journal: Am J Infect Control DOI: 10.1016/j.ajic.2020.03.017 sha: 3ab8b575a11534f6bcc790669105474a7e0f0931 doc_id: 916612 cord_uid: jngjsacg nan Discharged patients turning positive again for SARS-CoV-2 None. None. P-JH participated in the data collection and coordination and analyzed the clinical data. L-EY participated in the data collection. W-MK and Z-GQ conceived the study, participated in its design and coordination, and analyzed the clinical data. All authors helped draft the manuscript. Written consent for publication was obtained from the patients. caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has gradually become a global health concern. 1 As of Mar 23, 2020, 332 930 people have a confirmed infection and 14 510 people have died worldwide. 2 Up to now, respiratory droplets and close contact were considered as the major transmission route of COVID-19. 3 Here, we report the clinical and epidemiological characteristics of seven discharged patients who turned positive again (named as turn-positive patients) for SARS-CoV-2 on quantitative RT-PCR (qRT-PCR). The detailed timeline is presented in Appendix 1. On Jan 17, 2020, patient 1 (male, 67-year-old), who had travelled from Wuhan (Hubei, China) to Guangzhou (Guangdong, China), had a fever (37.8°C) and cough with abnormal chest X-ray images, and his throat swab was positive on qRT-PCR (Jan 24). Patient 2 (son-in-law of patient 1) had a fever (38.9°C) and chills but no cough with normal X-ray and positive throat swab (Jan 24). Patient 3 (wife of patient 1) had no fever (37.0°C) but cough, expectoration, normal X-ray, and positive throat swab (Jan 27). Patient 4 (grandson of patient 1) had no fever (36.3°C) but cough, normal X-ray, and positive throat swab (Jan 27). All patients were successively admitted to our hospital. After treatment for 18 days (patient 1 and 2), 19 days (patient 3), or 12 days (patient 4), they were discharged with no symptoms and normal imaging and qRT-PCR results (discharge criteria). 4 On Feb 19, patient 1 was re-admitted to our hospital with no symptoms but abnormal computed tomography (CT) images and positive qRT-PCR results. On Feb 22, patient 2, 3, and 4 were re-admitted to our hospital with no symptoms, normal (patient 4) or abnormal CT images (patient 2 and 3), positive nasal swab but negative throat or anal swab on qRT-PCR. During the second hospitalization, non-organic insomnia and increased anxiety was observed in patients 2 and 3. After treatment for 6 days (patient 1), 5 days (patient 2 and 4), or 7 days (patient 3), they were discharged but quarantined in our hospital. On Jan 24, patient 5 (female, 38-year-old), who returned to Guangzhou from Wuhan and on Jan 29, patient 6 (male, 29-year-old), whose father had returned to Guangzhou from Wuhan, presented with fever (37.5°C and 38.2°C, respectively) but no cough and had normal X-ray but positive throat swab. Patient 7 (female, 21-year-old) had a fever (37.3°C), itchy throat but no cough, normal X-ray but positive qRT-PCR results (Jan 31). Patients 5, 6, and 7 were admitted to our hospital. After treatment for 18 days (patient 5), discharged. Patients 5 and 6 moved to a hotel, whereas patient 7 went home. On Feb 22, patient 5 was re-admitted to our hospital with no symptoms and normal X-ray but positive throat swab. On Feb 26, patient 6 was re-admitted to our hospital with no symptoms, normal CT, and negative throat swab but positive anal swab. On Feb 24, patient 7 was re-admitted to our hospital with no symptoms but abnormal CT, positive nasal swab but negative throat or anal swabs. During treatment, negative throat swab but positive anal swab was observed on patient 5 (Feb 24) and patient 6 (Feb 27, Feb 28, Mar 2, Mar 3, and Mar 4). After treatment for 8 days (patient 5), 10 days (patient 6), or 5 days (patient 7), they were discharged but quarantined in our hospital. These cases highlight important issues that need our immediate attention. First, all seven turn-positive patients had shorter hospital stays, lower medical costs, and milder symptoms in their second hospital visit than in their first-time hospitalization (Appendix 2). These findings may be attributed to convalescent plasma as a potential therapy for SARS-CoV-2 infection, 5 which will be beneficial in the fight against COVID-19. Second, positive anal swab but negative throat swab was observed in two turn-positive patients (patient 5 and 6), and the diagnostic value of anal swab test in late stage of infection requires further investigation. Meanwhile, fomite transmission and environmental contamination by COVID-19 patients should not be ignored. [6] [7] [8] Imaging examination and qRT-PCR results were sometimes inconsistent, and therefore, a combination of these methods should be used for diagnoses. 8 Four of the turn-positive patients (patient [1] [2] [3] [4] were a family suggesting that the occurrence of turn-positive patients in a family cluster is a nonnegligible phenomenon. Furthermore, we should consider the possibility that the turn-positive patients were not completely cured the first time and were discharged based on a false-negative diagnostic test. To avoid false-negative diagnosis of positive patients, diagnostic tests with high specificity and sensitivity are urgently needed. Finally, nonorganic insomnia and increased anxiety was observed in two turn-positive patients (patient 2 and 3) indicating that timely mental health care for the SARS-CoV-2 infected patients is urgently needed, 9 especially turn-positive patients who require re-hospitalization and medical observation for 14 days after discharge. 10 As a new infectious disease, the pathogenesis and epidemiological and clinical characteristics of SARS-CoV-2 infection are still not well understood. 1, 10 Further studies on turn-positive patients infected with SARS-CoV-2 will deepen our understanding of the whole process of occurrence, development, and transformation of COVID-19. None. None. P-JH participated in the data collection and coordination and analyzed the clinical data. L-EY participated in the data collection. W-MK and Z-GQ conceived the study, participated in its design and coordination, and analyzed the clinical data. All authors helped draft the manuscript. Written consent for publication was obtained from the patients. A novel coronavirus from patients with pneumonia in China World Health Organization. Coronavirus disease (COVID-2019) situation reports-63 Recurrence of positive SARS-CoV-2 RNA in COVID-19: A case report General Office of National Health Commission, General Office of National Administration of Traditional Chinese Medicine. Diagnostic and treatment protocol for Novel Coronavirus Pneumonia (Trial version 7 Convalescent plasma as a potential therapy for COVID-19 Public health might be endangered by possible prolonged discharge of SARS-CoV-2 in stool Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient Comparison of different samples for 2019 novel coronavirus detection by nucleic acid amplification tests Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed National Health Commission of the People's Republic of China: the phenomenon of human-to-human transmission did not appear in the discharged We thank the patients, the nurses, and the clinical staff who provided care for the patients.