Repeat COVID-19 positive pts......

3,118 Views | 12 Replies | Last: 5 yr ago by BiochemAg97
Marcus Aurelius
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6:16p, 5/4/20
AG
I have an elderly patient admitted for COVID-19. She has survived and is doing well. She is no longer symptomatic. She has had 8 positive COVID swabs!!!! And she has been in the hospital for 6 weeks. Her nursing home requires 2 consecutive negative swabs. So she languishes in the hospital, at risk for nosocomial infections, deconditioning, malnutrition, delirium, psychiatric illness, to name a few.

Have others experienced this? Is this inactive viral particles? And what to do for these people? Frustrating. I understand the nursing home's policies but I really don't think she's infectious now.
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Not a Bot
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7:09p, 5/4/20
AG
Will try to find the link, but one of the SK studies on their "reinfected" patients determined it to be RNA remnants still in nasopharynx showing up on PCR.

Maybe she needs a neti pot. (Half joking)

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k00bz
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7:23p, 5/4/20
AG
Marcus. I am testing for SARS-CoV-2 in my lab. We are noticing that those who are hospitalized are shedding this virus for a while. I haven't seen six weeks yet but we have several over 4 weeks, fully recovered, that are still popping positive. The rRT-PCR test is more sensitive than most believe. Positive PCR test does not infer infectiousness. You are correct in that the test just picks up the viral rna wheather live or dead. I guess it's the best they have to go by to insure someone is not infectious until there is more data on a time since symptoms resolved methodology.
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TheMasterplan
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7:38p, 5/4/20
I'm in New Zealand.

Someone returned into my region (aka state) from overseas Mid-March and reportedly self isolated as instructed.

We went three weeks with zero cases (after having 14) and then all of a sudden we get a case at the end of April which was this person that came in Mid-march. She got tested end of April as well.

She has reportedly been in self-isolation the entire time and there was also a full lockdown here so odds are low she picked up in the public (so you would think).

She was also asymptomatic outside of a runny nose.

I'm not a doctor but thought it was amazing she still tested positive after all that time.
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momlaw
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In reply to Not a Bot • 7:42p, 5/4/20
AG
also .5 kidding

Navage
momlaw
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Tabasco
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In reply to Marcus Aurelius • 7:54p, 5/4/20
AG
Marcus Aurelius said:
I have an elderly patient admitted for COVID-19. She has survived and is doing well. She is no longer symptomatic. She has had 8 positive COVID swabs!!!! And she has been in the hospital for 6 weeks. Her nursing home requires 2 consecutive negative swabs. So she languishes in the hospital, at risk for nosocomial infections, deconditioning, malnutrition, delirium, psychiatric illness, to name a few.

Have others experienced this? Is this inactive viral particles? And what to do for these people? Frustrating. I understand the nursing home's policies but I really don't think she's infectious now.
Can you get a hold of two of those crappy China tests that don't work so you can get her out of there?
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Reveille
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In reply to Marcus Aurelius • 7:54p, 5/4/20
AG
Marcus Aurelius said:
I have an elderly patient admitted for COVID-19. She has survived and is doing well. She is no longer symptomatic. She has had 8 positive COVID swabs!!!! And she has been in the hospital for 6 weeks. Her nursing home requires 2 consecutive negative swabs. So she languishes in the hospital, at risk for nosocomial infections, deconditioning, malnutrition, delirium, psychiatric illness, to name a few.

Have others experienced this? Is this inactive viral particles? And what to do for these people? Frustrating. I understand the nursing home's policies but I really don't think she's infectious now.


I completely agree she is not likely at all infectious! She just likely still has viral RNA particles still so PCR tests is still positive.

This might be a good question for biochemAg97. Your can pm him if he doesn't respond here
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Ranger222
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8:59p, 5/4/20
AG
The South Koreans have data that suggest remnants of the viral genome can last up to months. Sorry to hear about your case but I'm sure there will be many more like it.

Do you have any ideas what are the cycle numbers being returned for the qPCR test? You could make an argument if they are decreasing over time or are in the ~30s, right above the threshold for a "positive" result. If they had any data logged prior that cycles leading to positive were in 20s and now weeks later are in 30s, you could argue she has cleared (if they are willing to listen other than positive/negative result).
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Marcus Aurelius
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In reply to Ranger222 • 9:47p, 5/4/20
AG
Good idea. I believe our assay is qualitative. I don't know if it is capable of a quantitative result. But I can find out.
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txtomster
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3:18p, 5/5/20
I work at a hospital in Houston . We have an employee that was positive in March . She only had a fever , no other symptoms . After 14 days she was tested and still showed positive , because she cannot come back to work until 2 negative tests. She continues to test positive and has not been able to return to work yet .
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aggiemike02
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8:32p, 5/5/20
AG
also in houston, family friend in law enforcement, asymptomatic for over 3 weeks and continued to test positive after ~1 week of lighter symptoms (fever mostly)
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BiochemAg97
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In reply to k00bz • 10:00p, 5/5/20
AG
k00bz said:
Marcus. I am testing for SARS-CoV-2 in my lab. We are noticing that those who are hospitalized are shedding this virus for a while. I haven't seen six weeks yet but we have several over 4 weeks, fully recovered, that are still popping positive. The rRT-PCR test is more sensitive than most believe. Positive PCR test does not infer infectiousness. You are correct in that the test just picks up the viral rna wheather live or dead. I guess it's the best they have to go by to insure someone is not infectious until there is more data on a time since symptoms resolved methodology.
It is possible to do a viral culture to see if there is live virus. Not something you would want to do on lots of people but is the only way to tell if she has live virus or residual RNA.

I have no idea where to send that but it wouldn't be a standard med lab.
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gunan01
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10:12p, 5/5/20
AG
This is happening in China too with some of the earliest positive patients. Hard to know if it's non-viable viral particles leading to continued positive assays, or an ineffectual immune response in certain individuals that holds the virus at bay but doesn't clear it.

https://www.reuters.com/article/us-health-coronavirus-china-patients-ins/recovered-almost-chinas-early-patients-unable-to-shed-coronavirus-idUSKCN2240HI
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BiochemAg97
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In reply to Reveille • 10:15p, 5/5/20
AG
Reveille said:
Marcus Aurelius said:
I have an elderly patient admitted for COVID-19. She has survived and is doing well. She is no longer symptomatic. She has had 8 positive COVID swabs!!!! And she has been in the hospital for 6 weeks. Her nursing home requires 2 consecutive negative swabs. So she languishes in the hospital, at risk for nosocomial infections, deconditioning, malnutrition, delirium, psychiatric illness, to name a few.

Have others experienced this? Is this inactive viral particles? And what to do for these people? Frustrating. I understand the nursing home's policies but I really don't think she's infectious now.


I completely agree she is not likely at all infectious! She just likely still has viral RNA particles still so PCR tests is still positive.

This might be a good question for biochemAg97. Your can pm him if he doesn't respond here


Yes, PCR tests for the RNA. Can't tell if live virus or residual viral RNA. Very sensitive, which is good for early detection but maybe not so good in this situation.

Also, even if she was shedding live virus, if the viral load is low enough she may not be infectious. Only nobody really knows what those limits are.

Unfortunately, I suspect the home will stick with the 2 negative tests regardless of reason. Easier to hide behind policy than to think about things. But I also understand they are worried about infecting a bunch of high risk individuals if she comes back infectious, so they will minimize risk.
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