Recovered COVID-19 patients with recurrent viral RNA exhibit lower levels of anti-RBD antibodies
Bingfeng Liu, Yaling Shi, Wanying Zhang, Rong Li, Zhangping He, Xiaofan Yang, Yuejun Pan, Xilong Deng, Mingkai Tan, Lingzhai Zhao, Fan Zou, Yiwen Zhang, Ting Pan, Junsong Zhang, Xu Zhang, Fei Xiao, Fang Li, Kai Deng, Hui Zhang
Abstract
Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly become a global pandemic. Most discharge criteria for patients with COVID-19 recommend two consecutive negative reverse-transcriptase polymerase-chain reaction (RT-PCR) test results from respiratory specimens over a 24-hour interval. Reports are accumulating of recurrent viral RNA-positive (RP) nasopharyngeal or anal specimens from recovered patients in China, Italy, South Korea, and France. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Two cohort studies reported that 14.5% (38/262) and 16.7% (69/414) of patients with COVID-19 retesting were positive for SARS-CoV-2 RNA after discharge. 2 , 6 The potential causes of RP specimens may be related to several aspects, such as virological factors, including residual viral reservoir, intermittent viral release, tissue distribution or false negatives, as well as immunological and sampling methodological factors. 3 , 9 , 10 Given that an increasing number of RP cases have been reported worldwide, this phenomenon cannot be simply ascribed to false-negative testing. It indeed occurs, as truly discharged patients could suffer reactivation or could be reinfected with SARS-CoV-2. 3 The risk of possible retransmission still exists, and the serological characteristics remain largely unknown, which could jeopardize the management of recovered COVID-19 patients. 11