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This is the first systematic review and meta-analysis (including 14 studies involving 2568 individuals) on recurrent SARS-CoV-2 RNA positivity among people who have recovered from COVID-19. The pooled estimate of the incidence of recurrent SARS-CoV-2 positivity was 14.8%, confirming that recurrent positivity among patients who have recovered and been discharged from the hospital is relatively common. The pooled estimate of the interval from disease onset to recurrence was 35.4 days, and from the last negative to the recurrent positive result was 9.8 days. Younger patients and those with a longer initial illness were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes, severe disease, and a low lymphocyte count were less likely to experience recurrent SARS-CoV-2 positivity.
The persistence of SARS-CoV-2 protein in some patients with recurrent SARS-CoV-2 positivity may be a sign of active viral replication, and so these patients could still be infectious. Future studies should explore the possibility of infectious individuals with prolonged or recurrent RNA positivity.
– Luiz Meirelles, DDS, MS, PhD
This abstract is available on the publisher's site.
Present study aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity. We searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was assessed using I2. Fourteen studies of 2568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.8% (95% confidence interval [CI] 11.44-18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.4 days (95% CI 32.65-38.24 days), and from the last negative to the recurrent positive result was 9.8 days (95% CI 7.31-12.22 days). Patients with younger age and a longer initial illness were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes, severe disease, and a low lymphocyte count were less likely to experience. Present study concluded that the incidence of recurrent SARS-CoV-2 positivity was 14.8% suggesting further studies must be conducted to elucidate the possibility of infectious individuals with prolonged or recurrent RNA positivity.