Chinese man diagnosed with COVID-19 on three separate occasions

[denem]

A Chinese man was diagnosed with COVID-19 on three separate occasions - internationally peer reviewed study.
My conclusion - either the current tests are not conclusive, or SARS-2 can go into effective hibernation.

Recurrent recurrence of positive SARS-CoV-2 RNA in a COVID-19 patient

Abstract
Background: Coronavirus disease 2019 (COVID-19) is a highly infectious disease. A small proportion of discharged patients may become positive again for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, even if they meet the discharge criteria. Herein, we report a rare COVID-19 patient with recurrent recurrence of positive SARS-CoV-2 RNA.

Case presentation: A 68-year-old man was admitted due to fever, muscle pain, and fatigue. He was initially diagnosed with COVID-19 according to two consecutive positive results for SARS-CoV-2 RNA plus clinical symptoms and chest CT findings, and was discharged from hospital when meeting the discharge criteria, including two consecutive negative results. He was tested positive for SARS-CoV-2 RNA twice during the quarantine and was hospitalized again. He was asymptomatic then, but IgG and IgM were both positive.

He was discharged [on the second ocassion] in the context of four consecutive negative test results for SARS-CoV-2 RNA after antiviral treatment. However, he was tested positive once again on the 3rd and 4th day after the second discharge, although still asymptomatic. IgG and IgM were still positive. After antiviral treatment, the results of SARS-CoV-2 RNA were negative in three consecutive retests, and he was finally discharged and quarantined for further surveillance.

Conclusion: This case suggests that a small proportion of convalescent patients may become positive again for SARS-CoV-2 RNA and be a virus carrier.

https://www.researchsquare.com/article/rs-23197/v1

[agingdem]

1. if this is a true virus

then it's possible it can go in and out of remission..and he'll probably always test positive symptoms or no symptoms

[denem]

2. Yes. The question is,

do they become contagious again months, even years after the initial infection.

[agingdem]

15. shingles

I get shingles a lot...don't ask...and all my blood tests come back positive for the varicella virus..even when the virus is in remission..however when I have those awful blisters I stay at home because I'm contagious until I'm not...go figure

[Blue_true]

21. Have you gotten one of the two shot regimens done? nt

[shanti]

34. That's the same as with

any other herpes virus, and there are a few. It hibernates and returns to torment periodically, but is not fatal. Is that what the covid virus is going to do? God help us.

[agingdem]

35. that's what I was thinking

is that why recovered covid patients are continuing to test positive?..

[DenverJared]

3. It appears that the viral RNA remains in superficial dead or live shed cells of the nasal mucosa

even after antibodies and CTLs (Cytotoxic T Lymphocytes) have eliminated the virus from the body.

It is possible that the shed cells are not cleared from sinus fluids and thus the nasopharyngeal swab tests positive repeatedly.

The RT PCR tests for RNA of the virus and not necessarily a live virus itself.

So, I wouldn't worry about this. Anyone who has antibodies cannot get a second infection.

[denem]

4. And the " fourconsecutive negative tests" before discharge from the second hospitalization?

Would you not expect superficial dead or live shed cells to register in one or more of these tests?

[DenverJared]

6. The discharges of debris from the sinuses are random

The virus cannot reinfect someone with antibodies. No virus can.

The only viruses that cause persistent infection are herpes viruses and they do do not pop up unless the antibody titer drops.

There are some 400+ corona viruses known to infect pangolins and civets and none of them infects animals that have antibodies to the viral proteins.

[denem]

8. I am not an expert but can't HIV can cause persistent infection?

[DenverJared]

14. HIV doesn't meet the definition of a persistent infection.

Persistent infection is where the body overcomes the current infection and gets cured. Then after some time of healthy existence, the virus comes out of dormancy and reinfects the person usually when the immunity is down. Those who get herpes sores on the face know that they get it right after spending too much time in the sun or after an extremely stressful week.

HIV never becomes dormant. Even when in the initial stages when the person is healthy, the virus is active in the lymph nodes muching up on follicular dendritic cell merrily. One it runs out of the FDCs, it causes symptoms again and lead to a rapidly downhill course if not intervened with ART.

[denem]

16. Thank you

much appreciated !

[denem]

17. A question -

given what we know about SARS-Cov-2, and the prospect for vaccines, how you you rate it's chances of becoming endemic (nationally)?

[DenverJared]

18. It won't become endemic

Last edited Sun Apr 19, 2020, 09:21 PM - Edit history (1)

Once >50% of people have recovered, the herd immunity will not allow another epidemic.

The coronaviruses do mutate but not as frequently as the influenza or common cold viruses. There are only three Coronaviruses so far that are known to cause disease in humans (SARS, MERS and Covid-19) but there are hundreds of them that cause infection in bats, pangolins, civets and other mammals.

If we stopped having close contact with those creatures, it is unlikely that another epidemic like this will ensue.

The issue is the Chinese people's appetite for exotic wild animals as delicacies and that has to be stopped. I'm sure China can do it. People should eat chicken instead of bats to save grandma. It is that simple.

On edit -- please check the definition of empirical. Empirical requires a group of people - not one case.

[denem]

22. I thought OC43 and 229E coronaviruses were endemic.

[DenverJared]

27. "Coronavirus" is a term which comes from viruses that have crown like spikes

So, yes, OC43, 229E AND NL63 as well as HKU1 are endemic but they have an entirely different pathophysiology and receptor affinity.

SARS-CoV-2 like SARS-CoV-1 and MERS-CoV are different and based upon the experience of SARS and MERS, it is extremely unlikely that Covid-19 will become endemic. However, there are no guarantees in biology!

[Thekaspervote]

23. Thx for the breakdown!

[Igel]

26. The other alternative is that he just got lucky.

Incredibly lucky, but given enough events even unlikely outcomes are possible.

The only number I've seen reported for China's PCR test is that it has about a 30% false negative rate.

If there's a 30% false negative rate (try 1) there's a 9% false negative rate for 2 tests, a 2.7% chance that 3 tests won't catch it, and a 0.8% chance that the fourth test will be a false negative.

Do 4 tests in a row and you will encounter cases with 4 false negatives in a row.

[Drahthaardogs]

7. THAT is not proven.

There is at least on woman who did become symptomatic again.

[DenverJared]

13. One woman is called an anecdote.

That is not science. Some people have an aunt Mathilda who could bake a cake while blindfolded ... doesn't mean everyone can do it.

[Drahthaardogs]

19. No.. this case is well documented

And being studied in China. The question is was it a relapse or was she re-infected.

I did my thesis on secondary plant metabolites for use as potential HIV drugs due to their ability to intercalate DNA. What was yours?

[DenverJared]

28. I am not going to reveal personal information here.

However, every physician and scientist out there knows that ONE CASE is an anecdotal novelty.

Approximately 600,000 patients have recovered from Covid-19 and there is only one case so far where it purportedly reoccurred.

The science (and data) are on the side of that being an anecdotal finding.

It shouldn't take a PhD to ascertain that 1 case in 600,000 is not a common occurrence.

[Drahthaardogs]

30. You have already put out lots of wrong information in this thread

My favorite has been that there are only 3 corona viruses that infect humans. You are obviously are no expert on PCR and how it works (I bet you have never done it, but read about it in a biological text), and you DON'T know what an anecdote is.

The FACT that the woman had tested negative and was symptom free but then experienced symptoms and tested positive is EMPERICAL - it was VALIDATED with a scientific test. It was not merely observational. She either relapsed or was re-infected. That this happened to one person out of 50,000 does NOT make it an anecdote any more than a rare anaphalactic reaction to a drug makes it anecdotal.

An on edit:. Sitting here proclaiming that once you make antibodies you are immune IS IRRESPONSIBLE because we suspect but do not know this to be true. There is doubt that we will have a vaccine. The WHO stated yesterday that there is no evidence that the presence of antibodies denotes immunity.

You don't know what you are talking about and need to stop.

Actually, you're probably a med student. Most of them appear to have gone on spring break during molecular genetics class.

[DenverJared]

32. Sir, I have three doctorate level letters after my name

and they involve exactly what we are talking about .. i.e. medicine, virology and immunology. Two of those come from the most prestigious places in the US.

We know antibodies make people immune from a given virus ... except for viruses that attack CD4 helper cells like the HIV. We test the effectiveness of vaccines by measuring antibodies generated against the vaccine and assume them to be protective. How do they know if a flu vaccine released each year is effective? There is no time for clinical trials - they simply check for an antibody response and release the vaccine into the market.

Smallpox vaccine (Variola) doesn't even use the smallpox virus but a live related virus (vaccinia) and the immune response had been clinically evident even before we could test for immunological parameters and certainly before flow cytometry to actually measure naive, activated and zombie cytotoxic T lymphocytes.

In any event, this is not a scientific forum so I don't need to produce citations to prove that my posts were correct. However, since you seem to know the path, you are welcome to do research on medline and find articles that support what I stated.

[Drahthaardogs]

33. Both the CDC and the WHO are more reserved than you

Lots of test subjects are showing weak or no antibodies. It is unknown if they can be re-infected.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144858/


Also, an Ro of 5.6 (newly calculated number) requires a population of > 80% to have herd immunity, not 50% like you claimed.


https://www.google.com/amp/s/www.forbes.com/sites/marleycoyne/2020/04/17/coronavirus-antibodies-may-not-make-you-immune-who-warns/amp/


https://www.google.com/amp/s/abcnews.go.com/amp/Health/questions-remain-covid-19-recovery-guarantee-immunity-reinfection/story%3fid=70085581

https://www.cdc.gov/coronavirus/types.html

https://www.google.com/amp/s/www.cnbc.com/amp/2020/04/17/who-issues-warning-on-coronavirus-testing-theres-no-evidence-antibody-tests-show-immunity.html

Monoclonal antibodies are the wave of the future. Interesting story is so-called "Venom Man", much of Glanville's work has revolutionized the monoclonal field.

You confuse "outlier" with "anecdote", but whatever.

[DenverJared]

36. ...

Hilarious. You are citing news accounts instead of reputable journals.

WHO and CDC have been anything but reliably scientific in this pandemic. WHO was hijacked by the Chinese and the CDC has been hijacked by Trump.

I don't trust data from China as well ... it is all over the place.

I am studying data from Italy and UK which appears to be more reliable.

[Drahthaardogs]

37. Trump talking points...

And you don't understand endemic either. The population is 100% suceptible since we have no immunity. The Ro = 5.6.

The virus will almost certainly be endemic. Almost everyone agrees on that.

[Proud Liberal Dem]

10. I remember a news story a few weeks ago(?)

that was talking about how on a contaminated cruise ship that they had found viral remnants up to 17 days later, which may be true but the question remains of how likely that that viral material was active/infectious. This is something that will obviously require further studies.

[DenverJared]

12. I'll give you a simple example

If you take the virus from the culture and heat it to 60°C for 15 minutes, all virus will die and become non-pathogenic. However, the Covid-19 RT PCR on that sample will test positive because the RNA is still there.

[Generic Brad]

9. Or the tests are flawed

[Proud Liberal Dem]

11. Or the virus is very wiley in some people

Thankfully, this is not happening across the board, at least as far as we know. Have we had any incidence of new positive tests in recovered patients so far (or is the testing not there to help confirm this)?

[Blue_true]

24. Yeah. It infects two people with the same physical and other outward profiles. One person hardly

notices. It kills the other very fast. Why?

[Proud Liberal Dem]

31. I agree. It's really wild

[Blue_true]

20. Maybe it behaves like the virus that causes Shingles, except it comes back to life faster. nt

[roamer65]

25. Some people did not clear SARS-CoV-1 for up to 8 months.

Relax people.

[BGBD]

29. I've read of

these people testing positive again, but on several occasions attempts were made to grow the virus from the samples taken, but failed. Meaning the virus found in these tests were inactive. Basically they were dead. Makes sense here too since on both occasions he was asymptomatic. Inactive virus can't infect someone else either.