The comprehensive characterization of clinical and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing data for patients with repeatedly positive SARS-CoV-2 tests can help prioritize suspected cases of reinfection for investigation in the absence of sequencing data and for continued surveillance of the potential long-term health consequences of SARS-CoV-2 infection. ABSTRACT In the absence of genome sequencing, two positive molecular tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) separated by negative tests, prolonged time, and symptom resolution remain the best surrogate measure of possible reinfection. Using a large electronic health record database, we characterized clinical and testing data for 23 patients with repeatedly positive SARS-CoV-2 PCR test results ≥60 days apart, separated by ≥2 consecutive negative test results. The prevalence of chronic medical conditions, symptoms, and severe outcomes related to coronavirus disease 19 (COVID-19) illness were ascertained. The median age of patients was 64.5 years, 40% were Black, and 39% were female. A total of 83% smoked within the prior year, 61% were overweight/obese, 83% had immunocompromising conditions, and 96% had ≥2 comorbidities. The median interval between the two positive tests was 77 days. Among the 19 patients with 60 to 89 days between positive tests, 17 (89%) exhibited symptoms or clinical manifestations consistent with COVID-19 at the time of the second positive test and 14 (74%) were hospitalized at the second positive test. Of the four patients with ≥90 days between two positive tests (patient 2 [PT2], PT8, PT14, and PT19), two had mild or no symptoms at the second positive test and one, an immunocompromised patient, had a brief hospitalization at the first diagnosis, followed by intensive care unit (ICU) admission at the second diagnosis 3 months later. Our study demonstrated a high prevalence of compromised immune systems, comorbidities, obesity, and smoking among patients with repeatedly positive SARS-CoV-2 tests. Despite limitations, including a lack of semiquantitative estimates of viral load, these data may help prioritize suspected cases of reinfection for investigation and continued surveillance. IMPORTANCE The comprehensive characterization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and clinical data for patients with repeatedly positive SARS-CoV-2 tests can help prioritize suspected cases of reinfection for investigation in the absence of genome sequencing data and for continued surveillance of the potential long-term health consequences of SARS-CoV-2 infection.
[1]
M. Collins,et al.
The Importance and Challenges of Identifying SARS-CoV-2 Reinfections
,
2020,
Journal of Clinical Microbiology.
[2]
M. Cevik,et al.
SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis
,
2020,
The Lancet Microbe.
[3]
C. Cordon-Cardo,et al.
Robust neutralizing antibodies to SARS-CoV-2 infection persist for months
,
2020,
Science.
[4]
J. A. Cook,et al.
Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study
,
2020,
Journal of Hepatology.
[5]
C. Wanner,et al.
Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe
,
2020,
Kidney International.
[6]
Ankur Khajuria,et al.
The effect of smoking on COVID‐19 severity: A systematic review and meta‐analysis
,
2020,
Journal of medical virology.
[7]
Sharon J Peacock,et al.
Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.
,
2020,
JAMA.
[8]
E. Buscarini,et al.
High rates of 30-day mortality in patients with cirrhosis and COVID-19
,
2020,
Journal of Hepatology.
[9]
R. López-Vélez,et al.
Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort
,
2020,
The Lancet HIV.