Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19

Landi, Francesco; Carfi, Angelo; Benvenuto, Francesca; Vincenzo, Bradi; Ciciarello, Francesca; Monaco, Maria Rita Lo; Martone, Anna Maria; Napolitano, Carmen; Pagano, Francesco; Paglionico, Annamaria; Petricca, Luca; Rocchi, Sara; Rota, Elisabetta; Salerno, Andrea; Tritto, Marcello; Gremese, Elisa; Bernabei, Roberto

Introduction As an emerging infectious disease, the clinical and virologic course of coronavirus disease 2019 (COVID-19) require better investigation. The aim of the present study is to identify potential risk factors associated with persistent positive nasopharyngeal swab real-time reverse transcription polymerase chain reaction (RT-PCR) tests in a large sample of patients who recovered from COVID-19. Methods After the acute phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic infection, the Fondazione Policlinico A. Gemelli IRCSS of Rome established a post-acute care service for patients discharged from the hospital and recovered from COVID-19. Between April 21 and May 21, 2020, a total of 137 individuals who officially recovered from COVID-19 were enrolled in the present study. All patients were tested for the SARS-CoV-2 virus with nucleic acid RT-PCR tests. Analysis was conducted in June 2020. Results Of the 131 patients who repeated the nasopharyngeal swab, 22 patients (16.7%) tested positive again. Some symptoms such as fatigue (51%), dyspnea (44%), and coughing (17%) were still present in a significant percentage of patients, with no difference between patients with a negative test compared to those who tested positive. The likelihood of testing positive for SARS-CoV-2 infection was significantly higher among participants with persistent sore throat (prevalence ratio=6.50, 95% CI=1.38, 30.6) and symptoms of rhinitis (prevalence ratio=3.72, 95% CI=1.10, 12.5). Conclusions This study is the first to provide a given rate of patients (16.7%) who test positive on RT-PCR test for SARS-CoV-2 nucleic acid after recovering from COVID-19. These findings suggest that a significant proportion of recovered COVID-19 patients still could be potential carriers of the virus. In particular, if patients continue to have symptoms related to COVID-19, such as sore throat and rhinitis, it is reasonable to be cautious by avoiding close contact, wearing a face mask, and possibly repeating a nasopharyngeal swab.