Recurrent SARS-CoV-2 RNA positivity after COVID-19: A systematic review and meta analysis

Azam, Mahalul; Sulistana, Rina; Ratnawati, Martha; Fibriana, Arulita Ika; Bahrudin, Udin; Aljunid, Syed Mohamed

Background: Previous studies reported recurrent SARS CoV2 RNA positivity in individuals who had recovered from COVID 19 infections. However, little is known regarding the systematic review of recurrent SARS-CoV-2 RNA positivity. The current study conducted a systematic review and meta-analysis, 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. Methods: 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. Results: Fourteen studies of 2,568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.81% (95% confidence interval [CI]: 11.44-18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.44 days (95% CI: 32.65-38.24 days), and from the last negative to recurrent positive result was 9.76 days (95% CI: 7.31-12.22 days). Patients with younger age (mean difference [MD]=-2.27, 95% CI: -2.95 to -1.80) and a longer initial illness (MD=8.24 days; 95% CI: 7.54-8.95; I2=98.9%) were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes (RR=0.52; 95% CI: 0.30-0.90; I2=53%), severe disease (RR=0.54; 95% CI: 0.35-0.84; I2=70%), and a low lymphocyte count (RR=0.58; 95% CI: 0.39-0.86; I2=48%) were less likely to experience recurrent SARS CoV 2 positivity. Conclusions: The incidence of recurrent SARS CoV 2 positivity was 14.81%. The estimated interval from disease onset to repeat positivity was 35.44 days, and the estimated interval from the last negative result to recurrent positive result duration was 9.76 days.