Recovered, almost: China's early patients unable to shed coronavirus
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[April 22, 2020]
By Brenda Goh
WUHAN, China (Reuters) - Dressed in a
hazmat suit, two masks and a face shield, Du Mingjun knocked on the
mahogany door of a flat in a suburban district of Wuhan on a recent
morning.
A man wearing a single mask opened the door a crack and, after Du
introduced herself as a psychological counsellor, burst into tears.
"I really can't take it anymore," he said. Diagnosed with the novel
coronavirus in early February, the man, who appeared to be in his 50s,
had been treated at two hospitals before being transferred to a
quarantine centre set up in a cluster of apartment blocks in an
industrial part of Wuhan.
Why, he asked, did tests say he still had the virus more than two months
after he first contracted it?
The answer to that question is a mystery baffling doctors on the
frontline of China's battle against COVID-19, even as it has
successfully slowed the spread of the coronavirus across the country.
Chinese doctors in Wuhan, where the virus first emerged in December, say
a growing number of cases in which people recover from the virus, but
continue to test positive without showing symptoms, is one of their
biggest challenges as the country moves into a new phase of its
containment battle.
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Those patients all tested negative for the virus at some point after
recovering, but then tested positive again, some up to 70 days later,
the doctors said. Many have done so over 50-60 days.
The prospect of people remaining positive for the virus, and therefore
potentially infectious, is of international concern, as many countries
seek to end lockdowns and resume economic activity as the spread of the
virus slows. Currently, the globally recommended isolation period after
exposure is 14 days.
So far, there have been no confirmations of newly positive patients
infecting others, according to Chinese health officials.
China has not published precise figures for how many patients fall into
this category. But disclosures by Chinese hospitals to Reuters, as well
as in other media reports, indicate there are at least dozens of such
cases.
In South Korea, about 1,000 people have been testing positive for four
weeks or more. In Italy, the first European country ravaged by the
pandemic, health officials noticed that coronavirus patients could test
positive for the virus for about a month.
As there is limited knowledge available on how infectious these patients
are, doctors in Wuhan are keeping them isolated for longer.
Zhang Dingyu, president of Jinyintan Hospital, where the most serious
coronavirus cases were treated, said health officials recognised the
isolations may be excessive, especially if patients proved not to be
infectious. But, for now, it was better to do so to protect the public,
he said.
He described the issue as one of the most pressing facing the hospital
and said counsellors like Du are being brought in to help ease the
emotional strain.
"When patients have this pressure, it also weighs on society," he said.
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DOZENS OF CASES
The plight of Wuhan's long-term patients underlines how much remains
unknown about COVID-19 and why it appears to affect different people in
numerous ways, Chinese doctors say. So far global infections have hit
2.5 million with over 171,000 deaths.
As of April 21, 93% of 82,788 people with the virus in China had
recovered and been discharged, official figures show.
Yuan Yufeng, a vice president at Zhongnan Hospital in Wuhan, told
Reuters he was aware of a case in which the patient had positive retests
after first being diagnosed with the virus about 70 days earlier.
"We did not see anything like this during SARS," he said, referring to
the 2003 Severe Acute Respiratory Syndrome outbreak that infected 8,098
people globally, mostly in China.
Patients in China are discharged after two negative nucleic acid tests,
taken at least 24 hours apart, and if they no longer show symptoms. Some
doctors want this requirement to be raised to three tests or more.
China's National Health Commission directed Reuters to comments made at
a briefing Tuesday when asked for comment about how this category of
patients was being handled.
Wang Guiqiang, director of the infectious disease department of Peking
University First Hospital, said at the briefing that the majority of
such patients were not showing symptoms and very few had seen their
conditions worsen.
"The new coronavirus is a new type of virus," said Guo Yanhong, a
National Health Commission official. "For this disease, the unknowns are
still greater than the knowns."
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![](../images/042220pics/news_m27.jpg)
Medical personnel in protective suits wave hands to a patient who is
discharged from the Leishenshan Hospital after recovering from the
novel coronavirus, in Wuhan, the epicentre of the novel coronavirus
outbreak, in Hubei province, China March 1, 2020. China Daily via
REUTERS
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REMNANTS AND REACTIVATION
Experts and doctors struggle to explain why the virus behaves so
differently in these people.
Some suggest that patients retesting as positive after previously
testing negative were somehow reinfected with the virus. This would
undermine hopes that people catching COVID-19 would produce
antibodies that would prevent them from getting sick again from the
virus.
Zhao Yan, a doctor of emergency medicine at Wuhan's Zhongnan
Hospital, said he was sceptical about the possibility of reinfection
based on cases at his facility, although he did not have hard
evidence.
"They're closely monitored in the hospital and are aware of the
risks, so they stay in quarantine. So I'm sure they were not
reinfected."
Jeong Eun-kyeong, director of the Korea Centers for Disease Control
and Prevention, has said the virus may have been "reactivated" in 91
South Korean patients who tested positive after having been thought
to be cleared of it.
Other South Korean and Chinese experts have said that remnants of
the virus could have stayed in patients' systems but not be
infectious or dangerous to the host or others.
Few details have been disclosed about these patients, such as if
they have underlying health conditions.
Paul Hunter, a professor at the University of East Anglia's Norwich
School of Medicine, said an unusually slow shedding of other viruses
such as norovirus or influenza had been previously seen in patients
with weakened immune systems.
In 2015, South Korean authorities disclosed that they had a Middle
East Respiratory Syndrome patient stricken with lymphoma who showed
signs of the virus for 116 days. They said his impaired immune
system kept his body from ridding itself of the virus. The lymphoma
eventually caused his death.
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Yuan said that even if patients develop antibodies, it did not
guarantee they would become virus-free.
He said that some patients had high levels of antibodies, and still
tested positive to nucleic acid tests.
"It means that the two sides are still fighting," he said.
MENTAL TOLL
As could be seen in Wuhan, the virus can also inflict a heavy mental
toll on those caught in a seemingly endless cycle of positive tests.
Du, who set up a therapy hotline when Wuhan's outbreak first began,
allowed Reuters in early April to join her on a visit to the
suburban quarantine centre on the condition that none of the
patients be identified.
One man rattled off the names of three Wuhan hospitals he had stayed
at before being moved to a flat in the centre. He had taken over 10
tests since the third week of February, he said, on occasions
testing negative but mostly positive.
"I feel fine and have no symptoms, but they check and it's positive,
check and it's positive," he said. "What is with this virus?"
Patients need to stay at the centre for at least 28 days and obtain
two negative results before being allowed to leave. Patients are
isolated in individual rooms they said were paid for by the
government.
The most concerning case facing Du during the visit was the man
behind the mahogany door; he had told medical workers the night
before that he wanted to kill himself.
"I wasn't thinking clearly," he told Du, explaining how he had
already taken numerous CT scans and nucleic acid tests, some of
which tested negative, at different hospitals. He worried that he
had been reinfected as he cycled through various hospitals.
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His grandson missed him after being gone for so long, he said, and
he worried his condition meant he would never be able to see him
again.
He broke into another round of sobs. "Why is this happening to me?"
(Reporting by Brenda Goh; Additional reporting by Jack Kim in Seoul,
Elvira Pollina in Milan, Belen Carreno in Madrid, and Shanghai
newsroom; Editing by Philip McClellan)
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