Although there is no conclusive data on whether persons deemed recovered from Covid-19 but retest positive could spread the virus to other people, research from a number of institutions have been suggesting that so far it appears as if they don't.
On Thursday, the Consortium was provided with a letter sent to a Covid-19 patient from Dept. of Health Territorial Epidemiologist Dr. Esther Ellis, advising the patient that she was cleared to rejoin the community. "Based on the resolution of symptoms as self-reported to the Virgin Islands Department of Health, [name redacted] may discontinue home isolation and resume normal activities effective August 15th," reads the letter from D.O.H.
Going based on Centers for Disease Control and Prevention guidelines, D.O.H. does not require persons who contract the novel coronavirus to be tested a second time before being cleared as recovered. Instead, the department relies on those persons to self-report their condition, and after a 10-day period of quarantine for most patients, they are advised to leave quarantine.
The person who received the letter attempted to report back to work, however her employer said she needed to be tested a second time. When the employee retested, her result came back positive. The gray area is whether this employee had actually recovered and, as new research assume, had traces of the virus in her body that were not transmissible or whether this person was still sick with the virus.
Research performed by the Korea Centers for Disease Control and Preventions (KCDC), which was initiated on April 14 following growing concern at the time that persons who had been discharged were testing positive, concluded that the positive results were probably not transmissible. The research found that between 12.8 percent to 48.9 percent of individuals who had tested positive for the virus and had recovered and discharged, still yielded positive results. This could either mean that the two-week quarantine period was not enough or the traces found in the discharged patients were not potent enough to infect anyone.
The research suggested the latter: "For the 285 re-positive cases investigated, a total of 790 contacts were found," stated the research. "Minimum 14-day monitoring found 27 of the contacts to be positive, 24 of which were cases that were previously confirmed."
Additionally, there were 3 newly confirmed cases from the 790 contacts of re-positive cases, all of whom had probably been in contact with persons who were infected outside of the cases that retested positive, the research found.
In March, World Health Organization Director General Tedros Adhanom Ghebreyesusm, said, "People infected with COVID-19 can still infect others after they stop feeling sick." At the time, the W.H.O. was still recommending that people who were confirmed positive with Covid-19 would require a second test before being released from isolation. In June, the W.H.O. said its recommendation was "based on our knowledge and experience with similar coronaviruses, including those that cause SARS and MERS."
The latest W.H.O. criteria for discharging patients from isolation (including discontinuing transmission-based precautions) without requiring retesting was issued on June 17. They include:
- For symptomatic patients: 10 days after symptom onset, plus at least 3 additional days without symptoms (including without fever [and without respiratory symptoms)
- For asymptomatic cases: 10 days after positive test for Covid-19
"For example, if a patient had symptoms for two days, then the patient could be released from isolation after 10 days + 3 = 13 days from date of symptom onset. For a patient with symptoms for 14 days, the patient can be discharged (14 days + 3 days =) 17 days after date of symptom onset. For a patient with symptoms for 30 days, the patient can be discharged (30+3=) 33 days after symptom onset)," the W.H.O. explained.
According to Boston media firm WBUR, the question of whether a positive test means someone is still contagious is becoming very difficult for some hospitals in the state of Massachusetts. Dr. Richard Ellison, epidemiologist at Central Massachusetts-based UMass Memorial Medical Center, said it’s hard to know what precautions to take when patients who appear to have recovered from COVID-19 come back with complications or for surgery or because they’ve had an accident.
“Do hospitals say we have to treat this person the same way we treat someone who is very sick with COVID right now?” he asked. “We’ve got limited supplies of gowns and gloves and masks. Do we want to use these taking care of some unnecessarily?”
Dr. Ellison said patients who continue to test positive but are ready for discharge are a challenge for hospitals as well. He said he has encountered patients who live in nursing homes or assisted living apartments who can’t go home because their facility requires two negative tests. According to WBUR, Dr. Ellison said test results are needed that show a low positive or high positive, for example, or that tell someone whether the virus is active or dead. Those tests aren’t available yet.
“Right now we’re getting a black and white answer,” he said, according to WBUR. “The test is positive or it’s negative, but we’re not getting variation in that.”
As to why a Covid-19 test may still find signs of the virus weeks and months in someone who has been deemed "recovered", Dr. Erica Shenoy, associate chief of infection control at Massachusetts General Hospital explained to WBUR that the test looks for genetic material that signals the presence of the virus.
“It doesn’t tell you if it’s alive,” she said. “So just because you identify virus through this test does not mean that the person is infectious and capable of spreading disease to others.”
Even so, the USVI's discharging strategy may need revisiting, especially with the mounting number of cases and the high amount of individuals being cleared to rejoin the community. The department at one point had to explain to this publication confusing Covid-19 recovered numbers.
D.O.H. listed as recovered 39 individuals between Tuesday and Wednesday, and 26 between Wednesday and Thursday, for a total of 65 recoveries in the last two days. Between Thursday and Friday, the number decreased significantly to 6. The department said 655 people had recovered as of Friday, while 295 remained active.
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