More and more doctors are seeing former Covid-19 patients return to consult them about six weeks after leaving hospital with symptoms that are not respiratory.
“Covid-19 could become a chronic disease”. From China to France, more and more doctors are seeing former Covid-19 patients return to consult them about six weeks after leaving hospital with symptoms that are not respiratory. “They complain of diarrhoea, muscle or joint pain, lividoses [marbrures sur les jambes, NDLR] or skin manifestations”lists Benjamin Davido, infectious disease specialist who works at the Raymond-Poincaré Hospital (Garches) in the Paris region, with Futura-Sciences. In the majority of cases, the patients are women and rather young. Half of them test positive for Covid-19.
In China, doctors have reported similar cases. In Wuhan, the cradle of the epidemic, for example, a patient remained positive for 49 days. As of April 24, according to Jiao Yahui, an inspector with the National Health Commission of Hubei Province, where Wuhan is located, more than 30 recovered Covid-19 patients continued to test positive. Chinese doctors have also reported some cases having tested negative after being infected and then coming back positive without showing symptoms.
This phenomenon is a real headache for hospitals. If they normally only have the right to let cured patients leave after two negative PCR tests, in order to be certain that they are no longer contagious, in France, the rule has been abandoned because it is too complicated. “We keep cured patients unnecessarily when they could benefit from rehabilitation care sooner”, explains Benjamin Davido. Not to mention the lack of beds and the financial and psychological cost for people condemned to be isolated for several weeks and perpetually worried.
The vagueness of the tests
The infectious disease specialist is also very skeptical about the tests. Indeed, PCR tests which are based on the detection of the genome in nasopharyngeal samples say little about the presence of the virus in the body. After a while, SARS-CoV-2 will lodge in the lungs and is no longer detectable. Thus, people detected positive twice several weeks apart would be due to a release of pieces of dead virus in the body. It is therefore unknown whether they would be contagious again or not. For now, even serological tests that measure antibodies are unable to give conclusive results regarding immunity.
In China, several epidemiologists argue, however, that recovered patients who continue to test positive are probably no longer infectious. For them, it also seems unlikely that a human can carry the virus all his life. According to Rong Meng, an infectious disease expert at Ditan Hospital in Beijing, although the virus has continued to be detected in some recovered patients, studies have shown that they are much less contagious in these cases. What’s more, a positive result in a nucleic acid test does not necessarily mean that the virus is active, he recalls.
According to Zhang Boli, president of the Tianjin University of Traditional Chinese Medicine, genome sequencing of the remaining viruses from some cured Covid patients showed that the virus had died. This could therefore suggest that only traces of the genetic material of SARS-CoV2 remained in the patients’ bodies.
A second wave of new symptoms?
The case of the man who tested positive for the virus for 49 days in Wuhan is exceptional. This patient presented with fever and other symptoms on January 25 but recovered after a week of treatment. He later tested positive for the virus on February 8. In the following weeks, he underwent nine nucleic acid tests. He tested negative only once, on March 11. He also underwent two antibody tests in late February which came back positive for one form of immunoglobulin but negative for another. These results suggest that the infection persisted for a time but subsided from the acute phase, explain the doctors who treated him.
On March 15, the patient received plasma therapy, which involves transfusing antibody-rich blood components. A few hours later, he suffered from a high fever but his temperature returned to normal the next day. For the next two days, his tests for the virus came back negative. “Without plasma treatment, this patient could become a case of chronic infection.explain the doctors to the newspaper Caixin. We want to know how many patients have similar situations.”
Thereby, “Covid-19 could become a chronic disease”, comments Wang Qingshu, a doctor at Wuhan Hospital. The dreaded second wave of Covid is that of patients returning to hospital with various symptoms after being discharged. However, for Benjamin Davido, this phenomenon is not unique to the coronavirus: it may well be that many previously unexplained illnesses are linked to previously caught viruses. “In many autoimmune diseases, such as lupus or reactive arthritis, there is no identified cause. Sometimes people never even consult. Here, because patients have tested positive for coronavirus, we link their symptoms to that”he explains to Futura-Siences.
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