BREAKING! COVID-19 News: Case Of SARS-CoV-2 RNAemia In Healthy Recovered COVID-19 Patient Opens The Gateway To Numerous Implications!
: It has been generally assumed by medical experts and physicians that once a person recovers from COVID-19,(recovery in this case as per the US CDC guidelines and criteria) it would take a couple for weeks for the viral clearance and that the person would be free from the virus. However due to more cases of emerging long term health complications among recovered and even asymptomatic patients of which some cannot be just attributed to effects caused just during the stages of infection, more experts are believing that viral reservoirs are existing in certain tissue and organs and are continuing to cause damage to the human host but not in the way during initial stages of infection.
A recent case study by researchers from Stanford University School of Medicine and Stanford Blood Center in California involving a blood donor might actually prove this hypothesis and at the same time open the path to numerous other implications.
The case report involved a healthy blood donor who after 40 days of being being officially recovered from COVID-19 exhibited SARS-CoV-2 RNAemia.
The case report also raises questions about the possibility of SARS-CoV-2 coronavirus transmission by blood, how safe are blood transfusions in this COVID-19 era and also guidelines and criteria for classification recovery status and also blood collection and testing protocols at blood banks.
The research findings were published in the journal: Annals of Internal Medicine. https://www.acpjournals.org/doi/10.7326/L20-0725
RNAemia is when the active virus are present in the blood.
It was observed at the Stanford blood bank that asymptomatic donors infected with SARS-CoV-2 may pose a risk to the safety of the blood supply. Previous reports described detection of viral RNA in donor plasma, these donors tested positive for SARS-CoV-2 in a respiratory specimen or developed fever shortly after donation, suggesting that the donation occurred early in the course of their infection.
However in this case report, the donor having recovered for more than 40 days, had the virus in his blood.
The Stanford Blood Center utilized aSARS-CoV-2 real-time, reverse transcriptase polymerase chain reaction (RT-PCR) test blood donations (Stanford Institutional Review Board protocol 55550) targeting the SARS-CoV-2 envelope gene in plasma mini-pools of 6 donors . The RT-PCR has a 95% lower limit of detection of 123 copies/mL (95% CI, 100 to 146 copies/mL) by probit analysis.
The donor in this case had symptoms of upper respiratory infection in early March, including body aches and sore throat without fever. The donor did not seek medical attention and was not tested for SARS-CoV-2 at that time.
The blood bank’s cycle threshold value (Ct) for the positive mini-pool sample was 40.9, and the concerned blood donor sample was positive at a Ct of 42.1—both results at the limit of detection for the assay. The study team confirmed SARS-CoV-2 RNA detection by RT-PCR targeting the nucleocapsid gene (N2 region: Ct, 37.8) (4
) from a separate sample d
rawn from the donor on the day of donation, thereby making cross-contamination highly unlikely. Negative plasma controls were included on each run, and SARS-CoV-2 RNA was not detected.
Serologic testing for antibodies against the SARS-CoV-2 spike protein receptor-binding domain revealed the donor to have positivity at the assay cutoff for IgG (wavelength, 450 nm; optical density, 0.30; cutoff, 0.30), but negativity for IgM and IgA. Additional serologic testing (IgM, IgG, and IgA) against the SARS-CoV-2 spike (S1 domain) and nucleocapsid proteins yielded negative results. Given these equivocal and negative findings, neutralization assays were not performed.
After the donor was notified about the results, and 5 days after the donation date, RT-PCR assay of the donor's nasopharyngeal swab specimen showed no SARS-CoV-2 RNA.
According to the researchers, the confirmation of donor RNAemia more than 1 month after symptom resolution is concerning in light of current guidelines, which do not recommend SARS-CoV-2 screening in the general allogeneic bllod donor population.
Significantly in this case, plasma viral RNA was reproducibly detected at a time point that exceeded recommendations for deferral based on time since symptom resolution (14 days). Of importance, these results are unlikely to be false-positive given that 2 different regions of the SARS-CoV-2 genome were detected in separate specimens collected on the day of donation and that quality control passed on all runs, including the absence of amplification in the negative controls.
It should be noted however, the infectivity of SARS-CoV-2 from blood remains unknown and, to date, medical researchers are not aware of cases of transfusion-transmitted COVID-19. Furthermore, the risk for transmission of other transfusion-transmitted viral infections, such as HIV-1, is correlated with virus load, indicating that if blood-borne transmission is possible, the low level of SARS-CoV-2 detected in this case was unlikely to be transmitted. Taken together, these data suggest that this donor posed a limited but uncertain risk to the safety of the blood supply.
This case raises alarms about blood donation policies, particularly as infections increase with the relaxation of shelter-in-place orders worldwide. Although this case is insufficient to recommend universal SARS-CoV-2 blood screening, out of an abundance of caution and in the interest of further defining the risk to the blood supply, it is highly recommended to continue donor screening for SARS-CoV-2 RNA and has extended the deferral period from 28 to 56 days after resolution of symptoms.
This case also highlights the possible presence of the active virus in the blood of recovered individuals and has implications as to how recovery criteria and guidelines are being based on and also has implications of long term health complications.
The key question is ...are we approaching the whole recovery criteria the wrong way? Besides just nasal swabs for testing or even saliva these days, should not blood testing also be used? Should we not be approaching it similarly to a certain degree as in HIV ie blood test and viral load testings. Why are we making assumptions and only basing recovery from virus present in the nasal swabs?
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