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Source: COVID-19 Fallacies  Dec 02, 2020  2 years ago
COVID-19 Fallacies: Woman Still Sheds SARS-CoV-2 Virus After More Than 4 Months Of Getting Infected, Challenging Current Misconceptions
COVID-19 Fallacies: Woman Still Sheds SARS-CoV-2 Virus After More Than 4 Months Of Getting Infected, Challenging Current Misconceptions
Source: COVID-19 Fallacies  Dec 02, 2020  2 years ago
COVID-19 Fallacies: There are lots of variables being used in the management of the current COVID-19 pandemic that are not yet properly and scientifically proven yet they are being adopted major policies. For instance, it has been widely assumed that incubation periods of the SARS-CoV-2 coronavirus is between 5 to 6 days and the maximum it could be 14 days, hence the unreliable quarantine periods of 14 days being imposed in most stupid countries by clueless health authorities. In reality these incubation periods can be anything as it depends on the infecting strains of the SARS-CoV-2 coronavirus and the individual’s genetic makeup along with other factors such as existing comorbidities, age etc. there are already reported documented cases of incubation periods far longer than even 28 days!
 
The same goes for the issues about the current nasal swab PCR tests and even about the subject of viral persistence, about the virus mode of transmission and the issues of being airborne etc.
 
Now one documented case is also challenging the notion about viral shedding that most experts assume to be not more than 17 days after infection.
 
It has been seen that in China, the authorities adopt sweeping measures to contain the virus, from lockdowns to compulsory hospitalization of every known case, regardless of symptoms, until two successive tests were returned negative. This policy aimed to prevent viral transmission from occurring once a case was identified.
 
Shockingly, a new study published in the peer reviewed Journal of Biomedical Research describes a case in which the standard diagnostic measures failed to achieve such containment of transmission. Despite this rigorous approach, the investigators came across a patient who was still shedding SARS-CoV-2 even after two consecutive tests turned out negative. The case came to light during a surveillance study, when a repeat test on the patient turned out to be positive. https://www.jbr-pub.org.cn/article/doi/10.7555/JBR.34.20200099
 
The female patient of about 68 years was admitted on January 21, 2020, with a four-day history of sore throat and a cough. She had been in Wuhan for 15 days before returning to her home city of Nanjing on January 16. There were no specific physical findings, and blood tests were also within normal limits.
The serology test to influenza A and B showed the absence of IgM against these viruses, as well as for parainfluenza. HIV serology was negative. A CT  scan of the chest showed a small characteristic ground-glass opacity in the right lower lobe of the right lung, and SARS-CoV-2 infection was confirmed by a reverse transcriptase-polymerase chain reaction (RT-PCR) performed on a throat swab. She continued to be monitored, and the viral load was measured on alternate days.
 
The female patient was treated with combined antivirals, including aerosolized interferon-α at a dose of 5 million units twice a day, from January 22 to February 5, 2020, along with lopinavir/ritonavir, started a day later, for the same period. She also had intravenous immunoglobulin 20g a day for 5 days starting January 23.
 
However despite these therapies, her illness progressed. On January 25, she became febrile, and pneumonia spread throughout both lungs by January 27, leading to the initiation of methylprednisolone at 40mg a day for five days from January 28. This led to a marked clinical improvement.
 
It w as noted that by February 5, she had three negative tests, one after the other, resulting in her discharge the same day, at 19 days from the first symptom.
 
Importantly following her discharge, she was quarantined at home, in a four-member household. On February 22, a throat swab was taken from her again by the local Center for Disease Control staff, with an inconclusive result. A repeat sample of induced sputum was taken the next day. This turned out to be PCR positive, at 37 days from the onset of symptoms.
 
It was also reported that the patient was completely asymptomatic, and her chest CT showed no signs of a relapse. Nonetheless, local CDC policy dictated that she be readmitted to the hospital because of the positive PCR test. She was monitored by both throat swab and induced sputum PCR, and aerosolized interferon-α was repeated at the same dose, along with arbidol and chloroquine phosphate for 2 weeks and 1 week, respectively. She remained asymptomatic and free of chest signs on CT, but sputum remained persistently positive for the viral RNA even on May 24, more than 4 months from symptom onset.
 
Detailed blood test showed that her lymphocyte count at this time was normal, but the CD8+ T cell count was absolutely and relatively low throughout the illness. During her period of moderate to severe COVID-19, the lymphocyte count dropped still further, but increased in parallel with her clinical improvement.
 
Alarmingly on day 40 and day 43, her serum IgM was slightly elevated above baseline and became normal by day 73. Her IgG levels were a little higher but followed the same declining trend. A surrogate virus neutralization test (sVNT) was carried out for neutralizing antibody titer, and found the effective titer to be only 1:10 to 1:20.
 
It was reported that on day 83, a cytokine analysis showed no evidence of infection or illness, with all tested cytokines like IL-2, IL-4, IL-6, IL-19, TNF-α and IFN-γ within normal limits. A sputum viral culture on April 28, meanwhile, turned out to be negative. This was day 102 from symptom onset.
 
Finally the sputum tested negative from day 129 onwards, in 8 consecutive PCR tests, leading to her discharge on day 137 from symptom onset, still without any symptoms or clinical features.
 
Shockingly the prolonged period of viral shedding, in this case, contrasts sharply with the median period of 17 days as estimated for Wuhan patients. However, in some cases, symptoms may come to an end, but viral shedding continues for up to 60 months, as described in some earlier studies. The current study, however, describes “the longest duration of SARS-CoV-2 viral shedding: for more than 4 months.”
 
Many are now questioning what determines the period of viral shedding?
 
Certain experts have cited high temperature at admission, the time from the onset of symptoms to admission, and the length of hospitalization, as indicators of prolonged shedding. In the current study, this woman was febrile at presentation, and at admission, which occurred 4 days from symptom onset. She also had no comorbidities.
 
According to some experts, the only explanation offered is a potentially low IgG antibody titer, which may indicate that antibody therapy is essential in COVID-19 management. In fact, five patients with critical disease recovered with convalescent plasma therapy. This still does not tell us why this patient continued to shed the virus, even though she had received convalescent plasma containing high titers of neutralizing antibody.
 
Some speculate that reinfection could have occurred, accounting for the late or repeated positive? The researchers think not, in the absence of new symptoms, failure to display IgM antibody rise after the second hospitalization, and lack of exposure since all her family members were negative for the virus.
 
However further studies will show if the viral RNA represents a dead or live infectious virus. One study indicates that the amount of infectious virus is very small, and cannot be isolated after 8 days from the onset. Moreover, none of her three household members were infected, nor did they develop antibodies, despite living with her for 2-3 weeks.
 
The study team suggests, “Viral RNA shedding in the sputum of COVID-19 patients may last for over 4 months. Two consecutive negative nucleic acid tests may not be prerequisite for ending quarantine in such patients.”
 
There are many such documented anomalies being reported all over the whole with regards to incubation periods, viral shedding etc and its time that that the research and scientific community look into these areas in a more detailed perspective as many of the current perceptions which are being used in governmental and health policies to manage the COVID-19 pandemic could be totally wrong and is only exacerbating the situation. The current nasal swab PC tests also needs to be looked into deeply and a more accurate testing platform needs to be developed as viral persistence is another issue which needs to be addressed and fast.
 
For more on COVID-19 Fallacies, keep on logging to Thailand Medical News.
 

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