Mar 07, 2020 08:25 AM

Covid-19 Relapse Mystery May Be Linked to Controversial Treatment, Researchers Say

Doctors try to understand why recovered Covid-19 patients test positive again. Photo: Bloomberg
Doctors try to understand why recovered Covid-19 patients test positive again. Photo: Bloomberg

The mystery of recently recovered Covid-19 patients testing positive for the virus again may have to do with a controversial strategy for treating the disease, the biological characteristics of the pathogen, or patients’ clinical status and underlying conditions, according to frontline doctors in Wuhan.

Doctors led by Liu Hui Guo, a respiratory physician at Huazhong University of Science and Technology’s affiliated hospital, warn that the virus is “sly” and not fully understood in a research paper published by the Chinese Journal of Tuberculosis and Respiratory Diseases.

Recovered patients tested positive again in several provinces, raising concerns that the outbreak could gain ground again following days of declines in new infections in most parts of China. Some experts suggested that the phenomenon may reflect lax discharge criteria or that the virus is just too hard to eliminate. Such cases were reported in southern Guangdong as well as in Tianjin, Sichuan, Hubei and Hunan. A 36-year-old man died of Covid-19 just five days after being declared recovered from the disease and being discharged from a hospital.

In their paper, Liu and colleagues suggest that positive tests among recovered patients might be a characteristic of the new virus and reflect the lack of a deep, comprehensive understanding of it. The article doesn’t provide a clear definition of “relapse,” and so far there are no reports of whether those who test positive again have symptoms or infect other people.

Older patients and those with poor immune systems and underlying diseases are at greater risk of relapse, the researchers write. These patients are also prone to infection in the first place. Some recovered patients with diabetes and high blood pressure might have the virus not completely eliminated and be more prone to contracting other bacterial infections once released from hospitals, the authors say.

The controversial use of Glucocorticoids is also linked to cases of relapse, according to the paper. Glucocorticoids are a class of steroid hormones that are highly effective at reducing inflammation and suppressing the immune system in the treatment of Covid-19.

Though this treatment can inhibit a cytokine storm set off by the immune system in response to the virus and prevent further aggravation of lung damage, the steroid can also cause patients to retain the virus for longer periods of time, making it even harder to eliminate, the paper says.

The researchers also say the possibility of virus variation can’t be ruled out. As Covid-19 is a new infectious disease, it’s unknown how much protection antibodies in recovered patients provide or how long they may be effective, the paper says. It’s also unclear whether recovered people can be infected again if they are re-exposed to the virus.

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The paper suggests classifying Covid-19 patients into four groups: common patients without steroid treatment, common patients with steroid treatment, patients ages 60 or older, and recovered severe patients.

Each group could then have differentiated discharge criteria, the authors say. For example, perhaps patients who received steroid treatments should have stopping taking the medications and recorded normal temperature readings for at least a week before they are discharged, the paper suggests.

All recovered patients should be under quarantine and observation for at least two weeks upon discharge, the authors write. This suggestion conforms with the newest edition of treatment plans issued by the National Health Commission.

Contact reporter Denise Jia ( and editor Bob Simison (

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