The Straits Times (28 February 2020)
SINGAPORE - To be doubly sure, patients who recovered are checked again when they return for follow-up
The 66 Covid-19 patients who have been discharged in Singapore no longer have the virus in them and cannot pass the infection on to others, experts at the National Centre for Infectious Diseases (NCID) said.
However, it is not known if patients can get infected more than once, as not enough is known yet about a person’s immune response to the disease.
To be doubly sure, Dr Shawn Vasoo, clinical director of the NCID, said the centre has started taking swabs from patients who are well when they return for a follow-up check two weeks after discharge.
He said it would be rare for a patient to become infectious again, but noted “we will be evaluating this”.
The Japanese authorities said a woman there tested positive for the disease for a second time three weeks after recovering and returning home. But not enough information is available on the case, and the Singapore authorities are reaching out to their Japanese counterparts to determine the exact circumstances.
Reports have also surfaced in China that one in seven patients who has recovered is still infectious.
The Straits Times spoke to experts about how Singapore makes sure patients who are discharged are not infectious, and about the possibility of getting Covid-19 more than once.
Professor Leo Yee Sin, executive director of NCID, said doctors here monitor viral shedding in a patient’s respiratory tract – in other words, they check if the patient is still releasing live virus and thus remains contagious. This is done by taking nasal or throat swabs or sputum.
Virus shedding stops when the patient no longer has the virus in him.
“Patients are discharged only when they have clinically recovered and molecular testing indicates they have stopped shedding the virus,” she said. This means that should they sneeze or cough, there is no release of virus that could contaminate surfaces or infect others.
Many of the patients would be feeling well, especially in the last few days of their hospital stay, but keeping track of viral shedding is a precaution Singapore has taken.
Prof Leo said when tests show that patients are completely cured and no longer have the virus in them, they are still kept in the hospital for at least another day, waiting for the results of a second test done 24 hours after they have received the first all-clear results. Beyond that, she added: “Cases who are discharged are reviewed at our clinic.”
Dr Li Yueping, director of the intensive care unit at China’s Guangzhou No. 8 People’s Hospital, had said that test results of 14 per cent of its patients who had been discharged returned to positive when they went for follow-up checks. However, the hospital also said it was still unclear whether the virus detected in the recovered patients was still active.
Dr Vasoo said this is not surprising – nor is it worrying.
The virus was found in anal swabs.
He said data from the Sars (severe acute respiratory syndrome) outbreak in 2003 found the virus in patients’ stool for about four weeks after they had recovered. But this does not mean the virus is still viable, he said, adding that the virus spreads through droplets. If it is not found in respiratory secretions, people should not be able to infect others.
Even if the virus in the stool is still active, it “should not be a source of transmission with modern sanitation and hygiene being observed”.
On whether discharged patients can be infected again by the coronavirus – as Osaka’s prefectural government said had happened to one of its earlier patients, a female tour bus guide – Dr Vasoo said doctors currently do not know how long patients remain immune to the disease.
“We need to study the immune response of patients infected with Covid-19. At the moment it is unknown if patients infected by Covid-19 will have long-lasting immunity to the virus,” he said.