Don't postpone surgery of cured asymptomatic persons even if re-test shows positive: Kerala Health Dept

The Health Department has issued an advisory on Thursday against postponing the surgeries of asymptomatic patients who show positive for SARS-CoV-2 virus in a NAAT test done within three months of them being declared cured of COVID-19.

The NAAT positivity in an asymptomatic cured patient is not a sign of lingering infection, the health advisory emphasised.

The advisory said that patients who had been cured of COVID-19 need not undergo re-testing within three months of being declared cured. However, it acknowledges that re-tests would have to be conducted within the period in certain occasions as a matter of routine precaution, like in the case of surgeries, dialysis and also for officials lined up for election duty.

But if re-testing is required within the period, the advisory insists that the test performed should be a rapid antigen test. "In case, NAAT is done, positivity in an asymptomatic individual who has recovered from COVID-19 should be taken only as RNA shedding and should not be equated with infectivity," the advisory stated.

The advisory has been issued in the wake of reports of widespread confusion among cured patients. Field officers have noted that certain cured COVID-19 patients when subjected to RT-PCR test threw up positive results and were, therefore, uncertain of their status.

It is true that a subset of patients with lab-confirmed SARS-CoV-2 infection have been identified to be PCR-positive for a long time after clinical recovery. Viral RNA shedding has also been observed for as long as 104 days from the onset of symptoms in upper respiratory tract specimens.

Here is what the advisory says about this phenomenon: "It is important to note that the identification of SARS-CoV-2 RNA through the RT-PCR test (which identifies the viral RNA shedding) cannot be equated with the presence of viable, infectious virus within a patient." In other words, these are viral remnants not powerful enough to cause infections.

The advisory further said that in mild cases, infective virus cannot be cultured after 10 days and in moderate to severe cases, such infective strains could not be cultured after 15 to 20 days from the onset of symptoms.

Thus, the conclusion. "NAAT positivity beyond this time-frame in asymptomatic recovered patients should not be considered as re-infection within the next three months."

Nonetheless, the advisory said that re-testing should be done on persons who develop symptoms consistent with COVID-19 within three months of being declared cured, especially if there are no other triggers for the symptoms and also if they had developed these symptoms within 14 days of having come into contact with an infected person.

Such persons, the advisory said, should be isolated right from the moment the test is done on them.