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Patient Tested COVID-19 Positive even after 4 Months of Symptom Onset

A 68-year-old woman was admitted on 21 January 2020, with a four-day history of sore throat and cough. She had been to Wuhan in 15 days before returning to her home city. RT-PCR test confirmed COVID-19. She was treated with antivirals, including aerosolized interferon-alpha. Her illness progressed despite these therapies.

On 25th January. pneumonia spread to both lungs and methylprednisolone was initiated. By the 5th of February, she had three negative tests and was discharged 19 days from the first symptom onset. She was further quarantined home and a swab test on February 22 was inconclusive. At 37 days from symptom onset, she was found to be PCR positive. She was asymptomatic and her chest CT revealed no signs of a relapse. As per the local CDC policy, she was hospitalized. Her lymphocyte count was normal. On day 40, her serum IgM was slightly elevated and was normal by day 73.

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. On day 83 cytokine analysis revealed no infection. The sputum tested negative from day 129 onwards, in 8 consecutive PCR tests. Her positive tests could be attributed to prolonged viral shedding. What determines the period of viral shedding? Some 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.

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