COVID-19 relapse: Can you get coronavirus infection twice?

According to the current global treatment protocols, patients who have been tested COVID-19 positive have to go into an immediate quarantine - at home or in a hospital, depending on the severity of the symptoms, age, underlying conditions like heart disease, hypertension, diabetes, lung disease, etc. Once the current treatment protocol is complete, the patient is tested twice. 

It’s only after two consecutive negative RT-PCR test results that patients of COVID-19 are being discharged. Two tests are done to ensure no false negatives, and that the patient’s body has indeed developed antibodies against the COVID-19 virus and infection. 

However, since there have been some cases of relapses in China and one in Japan - where doctors and epidemiologists have ensured that the patients did have two consecutive negative tests - it begs the question if what scientists know about viruses and the production of antibodies actually works in the case of COVID-19 or not.

Scientists at the American Thoracic Society have found that recovered patients continued to shed the virus for days after two consecutive negative tests for COVID-19. The scientists - who did their study with 16 patients in Beijing, China - published their findings in the American Journal of Respiratory and Critical Care Medicine in a paper titled "Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection" on 23 March 2020. Of course, more research needs to be done to determine if this viral load is high enough to cause a relapse or infect another person. What the researchers did recommend, for now, was to extend the period of quarantine for patients by two more weeks after recovery.

Relapses of a disease as contagious as COVID-19 is a cause for concern. Patients who have been cleared to go home after two negative tests are naturally going to feel relief and look forward to their rehabilitation. However, a relapse can take a physical as well as a mental toll on the patient - not to mention the load it can be on an already overworked global healthcare community.

The current cases of relapses in China and Japan have therefore been studied properly to understand if the risk of relapse is high globally. Studies published in journals like Cell Death and Differentiation, the British Medical Journal and the International Journal of Infectious Diseases in March 2020 have thrown some light on these cases.

These studies reveal that there can be three causes behind these relapses:

• The patients were simply not fully recovered despite meeting the discharge criteria, i.e. not showing any symptoms and swab tests, chest X-rays, etc., showing no visible presence of the virus.
• The RT-PCR test results showed false negatives before their discharge, which means the virus was not eliminated completely.
• The patient’s immune system was unable to induce any virus-eliminating response to COVID-19, despite the symptoms becoming less severe or abating completely. 

Given these causes, it’s very important to continue proper surveillance and treatment of existing patients to make sure their immune responses are properly monitored until complete recovery. These causes also need to be taken into account by researchers and epidemiologists attempting to create vaccines for COVID-19.

While it can be extremely worrying to experience a relapse of COVID-19, both for you as well as your loved ones, it’s important to not lose hope. This means that you’ll have to continue with your isolation, and whether you’re doing so at home or at a hospital would not make much of a difference mentally, since feeling anxious and cut-off from civilisation is quite natural during a crisis like this.

What you need to continue focusing on is defeating this virus and eliminating it completely from your system. Cooperate fully with all healthcare professionals and be patient with them. This is as much a novel scenario for them as it is for you. Keep in touch with your family and loved ones through phone calls and video calls. Focus your energy on eating well, exercising (if recommended by the doctors), reading books and meditating to de-stress.