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Some COVID-19 patients still have coronavirus after symptoms disappear, possibly endangering health workers

The message is clear: Nurses and physicians should treat asymptomatic patients as carefully as symptomatic patients.

Jeff Lagasse, Associate Editor

About half of patients treated for mild COVID-19 infection still had coronavirus for up to eight days after symptoms disappeared -- something that healthcare workers may want to keep in mind as they remain on the front lines in treating those afflicted with the rapidly spreading disease.

In "Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection," the authors reported on a study of 16 patients with COVID-19 who were treated and released from the Treatment Center of PLA General Hospital in Beijing between January 28 and Feb. 9. The patients were about 35.5-years-old, on average.

Researchers collected samples from throat swabs taken from all patients on alternate days and analyzed. Patients were discharged after their recovery and the confirmation of negative viral status by at least two consecutive polymerase chain reaction tests.

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Patients kept "shedding" the virus for up to eight days even after the resolution of their symptoms, and since their symptoms were mild, there's reason to believe that those with more severe infections may have the ability to spread the virus for even longer.

WHAT'S THE IMPACT

The primary symptoms in the Beijing patients included fever, cough, pain in the pharynx and difficult or labored breathing. Patients were treated with a range of medications.

The time from infection to onset of symptoms (incubation period) was five days among all but one patient. The average duration of symptoms was eight days, while the length of time patients remained contagious after the end of their symptoms ranged from one to eight days. Two patients had diabetes and one had tuberculosis, neither of which affected the timing of the course of COVID-19 infection.

For anyone infected with the coronavirus, the authors cautioned that anyone with mild respiratory symptoms who is already staying at home should extend their quarantine another two weeks after recovery to ensure they're not infecting other people.

For healthcare workers, the message was simple: Since COVID-19 patients can still be infectious even after their symptomatic recovery, nurses and physicians should treat asymptomatic patients as carefully as symptomatic patients.

That's especially critical given that healthcare workers are more at risk of contracting the virus due to the nature of their jobs.

The researchers emphasized that all of these patients had milder infections and recovered from the disease, and that the study looked at a small number of patients. They noted that it is unclear whether similar results would hold true for more vulnerable patients such as the elderly, those with suppressed immune systems and patients on immunosuppressive therapies.

THE LARGER TREND

Dr. James Adams of Northwestern University's Feinberg School of Medicine, and Dr. Ron Walls of Harvard Medical School, wrote in a recent paper that the combination of stress and possible exposure puts healthcare professionals at greater risk of contracting COVID-19 and potentially spreading it to others -- which adds to the risk of overstress due to burnout.

There are, however, some best practices that have started to emerge that can help to protect those on the front lines.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com