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In South Korea, recovered patients test positive

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SEOUL (The Wall Street Journal) — More than 160 South Koreans have tested positive a second time for the coronavirus, a development that suggests the disease may have a longer shelf life than expected.

Many had volunteered for re-examination after exhibiting symptoms such as coughing. Others submitted to extra testing on little more than a hunch despite not showing symptoms. So far, these patients — all of whom needed to twice test negative before leaving medical supervision — haven’t spread the virus to others, local health officials say. The initial belief, according to South Korean doctors directly involved with a government review, is that the virus has “reactivated” in the patients, meaning the disease went dormant and came back. The research remains ongoing and inconclusive. The Seoul government’s report will take at least a month to complete, they say.

South Korea is closely watched as an early indicator of how Covid-19 lingers across a population, having flattened its curve of new infections and now contemplating an unwinding of social-distancing measures. The results showing people testing positive a second time could signal a worrisome potential for the virus to linger that could affect health policy.

“It may be that you have to test these recovered people every month for symptoms or viruses,” said Mary Guinan, a former chief scientific adviser to the U.S. Centers for Disease Control and Prevention director. “Maybe it comes and goes. We don’t know.”

The development could add extra pressure on governments’ testing supply and availability. It also raises the stakes for those who fall ill, as their battle against the disease may last much longer than previously imagined. China, Japan and India have also reported cases of recovered patients testing positive again.

Medical experts are still struggling to understand many aspects of the new coronavirus and the disease it causes, Covid-19. The coronavirus appears to colonize in the human body in two stages. Initially, the upper respiratory passages of the nose and sinus are infected. As the infection progresses and becomes more severe, the virus spreads into the lower respiratory tract and the lungs, where it may linger and become more difficult to detect by testing kits used world-wide.

Prior coronavirus strains, such as MERS and SARS, didn’t have significant cases of reactivation or reinfection, dissipating quickly after the first time a person gets ill, said Deenan Pillay, a virology professor at University College London.

South Korean health officials and advisers, based on their initial review of the results, don’t suspect inaccurate testing to be a culprit. Test-kit makers and laboratories say South Korea’s kits have a 95% sensitivity to the coronavirus.

The World Health Organization, which has been in touch with Seoul officials, acknowledged this week that not all recovered patients appear to have the antibodies to stave off a second infection.

The cases occurred an average of 13.5 days after patients were discharged, according to South Korea’s Centers for Disease Control and Prevention, lowering the likelihood they crossed paths with the illness for a second time.

South Korean doctors are seeking more data to confidently determine that the patients had tested positive again with the same virus and haven’t infected others. But health officials have refrained from labeling them as “reinfections.”

For weeks, South Korea, with 10,635 confirmed cases as of Friday, was the most hard-hit country other than China. But it slowed infections through widespread testing, aggressive contact tracing and citizens voluntarily staying indoors. Its national legislative election last week drew the highest turnout since 1992.

Until last week, the Seoul government had no national policy requiring discharged virus patients get retested after leaving a medical facility. But recently, local government officials have tested entire facilities such as nursing homes, including recovered coronavirus patients. On Tuesday, local governments received guidelines from South Korea’s CDC advising that discharged patients be under quarantine for 14 days while their symptoms are monitored.

The country’s number of patients testing positive again for coronavirus nearly doubled this week to 162. The first case was a 73-year-old woman who had been discharged on Feb. 22. She called the health clinic five days later, reporting minor symptoms. The patient had remained home after being released. She hadn’t come in contact with anyone else during the five days and remained at home alone, according to health authorities. She was hospitalized after testing positive once again on Feb. 28.

The patient’s immune system had been weakened due to old age, which health officials believe contributed to the second positive result because she didn’t develop enough antibodies.

“It’s clear that we don’t fully understand what it means to have immunity against this virus,” said Keiji Fukuda, a former WHO official who worked on other recent major outbreaks.

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