A 36-year-old man has died of respiratory failure in Wuhan, five days after being discharged from one of the makeshift hospitals built to contain the outbreak, according to a report by Shanghai-based news portal The Paper.
The report, which was later removed, said Li Liang had been admitted to the hospital – built to treat patients with mild and moderate symptoms – on February 12, according to his wife, surnamed Mei. He was discharged two weeks later with instructions to stay in a quarantine hotel for 14 days.
Mei said her husband was not feeling well two days after leaving the hospital, with dry mouth and gaseous stomach. On March 2, Li said he felt sick and was sent to a hospital, where he was certified dead that afternoon.
The death certificate issued by the Wuhan health commission said the direct cause was Covid-19, and listed respiratory blockage and failure as the symptoms which could have led to his death.
The Paper also reported that Fangcang Hospital – one of Wuhan’s makeshift facilities – issued an emergency notice on Wednesday that said more discharged patients had been readmitted after falling ill again. The hospital will begin conducting antibody tests on all patients before discharge from Thursday, to ensure they are fully recovered.
Xi Jinping’s state visit to Japan postponed
In the first official confirmation that the coronavirus outbreak will disrupt China’s diplomatic agenda, Tokyo said Chinese President Xi Jinping’s state visit to Japan – planned for early April – had been postponed.
Japan’s Chief Cabinet Secretary Yoshihide Suga said the delay would not affect relations between the Asian neighbours. Both countries had agreed to prioritise the fight against the coronavirus and a new itinerary would be arranged, he said.
Special clinic for recovered patients
A rehabilitation clinic for recovered Covid-19 patients opened on Thursday at the Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan.
The clinic will provide specific services to patients who are in isolation after their discharge from hospital. At present, recovered patients can consult doctors via the internet with delivery services for their medicines.
The clinic will mainly prescribe Chinese herbal medicines and also follow up with discharged patients and provide face-to-face consultation in the future. Zhang Qing, from the Hubei Provincial Hospital of Traditional Chinese Medicine, said patients highly recognised the effectiveness of herbal medicines.
Strict measures continue in Wuhan
Wuhan party chief Chen Yixin said on Wednesday the battle of Wuhan had entered a “critical” stage and ordered an inspection of people from other parts of the country still stranded in the city. Strict measures should remain in place, he said.
“The situation facing epidemic control in Wuhan is still complicated. We will not be able to contain the spread if we do not impose unified strict measures,” Chen said, according to the social media account of the Communist Party politics and law commission.
China reports 139 new infections
Mainland China reported 139 new cases of Covid-19, the disease caused by the coronavirus, on Thursday, up from 119 a day earlier, as well as 31 new deaths.
The National Health Commission said 134 of the new infections were in Hubei, epicentre of the outbreak, with 131 in its provincial capital Wuhan. All of the latest deaths also occurred in the province.
As of Wednesday, 80,409 people had been infected on the mainland, and 3,012 have died. Some 52,045 patients had recovered from the disease. The commission also said there had been 20 imported cases – a worrying development for China which has prompted some cities to introduce quarantine measures.
China recognises whistle-blower doctor
China has included the whistle-blower doctor Li Wenliang, who died of Covid-19, among a group of people recognised for their help in the fight against the epidemic.
Li, a 34-year-old ophthalmologist, warned a group of medical school classmates on December 30 about an outbreak at his hospital in Wuhan of a mysterious viral pneumonia resembling severe acute respiratory syndrome (Sars), which infected more than 8,000 people and killed 813 worldwide.
Li, who died on February 7, was among 506 healthcare and response workers recognised by the National Health Commission on its website on Thursday.
Singapore research highlights need for disinfectant
New research from Singapore indicates patients with the deadly coronavirus extensively contaminate their bedrooms and bathrooms, underscoring the need to routinely clean high-touch surfaces, basins and toilet bowls.
The virus was however killed by twice-a-day cleaning of surfaces and daily cleaning of floors with a commonly used disinfectant – suggesting current decontamination measures were sufficient as long as people adhered to them.
The research letter was published on Wednesday in the Journal of the American Medical Association following cases in China where the pathogen spread extensively through hospitals, infecting dozens of health care workers and other patients.
California declares emergency after first death
California Governor Gavin Newsom on Wednesday declared a statewide emergency after its first fatality from the new coronavirus – the first death to occur in the US outside Washington state.
The 71-year-old man, who had underlying health conditions, died at a hospital in Roseville, near Sacramento, health officials said.
He is believed to have been exposed to the virus during a cruise on board the Grand Princess – a sister ship to the Diamond Princess, where more than 700 passengers tested positive for Covid-19 – which travelled from San Francisco to Mexico from February 11-21.
Health authorities are looking for other passengers from the cruise who may have had close contact with the man, as well as a previous patient from the Bay Area linked to the same ship.
The emergency declaration was intended to help procure supplies quickly Newsom said, adding that California currently had 53 reported cases.
Nationwide, nearly 130 people, including repatriated citizens, have so far been reported to be infected, with the virus detected in more than a dozen states, according to the latest CDC figures published on Wednesday.
Switzerland reports first coronavirus death
A woman in western Switzerland has died after contracting the new coronavirus, the country’s first death from the rapidly spreading disease outbreak, regional police said on Thursday.
The woman, 74, had been hospitalised in the canton of Vaud since Tuesday, police said. She was a high-risk patient suffering from chronic disease, authorities added.
UAE tells residents not to travel over virus
The United Arab Emirates on Thursday warned its citizens and its foreign residents not to travel anywhere abroad amid the ongoing worldwide coronavirus outbreak, a stark warning for a country home to two major long-haul airlines.
The warning from the country’s Health and Community Protection Ministry comes as its capital, Abu Dhabi, sent 215 foreigners it evacuated from hard-hit Hubei province in China to a quarantine set up in its Emirates Humanitarian City. They include citizens of Egypt, Sudan and Yemen.
Health officials warned that those travelling abroad could face quarantine themselves at the discretion of authorities. The UAE is home to some 9 million people, with only about 1 million estimated to be Emirati citizens.
The UAE is home to Emirates, the government-owned airline based at Dubai International Airport, the world’s busiest for international travel. Abu Dhabi also is home to Etihad, the country’s national carrier. Both airlines have encouraged staff to take time off as international travel has dropped due to the virus.
School’s out for 290 million students
Almost 300 million students worldwide face weeks at home, with Italy the latest country to shut schools over the deadly new coronavirus.
Unesco said 290.5 million children in 13 countries were affected, while a further nine nations have implemented localised closures. “The global scale and speed of the current educational disruption is unparalleled and, if prolonged, could threaten the right to education.” Unesco chief Audrey Azoulay said.
Italy discourages kissing and shaking hands over coronavirus
Italy on Wednesday ordered schools and universities closed until March 15, ramping up its response as the national death toll rose to 107, the deadliest outbreak outside China. South Korea – the country with the largest number of cases outside China with nearly 6,000 – has postponed the start of the current term until March 23.
In Hong Kong schools are closed until at least April 20, while in Japan nearly all schools are closed after Prime Minister Shinzo Abe called for classes to be cancelled through March and spring break, slated for late March through early April.
Some 120 schools closed in France this week in areas with the largest numbers of infections. In Germany, the health minister said the outbreak was now a “global pandemic” – a term the World Health Organisation has stopped short of using – meaning the virus is spreading in several regions through local transmission.
Kim Jong-un sends message to South Korea
North Korean leader Kim Jong-un has expressed hope that neighbouring South Korea will overcome the coronavirus outbreak, in a letter sent to President Moon Jae-in on Wednesday.
Kim also voiced concern over his South Korean counterpart’s health, and discussed his view of the situation on the Korean peninsula, Yoon Do-han, Moon’s senior press secretary, said on Thursday.
South Korea, which has the biggest coronavirus epidemic outside China, with 6,088 confirmed cases and 40 deaths.
Around 60 per cent of confirmed cases have been linked to a branch of the Shincheonji Church of Jesus in Daegu, South Korea’s fourth largest city, according to Yonhap News Agency.
“Every day is sad and tough like a war. But our Daegu citizens are showing surprising wisdom and courage,” Daegu Mayor Kwon Young-jin told reporters on Thursday.
The South Korean government also declared a “special care zone” around Gyeongsan, a city of about 275,000 people 250km southeast of Seoul, promising extra resources such as face masks and warning people from travelling there.
Gyeongsan has recorded a spike in new cases, including at a nursing home. Similar zones have been declared around neighbouring Daegu city and Cheongdo County.
Two more cases at US base in South Korea
US Forces Korea (USFK) has reported two new cases, bringing its total to six among soldiers, employees or people related to the roughly 28,500 troops stationed in South Korea. Despite the new cases, USFK has resumed sending troops to bases in Daegu and surrounding areas, according to military newspaper Stars and Stripes.
Commanders believed the bases were protected from the outside population, and that troop rotations were needed to maintain readiness in the face of continued threats from nuclear-armed North Korea, the newspaper reported.
First local transmission death in Australia
Australia has recorded its second death from the coronavirus – the first from a “local transmission” – and warned on Thursday the crisis would subtract at least half a percentage point from its economic growth in the current quarter.
The death of a 95-year-old woman, who contracted the disease from a worker at her aged care home in Sydney, takes the number of infections in Australia to 52. The majority contracted the disease aboard the Diamond Princess cruise ship and were evacuated back to Australia for treatment. The country’s first fatality was a 78-year-old Perth man who contracted the virus on the ship and died in Australia.
Coronavirus fears spark toilet paper panic buying around the world
Concerns are growing in Australia that the illness may spread more rapidly as people in at least five of the confirmed cases contracted the virus locally.
Meanwhile, Treasury Secretary Steven Kennedy said it was too early to determine the long-term economic toll of the outbreak, but it would have an immediate and significant impact. “At this stage we expect the virus to detract at last half a percentage point from growth in the March quarter 2020,” he said.
First human transmission in New Zealand
New Zealand confirmed a third case of Covid-19, and what is believed to be its first case of human-to-human transmission on Thursday. The patient is an Auckland man in his 40s with close family members, also New Zealand residents, who recently returned home after visiting Iran.
“There is what appears to be a clear link with travel to Iran by a close family member. Our view remains that with continued vigilance the chance of widespread community outbreak remains low,” the country’s ministry of health said.
The latest patient is in self-isolation at home. Other family members had previously been unwell but had now fully recovered and were self-isolating, the health ministry said.
Singapore turns Turkish Airlines plane around
Singapore authorities ordered a Turkish Airlines aircraft to fly back to Istanbul without any passengers on Thursday, after a passenger who arrived on board the plane on Tuesday tested positive for coronavirus.
Singapore’s aviation regulator said the three pilots and 11 other crew of flight TK54 were on the return flight to Istanbul, where they would be placed in quarantine. Meanwhile, authorities in Singapore have begun tracing passengers on the flight who may have had contact with the infected person.
Singapore has 112 confirmed cases of coronavirus but about 70 per cent of patients have recovered.
Australia bans South Korea arrivals
Australia will ban the arrival of foreigners from South Korea and conduct enhanced screenings of travellers from Italy to help contain the spread of the coronavirus, Prime Minister Scott Morrison said on Thursday.
Morrison said Australia would also extend its travel ban on foreigners arriving from mainland China and Iran. “It affords the best protection and enables us to slow down the rate of transmission,” he said.
Second flight from Iran arrives in Gansu
A second chartered flight carrying 163 Chinese citizens from Iran arrived in Lanzhou in northwest China’s Gansu province on Thursday afternoon, the official Gansu Daily reported.
The passengers were transferred to the quarantine centre in the city for medical observation for at least 14 days. Their arrival came a day after 146 Chinese citizens flew in on another chartered flight from Tehran to Lanzhou.
As of Wednesday, Gansu province had reported 91 coronavirus cases and two deaths.
Gigi Choy, Teddy Ng
• South China Morning Post. Published: 9:23am, 5 Mar, 2020:
https://www.scmp.com/news/china/society/article/3065091/coronavirus-recovered-patient-dies-china-reports-139-new-cases
Coronavirus: why do ‘recovered’ patients test positive again?
• Despite the hospital release criteria set by Beijing, doctors say some people are being allowed home while still infected with the disease
• But new tests are in development that could make the diagnostic process more effective
A number of coronavirus patients in mainland China have tested positive for infection after earlier being cleared, according to official figures, though medical experts say it is unlikely they were infected twice and have warned against releasing people from hospital prematurely.
As of Tuesday, the virus had infected more than 80,000 people in mainland China, of whom more than 47,000 had been released from hospital, official data showed.
They were released after being getting a negative result in a reverse transcriptase-polymerase chain reaction (PCR) test – the most commonly used when testing for infection – but then tested positive again days or even weeks later.
On Monday, two people in the northern port city of Tianjin, where more than 130 cases have been confirmed, were sent back to hospital after testing positive for Covid-19 about a week after being told they had recovered from it. An earlier case involved a patient who tested positive for the disease two weeks after being sent home, the local health authority said.
In south China’s Guangdong province, 14 per cent of coronavirus patients released from hospital were later found to still be infected, the provincial disease control centre said last week.
Similar cases have been reported in other parts of the country, including Jiangsu and Sichuan provinces.
Why are people testing positive twice?
“It’s not that these people get a second infection, or a persistent infection, as some worried,” said Professor Jin Dong-yan, a molecular virologist from the Li Ka Shing Faculty of Medicine at the University of Hong Kong.
It was either because the tests were not done properly in the first place, or the patient was undergoing a long course of the disease, he said.
Various factors could cause the test results to be inaccurate, including the quality of the test kit and the way the sample was collected and stored, Jin said.
Under China’s testing criteria, people can be released from hospital if their body temperature is normal for three days, they have no respiratory problems, and the chest lesions shown on the computed tomography have significantly improved. They must also test negative in two consecutive negative PCR tests at least one day apart.
Wang Chen, head of the Chinese Academy of Medical Sciences, said last month that only 30 to 50 per cent of confirmed cases had a positive result in the PCR tests, and throat swabs had possibly generated many fake negative results.
As a result, China’s health authorities suggested combining epidemiological history, clinical and imaging manifestations with the PCR test in diagnosing Covid-19.
Professor Greg Gray from the infectious diseases division at Duke University in the United States and Singapore said that it was unlikely that faulty tests were responsible for the false negatives.
“Assuming the laboratories are experienced in running them, I would not expect lab quality to be the problem,” he said.
“The negative assays might be better explained by a poor quality specimen [not a deep nasopharyngeal swab] or the virus was at a very low count when the swabs were collected.”
Are people who have been released infective?
While China’s National Health Commission (NHC) said it had not found any new infections linked to such patients, local officials and doctors are more cautious.
“These patients have not infected other people, and some tested negative in their follow-up tests,” Guo Yanhong, an NHC official monitoring new cases, told a press conference on Friday.
Song Tie, deputy head of the Guangdong provincial disease control centre, agreed that such patients had not been the source of any new infections but said they might still be infective.
“If a person tests positive, in terms of disease control, he will definitely be considered a source of infection,” he said.
“From laboratory tests, we found that young patients will produce antibodies within two weeks. So even if they have positive results in PCR tests again, the risk of contagion is very low.
“We also found that some elderly patients may need more time to produce the antibodies. So they may keep releasing the virus and become a source of infection,” Guo said.
Zhang Zhan, a respiratory specialist at Renmin Hospital of Wuhan University also warned of possible infection by people who had been previously thought “cured”.
In an article published online on January 31, she said that eight days after one of her patients was deemed to have recovered from the infection a member of his family contracted the disease. The relative had not been in contact with anyone else since his return home.
Gray said: “It is possible to detect traces of the pathogen for some period after the patient is no longer infectious. That is, the patient’s immune system has killed the virus and what you are detecting is nonviable nucleic acid fragments of the virus.
“To investigate one would have to attempt to culture out the virus from the original swab specimens. If the virus grew you would know the virus was viable.”
So how do we stop this happening again?
In an article published last week, Zhang said that patients should be required to produce three negative PCR tests rather than two before being allowed to leave hospital.
Of the 44 people who met the national criteria for release, 26 tested positive in a third test, she said.
“[But] The rate of a positive result [in a fourth test] for those who have tested negative three times is very low,” she said.
In Shanghai, as well as meeting the release requirements set by the NHC, doctors also require patients to produce a negative test result from an anal swab, to show the virus is not present in their excrement.
Zhang Wenhong, who leads a team of experts in handling the coronavirus outbreak in the city, said that to date none of the patients released there had tested positive for infection in a later test.
Jin said the new testing methods would help to prevent such cases happening, including an antibody test that was being developed but not yet ready for mass production.
“It is easier to conduct and less demanding technically, so when it’s ready, it will be a good supplement to the PCR test,” he said.
Purchase the China AI Report 2020 brought to you by SCMP Research and enjoy a 20% discount (original price US$400). This 60-page all new intelligence report gives you first-hand insights and analysis into the latest industry developments and intelligence about China AI. Get exclusive access to our webinars for continuous learning, and interact with China AI executives in live Q&A. Offer valid until 31 March 2020.
Mandy Zuo
Additional reporting by Linda Lew
This article appeared in the South China Morning Post print edition as: Cleared patients return positive test
• South China Morning Post. Published: 11:00pm, 4 Mar, 2020:
https://www.scmp.com/news/china/society/article/3065022/coronavirus-why-do-recovered-patients-test-positive-again