Abstract
In many parts of the United States, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases have reached peak infection rates, prompting administrators to create protocols to resume elective cases. As elective procedures and surgeries get scheduled, ambulatory surgery centers (ASCs) must implement some form of widespread testing in order to ensure the safety of both the ASC staff and the patients being seen. The US Centers for Disease Control and Prevention (CDC) recently announced the approval of new serological testing for SARS-CoV-2, a test that can indicate the presence of IgM and IgG antibodies in the serum against viral particles. However, the possibility for reinfection raises questions about the utility of this new serological test, as the presence of IgG may not correspond to long-term immunity. SARS-CoV-2 has been known to form escape mutations, which may correspond to a reduction in immunoglobulin binding capacity. Patients who develop more robust immune responses with formation of memory CD8+ T-cells and helper CD4+ T-cells will be the most equipped if exposed to the virus, but, unfortunately, the serology test will not help us in distinguishing those individuals. Given the inherent disadvantages of serological testing, antibody testing alone should not be used when deciding patient care and should be combined with polymerase chain reaction testing.
Highlights
In many parts of the United States, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases have reached peak infection rates, prompting administrators to create protocols to resume elective cases
C oncerning reports released from the Korea Centers for Disease Control and Prevention (KCDC) have noted that up to 163 patients who were presumed to have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection ended up testing positive with polymerase chain reaction (PCR) testing yet again.[1]
One possible explanation for testing positive after a previously negative result could be that the initial negative results that signified patient recovery were false-negative results, as false-negative rates have been reported to be as high as 30% for SARS-CoV-2 PCR testing.[6]
Summary
In many parts of the United States, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases have reached peak infection rates, prompting administrators to create protocols to resume elective cases. There are numerous studies that have shown that the presence of inactive viral RNA outlasts infectious viral particles in the body.[7,8] While the immune system generates antibody responses to the surface protein of viral particles, the genetic material (RNA, DNA) left behind degrades over time.[9] positive PCR results after recovery may not necessarily signify reinfection, but rather the presence of leftover genetic material from previously active infection.
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