How should a positive PCR test result for COVID-19 in an asymptomatic individual be interpreted and managed?

Abstract

The rapidly increasing number of PCR-based SARS-CoV-2 tests as COVID-19 control measures has been leading not only to the discovery of positive results in asymptomatic individuals, but also to the re-testing of persons having contracted (proven or unproven) COVID-19 or having previously tested positive. In the face of interrogations as to the interpretation and management of these types of situations, and given the need to weigh collective and individual risks, we have carried out a review of the literature aimed at responding to the six following questions. Can PCR-based SARS-CoV-2 testing lead to false positives? For how long do the results remain positive? For how long can the results be associated with an actual risk of transmission / with infectivity in a symptomatic person? Is a newly positive PCR-based SARS-CoV-2 test result following one or more negative test results to be associated with a risk of transmission? Is a positive PCR-based SARS CoV-2 test result to be associated with a genuine risk of transmission / with infectivity in an asymptomatic person? Does the presence of antibodies detected by serology attest to control of the infection and consequently to non-contagiousness, even in the event of positive PCR-based SARS-CoV-2 test results? Having been initiated prior to the recently issued recommendations of the Haut Conseil de la Santé Publique (French public health council), this review is aimed at synthesizing practical proposals liable to evolve according to the advancement of scientific knowledge and the overall epidemic context.