Sustained Positivity and Reinfection With SARS-CoV-2 in Children: Does Quarantine/Isolation Period Need Reconsideration in a Pediatric Population?

Background: The coronavirus disease 2019 (COVID-19) pandemic is a once in a lifetime public health catastrophe that has driven the world not only into a medical crisis but has pushed to the brink of economic collapse. Prevention of transmission of the replication-competent virus to the susceptible host is the key to the control of COVID-19. The phenomenon of "sustained-positivity," "reinfections," and their role in disease transmission are poorly understood in adults and not even recognized in the pediatric population yet. This information is crucial for ascertaining the quarantine/isolation period for test-positive patients. Most of the time, adult studies' results are extrapolated and applied to children, but severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has treated children differently than adults. Material and methods: The Institutional Review Board (IRB) approval has been obtained. A retrospective electronic chart review of 989 SARS-CoV-2 polymerase chain reaction (PCR)/reverse transcription-PCR (RT-PCR) positive pediatric patients was performed. The aim was to look at the existence of sustained positivity and SARS -CoV-2 reinfection in the pediatric population, as was reported in the adults. Results: We present our retrospective observational study on 989 SARS-CoV-2 positive pediatric patients; 172 of these had repeated multiple testings, 68 had multiple consecutive positive tests over time, and 27 qualified for sustained-positive status. We also report on four pediatric COVID-19 reinfections. Conclusion: This is the first report on pediatric SARS-CoV-2 reinfection, one of very few on pediatric SARS-CoV-2 sustained positivity and reinfection. These two phenomena occur in children also as reported in adults but have several differences. The reinfection is possible within one to three weeks of becoming negative as against adults who have been reported to become positive in a minimum of 45-90 days from becoming negative. More extensive reporting is essential to ascertain the accurate quarantine/isolation recommendation in children.