International Journal of Healthcare Management

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Reactivation of Severe Acute Respiratory

Coronavirus-2 (SARS-CoV-2): Hoax or hurdle?

Otun Saha , Nadira Naznin Rakhi , Syeda Tasneem Towhid & Md. Mizanur
Rahaman

To cite this article: Otun Saha , Nadira Naznin Rakhi , Syeda Tasneem Towhid & Md. Mizanur
Rahaman (2020): Reactivation of Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2): Hoax or
hurdle?, International Journal of Healthcare Management, DOI: 10.1080/20479700.2020.1782660

To link to this article: https://doi.org/10.1080/20479700.2020.1782660

Published online: 19 Jun 2020.

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INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
https://doi.org/10.1080/20479700.2020.1782660

LETTER TO THE EDITOR

Reactivation of Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2): Hoax or

hurdle?
Otun Sahaa, Nadira Naznin Rakhib, Syeda Tasneem Towhidc and Md. Mizanur Rahamana
a
Department of Microbiology, University of Dhaka, Dhaka-1000, Bangladesh; bDepartment of Biotechnology and Genetic Engineering,
Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh; cDepartment of Microbiology,
Jagannath University, Dhaka, Bangladesh
ARTICLE HISTORY Received 2 May 2020; Accepted 4 May 2020

Dear Editor, the reinfection in monkeys was unsuccessful [3]. Besides,

reduced counts of CD3+ T cells, CD3+ CD4+ T cells, and
The world is currently grappling over the manage-
CD3+ CD8+ T cells in patients with viral pneumonia
ment of Coronavirus Disease 2019 (COVID-19)
along with significantly increased levels of IL-2R and
pandemic, while the plausible second wave of
IL-6 leading to impaired immunity arise the possibility
COVID-19 might be the worst nightmare for the
of inefficient viral clearance resulting into temporary
present world to combat once again with limited
viral latency [4] followed by reactivation [5]. Even the
preparation and exhausted facilities. So, the question
antiviral therapy (Oseltamivir or Arbidol or other gluco-
of relapse or reactivation of COVID-19 must be
corticoid therapy) received by the patients may contrib-
considered carefully. While challenging the pre-
ute to the relapse of the infection [2]. According to the
exposed rhesus macaque monkeys with Severe
director of the Infectious Disease Center, Rinku General
Acute Respiratory Syndrome Coronavirus-2 (SARS-
Medical Center, similar to the SARS-CoV causing the
CoV-2) showed no recurrence of COVID-19 [1],
pandemic in 2003, SARS-CoV-2 remains latent in certain
no definite answer is yet to be determined for
cells in the body and may again attack the respiratory
human subjects. On the contrary, countries like
tract and intestines upon reactivation (https://www.
China, South Korea has already reported 5 and
japantimes.co.jp/news/2020/02/28/national/coronavirus
116 patients (https://thehill.com/changing-america/
-reinfection/#.Xqm8TahKhPY). Moreover, the recur-
well-being/prevention-cures/492489-more-coronaviru
rence of COVID-19 has been reported from 4 to 17
s-patients-in-south-korea-are) respectively who were
days [2] after being diagnosed as recovered and thus
considered to be cleared of COVID-19 have tested posi-
these recovered patients may continue transmitting the
tive again, which raises the question about virus’s ability
disease threatening the containment strategies. This
to reactivate [2]. This ultimately raises the question
possibility of reactivation is also questioning the credi-
whether this SARS-CoV-2 has got the ability of some
bility of using COVID-19 convalescent plasma to treat
other viruses like Epstein–Barr virus, Ebola virus, and
COVID-19 patients. The lack of precise knowledge
varicella-zoster virus, which are commonly known with
about SARS-CoV-2 latency or its mechanism will not
reactivation capacity [2]. But before thinking it that far,
only increase the risk of transmission of the disease but
the recovery definition which is principally based on
also complicate the therapeutic innovations. So, consid-
two consecutive negative results for SARS-CoV-2 nucleic
ering the limited treatment option and high transmissi-
acid in Real-time RT–PCR tests along with an afebrile
bility, the issue of viral latency and reactivation needs
condition for at least 3 days, has to be analyzed well. It
to be addressed immediately to effectively intercept the
is possible that the false-negative results in RT–PCR
disease transmission thus avoiding the risk of recurrent
might mistakenly be interpreted as viral reactivation.
epidemic episodes.
Besides, the choice of specimen for RT–PCR might also
be responsible, as the virus might reside in organs that
were not considered primarily as testing specimens
Author’s contributions
with absence in the primarily selected specimen collect-
ing organs. On the other hand, the possibility of viral O.S., N.N.R. and S.T.T. drafted the manuscript.
reactivation can also not be ruled out, especially when M.M.R. developed the hypothesis, supervised the

CONTACT Md. Mizanur Rahaman razu002@du.ac.bd Department of Microbiology, University of Dhaka, Dhaka-1000, Bangladesh
© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 O. SAHA ET AL.
whole work and critically reviewed the drafted manu-
script. All authors read and approved the final
manuscript.
Acknowledgments
The authors would like to acknowledge Bangabandhu
Science & Technology Fellowship Trust for supporting
Otun Saha with PhD fellowship.
Disclosure statement
The authors declare that the research was conducted
in the absence of any commercial or financial relation-
ships that could be construed as a potential conflict of
interest.
References
[1] Bao L, Deng W, Gao H, et al. Reinfection could not
occur in SARS-CoV-2 infected rhesus macaques.
bioRxiv. 2020.
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1016/j.jinf.2020.03.053.
[3] Guo L, Wei D, Zhang X, et al. Clinical features predict-
ing mortality risk in patients with viral pneumonia: the
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DOI:10.3389 / fmicb.2019.02752.
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