Kyle Martin S. Alimurung¹, Sigrid D. Santos², Maria Clarina D. Mariano², Aliza S. Concepcion², Janice C. Caoili^3,

Background: The ongoing COVID-19 pandemic has led to heightened health risk to health professionals from recurrent symptomatic SARS-CoV-2 infections due to continuous exposure in the workplace. Objectives: To highlight the need for universal clinical guidelines to provide clarity on appropriate interpretation and management of symptomatic recurrent positive SARS-CoV-2 reverse-transcription polymerase-chain-reaction (RT PCR) test results among healthcare professionals (HCPs) with a documented history of COVID-19 exposure. Methods: We present five cases of HCPs working at Makati Medical Center in the Philippines who previously recovered from symptomatic COVID-19 infection and presented at least 87 days after recovery with recurrent symptoms consistent with COVID-19 infection along with positive nasopharyngeal and oropharyngeal swab (NPS/OPS) RT PCR on repeat testing, suggesting recurrent infection. Results: Our cases had a disease-free average interval of 99 days (range of 87 to 124 days) between infection episodes. On serologic testing, only one case developed IgM and IgG antibodies after first infection. Four of five cases were deemed sources of infection transmission for new confirmed COVID-19 cases during at least one of their infection episodes. Discussion: Our cases highlight the dilemma of lack of universal clinical guidelines regarding appropriate interpretation of and management of recurrent positive SARS-CoV-2 RT PCR HCPs who are continuously exposed in clinical settings where limited or no access to genotyping and viral culture are available to validate reinfections, whether with prevalent strains and/or variants.

COVID-19, SARS-CoV-2 RT PCR, coronavirus, recurrent, serologic testing, healthcare professionals