The PCR test is internationally regarded as the ‘gold standard’ for identifying various viral infections, including the detection of COVID-19. PCR testing produces a binary result of either ‘positive’ or ‘negative’ and in this type of testing, a positive detected result is reported when any level of the genetic material is identified during the PCR process. However, Dr Graham Fry, Tropical Medicine, Trinity College Dublin, Tropical Medical Bureau (Ireland) and Nomad Travel (UK), confirms that a patient of his has been forced into mandatory hotel quarantine and threatened with a court appearance after receiving a positive COVID-19 PCR test result after having a confirmed Covid infection a few months previously.
It is well recognised that in most cases, an individual who has contracted COVID-19 and is in good general health will not be infectious to others after about 10-14 days. However, these individuals can remain rt-PCT ‘positive’ for many weeks, which consequently affects their ability to return to work or to travel.
Dr. Fry’s patient travelled to London over the weekend of the 21st of May for essential purposes and had a PCR carried out on Friday (21st), as per travel regulations. This PCR test came back with a very weak positive result in line with his past infection.
In the results, the patients Ct was reported as 39.39 which confirmed that a minimal amount of residual COVID-19 genetic material was present. This is a well-recognised occurrence in post Covid patients. Typically, this will clear within 4 to 6 weeks, but it is recognised to remain present in a small number of individuals for months.
To clarify, this result does not indicate that they are infectious and international protocols, including the HSE, allow these patients return to normal activities including travel. For absolute confirmation that the patient was not infectious of COVID-19, an Antigen test was also undertaken which produced a negative result, confirming the positive PCR result was not related to an active COVID-19 infection.
Under HSPC guidelines, someone who has had a previous positive test for SARS-CoV-2 should not be retested within six months unless they develop symptoms suggestive of COVID-19. Further, the HSPC state, ‘In the event that an asymptomatic person is sampled and tested unintentionally within six months of a diagnosis of COVID-19 and the Ct value is high/low viral load, it can generally be assumed to represent residual viral nucleic acid unless they are symptomatic. Under these circumstances asymptomatic people do not need to restrict their movements or take any specific measures other than those that apply to everyone.’
For the purposes of post-Covid testing, the simple binary ‘detected’ / ‘not-detected’ reporting system needs to be updated to reflect the intricacies and relevance of Ct rates (this is the amplification needed during analysis to identify Covid-19 genetic material. The more the analyser needs to ‘amplify’ the sample the less genetic material is present).
Simple binary (yes/no) reporting does not separate out those who are currently infected (low Ct, e.g. 18) from those who had the virus weeks or months ago (high Ct, e.g. >38), where viral fragments remain and where the person has no symptoms and is not infectious.
Dr. Graham Fry gave this patient a letter confirming his earlier COVID-19 infection (in February 2021) and the fact that he was clinically non-infectious at this time. However, on arrival back into Ireland, the patient has been forced into mandatory quarantine and threatened with a court appearance. Dr. Fry made himself available to talk to both immigration and the Garda personnel but both groups refused.
Dr. Graham Fry explains, “In a short few weeks, with his confirmed history of Covid infection within 6 months, this patient will be eligible for the EU ‘Green Pass’ and entitled to travel within the European Union. To have to undergo mandatory quarantine at this time is both ridiculous and reeks of bureaucracy. It also potentially puts him at risk from others within that hotel environment. Self-quarantine at home would have been the easiest and most logical option if it was felt there was any risk.”
For comments / interview opportunities, please contact Niamh Waters, email@example.com, +353 860492394
Dr Graham Fry – Founder and Group Medical Director
The Tropical Medical Bureau was founded in 1986 by Dr Graham Fry. As a leading Tropical Medical Consultant in the country, Dr Fry plays a pivotal role in the organisation, whether consulting with patients, lecturing to medical students in Trinity College or dealing with media focussed tropical issues on radio and television. His enormous medical experience and expertise in technology have combined to ensure that the TMB occupies national pride of place in tropical medical care.
About Tropical Medical Bureau Group
The Tropical Medical Bureau Group (encompassing Nomad Travel in the UK) is the leading travel medicine clinic group in Ireland, specialists in providing the best information and medical care available for the international traveller. Collectively, the TMB Group sees approximately 60,000 patients on an annual basis, ranging from the private holiday maker to employees of commercial companies, and overseas volunteers to NGO’s and Government departments, all of whom benefit from the expertise of our highly experienced clinic staff.
Since it was founded in 1988, TMB has undergone major growth and expansion to currently encompass 30 clinics, 20 clinics in Ireland (four base clinics and 16 associate clinics). In 2016, TMB acquired Nomad Travel Clinics in the UK. Nomad Travel Clinics has 25 years’ experience in travel health, pharmacy & retail, throughout 10 clinics across the UK.
What distinguishes TMB is our vast experience and expertise, as well as our superb patient aftercare. All our patients have a detailed consultation with one of our specialised healthcare staff. This covers everything from food and water risks, mosquito avoidance, malaria and thrombosis, as well as risks associated from altitude exposure, and also Zika and COVID-19 risks, which may be associated with your trip. Following a detailed consultation, we then decide on which travel vaccines and malaria tablets are appropriate. Our specialised travel medicine software is constantly being updated with travel news, so if anything is happening in your destination that you need to be aware of, we’ll make sure you are.