Infectiousness of COVID-19 patients was considered to revise discharge policy

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On May 8, the Health Ministry’s revised policy said no testing is needed before discharging mild and moderate COVID-19 cases from dedicated facility. The decision was apparently taken based on the infectivity of COVID-19 patients.

The Health Ministry on Friday issued revised guidelines for discharging COVID-19 cases admitted to a COVID-19 care facility. According to the revised policy, mild, pre-symptomatic and moderate cases can be discharged from a COVID-19 care facility without being tested for the virus. It means that revised policy does not require mild/moderate patients to test negative for the virus to get discharged from a COVID-19 facility.

According to the revised policy, pre-symptomatic and mild cases can be discharged after 10 days of symptom onset and no fever for three days without a test prior to discharge. Similarly, moderate cases can be discharged without testing prior to discharge if the fever resolves within three days and the patient maintains saturation above 95% for the next four days (without oxygen support).

Explaining the rationale for discharging mild/moderate cases without testing, a senior ICMR scientist says: “Studies outside India have shown that positive test result does not mean the person is still infectious. They may be positive for the virus but can remain non-infectious.” He further explains that ten days after disease sets in people may not be infectious. But once discharged, they should stay at home for five days.

The Ministry revised the policy after also taking into account that hospitals are getting filled to capacity.

The Atlanta-based Centers for Disease Control and Prevention too had revised the guidelines on May 6 saying no negative test for the virus is needed before a hospitalised person can be discharged from hospital. The CDC says decisions about discharge from the hospital should be based on “clinical status and the ability of the accepting facility to meet their care needs and adhere to recommended infection prevention and control practices”.

Published in The Hindu on May 10, 2020