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Explained: When is a COVID-19 patient discharged?

Coronavirus (COVID-19): According to the National Centre for Disease Control (NCDC), if the laboratory results for the virus for suspect cases are negative, the discharge of such patients is guided by the clinical condition of the case. Such patients are monitored for 14 days.

A patient suffering from the coronavirus disease (COVID-19) is treated at the Cernusco sul Naviglio hospital in Milan, Italy. Reuters Photo

On Thursday, China released a new trial protocol for discharged COVID-19 patients, which includes re-testing, follow-up visits by doctors and health monitoring. This move comes just a day after China lifted the lockdown in Wuhan, the former epicentre of the coronavirus outbreak after a period of over 76 days.

As per this protocol, recovered patients are required to stay in isolation for up to 14 days, they should take their temperature readings daily and should note the development of any respiratory symptoms. Several reports have pointed out that recovered cases can test positive for COVID-19 again.

Further, China is also moving towards tackling the asymptomatic cases in the country now, since in the beginning of the outbreak the efforts were focussed on treating symptomatic cases and those in critical and severe conditions.

The protocol also mentions the setting up of plans by designated hospitals for patients’ return visits and re-testing. In the following weeks, a lot of experts and scientists will set their eyes on China to observe how the disease progresses or wanes. China’s National Health Commission (NHC) notes that the diagnosis and treatment plans need to be constantly adjusted according to the changing dynamics of the outbreak. Significantly, the steps China takes during this time and its effects will have important takeaways for the rest of the world, where the cases are still surging.

A COVID-19 patient, in China, is considered cured if they are afebrile (are not feverish) for more than three days, showcase improved respiratory symptoms, have reduced inflammation and if their nucleic acid tests for respiratory tract pathogen test negative twice consecutively with a sampling interval of at least 24 hours. Discharged patients are recommended to continue 14 days of isolation, are advised to wear a mask, live in a single room with good ventilation, to eat separately, to not maintain close contact with family members and are also advised to avoid outdoor activities. Follow up visits are recommended after two and four weeks.

A medical staff member is seen next to a patient suffering from the coronavirus disease (COVID-19) in the intensive care unit at the Circolo hospital in Varese, Italy. Reuters Photo

Discharge policy for COVID-19 cases in India

According to the National Centre for Disease Control (NCDC), if the laboratory results for the virus for suspect cases are negative, the discharge of such patients is guided by the clinical condition of the case. Such patients are monitored for 14 days.

On the other hand, a COVID-19 patient is discharged after evidence of chest radiographic clearance, viral clearance in respiratory samples and if two of the patient’s specimens test negative within a period of 24 hours.

Discharge policies in other countries

In Italy, a COVID-19 patient is considered cured after the resolution of symptoms and two negative tests for SARS-CoV-2 with a 24-hour interval. For patients who clinically recover earlier than seven days after onset, the Italian Health Ministry advises an interval of seven days between the first and the final test. On the other hand, for those isolated at home or asymptomatic cases, the patient may be considered free from the virus after a negative SARS-CoV-2 test done 14 days after the quarantine started.

In Singapore, patients can be discharged if they are afebrile for at least 24 hours, if two of their respiratory samples have tested negative by PCR in at least 24 hours and if it has been at least six days since the day of onset of illness. After discharge, the patient needs to be followed up if required with daily wellness calls.

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The US Center for Disease Control (CDC) notes that while the decision to discharge a patient is taken on a case-by-case basis, broadly the decision may be supported by negative rRT-PCR results from two consecutive sets of nasopharyngeal and throat swabs collected at least 24 hours apart (total four negative samples) along with a resolution of fever and an improvement in signs of illness and symptoms.

The European Centre for Disease Prevention and Control (ECDPC) notes that when deciding on criteria for hospital discharge of COVID-19 patients, health authorities should take into account factors such as the existing capacity of the healthcare system, laboratory diagnostic resources and the current epidemiological situation.

Here’s a quick Coronavirus guide from Express Explained to keep you updated: What can cause a COVID-19 patient to relapse after recovery? | COVID-19 lockdown has cleaned up the air, but this may not be good news. Here’s why | Can alternative medicine work against the coronavirus? | A five-minute test for COVID-19 has been readied, India may get it too | How India is building up defence during lockdown | Why only a fraction of those with coronavirus suffer acutely | How do healthcare workers protect themselves from getting infected? | What does it take to set up isolation wards?

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