The revised guidelines state that only severe cases of COVID-19 will be tested before discharge, while mild and moderate cases need not be tested at the time of discharge.
The Ministry of Health and Family Welfare (MoHFW) on Saturday released a revised policy on the discharge of patients hospitalised for COVID-19 infections. The revised guidelines state that only severe cases of COVID-19 will be tested before discharge, while mild and moderate cases do not need to be tested before they are discharged. Earlier, all patients were being tested and used to be discharged only when their chest radiograph exam was cleared and two consecutive RT-PCR tests returned negative.
The new policy:
Now, for mild/very mild/pre-symptomatic cases, the patient can be discharged after 10 days of getting the symptoms and if the patient does not report a fever for three days. A test is not needed and the patient will be advised to follow home isolation for seven days after they are discharged.
For moderate cases, the patient can be discharged if one, they are asymptomatic for 3 days or after 10 days of the patient reporting symptoms. Similar to mild cases, the patient will be advised to follow home isolation for seven days after discharge.
For severe cases, the patient will be discharged only after clinical recovery and if the patient tests negative once by RT-PCR after the symptoms subside.
Why was the discharge policy changed?
Health Ministry officials have stated that India’s policy has been changed in line with other countries who have changed the criteria for discharge from ‘test-based strategy to ‘symptom-based strategy’ or ‘time-based ‘strategy. This is because studies, as well as ICMR’s laboratory surveillance data, has shown that COVID-19 patients usually turn negative after a median duration of 10 days. Recent studies have also suggested that the viral load peaks in the pre-symptomatic period (2 days before symptoms) and goes down over the next 7 days.
How will we know if a patient is cured?
The Health Ministry has said that when the symptoms and signs of COVID-19 are resolved, and there is no fear of resurgence or subsequent transmission of infection, a person is said to have recovered from COVID-19.
Can a patient discharged on the new criteria spread infection?
The Health Ministry has said that available evidence in India does not indicate any increase in the risk of transmission from patients discharged based on the revised discharge criteria. The revised criterion also specifies that such patients must follow home isolation for seven days.
However, experts say that some patients could remain infectious beyond the 10 days of getting the symptoms.
“The home isolation element is a crucial part of the discharge policy and there is a need for people to understand that. Once you are discharged, it may not necessarily mean you are not still infectious,” Dr Anant Bhan, Researcher, Global Health, Bioethics and Health Policy, tells TNM.
“I think the Health Ministry’s calculation of 10 days is based on a median calculation of the time from when you show symptoms to the time you test negative. However, it’s important to remember that there could also be some people outside this range who remain infectious post the 10 days. I think this information should also be put out and reinforced in the public domain so that due care is taken post-discharge, including during the transfer to the home isolation venue, and at the home isolation venue, as well,” he adds.
Recently, there were two cases in Kerala where the test results of two patients continued to show positive for over 40 days despite their symptoms subsiding.
What precautions the patient should undertake during home isolation?
Patients in home isolation who are pre-symptomatic/very mild/mild confirmed cases of COVID-19 and do not have comorbidities have been asked to wear a triple-layer medical mask at all times. The patient must stay in the identified room and away from other people in the home, especially senior citizens and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease, etc. They should maintain strict personal hygiene and self-monitor his/her health with daily temperature monitoring an