The Union Health Ministry has revised its discharge guidelines for COVID-19 patients, stating that only those with severe illness need to be tested (through a swab test) and a negative report needs to be obtained before discharge.
The latest guideline adds that other categories of patients, including very mild, mild, pre-symptomatic and moderate cases, need not be tested before discharge.
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The two-page revised guideline replaces the previously existing rule under which patients (lab-confirmed cases) were discharged after two negative tests conducted on Day 14 and 21.
The guideline states that the revised policy is aligned with guidelines on the three-tier COVID-19 health facilities and the categorisation of patients based on clinical severity — mild, moderate and severe.
Interactive map of confirmed coronavirus cases in India
Reacting to the revised guideline All India Institute of Medical Sciences (AIIMS) Resident Doctors’ Association general secretary Srinivas Rajkumar said the decision to send back COVID-19 positive patients without testing was a disaster in the making.
“People sent back untested may spread the virus in the community. What was the government doing for 40 days without arranging enough testing facilities? Is government ready to sacrifice 2 lakh Indians or more to COVID-19 based on estimates?” he said.
Regular monitoring
As per the latest guideline — for mild, very mild and pre-symptomatic cases admitted to a COVID-19 care facility — patients will undergo regular temperature and pulse monitoring.
“Patient can be discharged after 10 days of symptom onset and if they have no fever for three days. There will be no need for testing prior to discharge,” the revised guideline says.
It adds that at the time of discharge, patients will be advised to follow the home isolation for seven more days.
It further clarifies that after discharge from the facility, if patients develop symptoms of fever, cough or breathing difficulty, they must contact the COVID-19 Care Centre or State helpline or 1075. Their health will again be followed up through tele-conference on Day 14.
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Moderate cases will undergo monitoring of body temperature and oxygen saturation.
If fever resolves within three days and a patient maintains saturation above 95% for the next four days (without oxygen support), he or she will be discharged after 10 days of onset of symptoms in case there is no fever without anti-fever drugs, no breathlessness and no need for oxygen.
“There will again be no need for testing prior to discharge, and home isolation for seven days is suggested, with close monitoring of health,” notes the guideline.
Explaining the rationale for discharging mild/moderate cases without testing, a senior ICMR scientist told The Hindu: “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 explained that 10 days after the disease sets in people may not be infectious. But once discharged, they should stay at home for five days. The Ministry’s revision also takes into account the fact that hospitals are reaching their handling capacities.
The U.S. Centers for Disease Control and Prevention too had revised the guidelines on May 6, saying that no negative test for the virus is needed before a hospitalised person can be discharged.
The CDC says decisions about discharge 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”.
(With inputs from R. Prasad in Chennai)
