Centre revises coronavius COVID-19 patient discharge rules. All you should know

The Union Ministry of Health and Family Welfare (MoHFW) on Friday (May 8) released its revised policy for the discharge of coronavirus COVID-19 patients. The revised policy was prepared in consultation with Indian Council of Medical Research and is in line with the ministry’s guidelines on the categorization of the patients
based on clinical severity and their management in the 3 tier COVID facilities.

Here are the Frequently Asked Questions (FAQs) on revised discharge policy:

1. What was earlier criteria for discharging COVID-19 patients

The earlier criteria for discharging rt-PCR positive were (a) chest radiograph has cleared and (b) two consecutive negative test results on rt-PCR.

2. What is the new discharge policy for COVID-19 patients?

For mild/very mild/pre-symptomatic cases
– Patient can be discharged after 10 days of symptom onset and no fever for 3 days
– No need for testing prior to discharge
– Patient will be advised to follow home isolation for a further 7 days after discharge

For moderate cases
– Patient can be discharged (a) if asymptomatic for 3 days and (b) after 10 days of symptom onset
– No need for testing prior to discharge
– Patient will be advised to follow home isolation for a further 7 days after discharge

For severe cases
– Clinical recovery
– Patient tested negative once by RT-PCR (after resolution of symptoms)

3. Why was the discharge policy changed?
Several countries have changed the criteria for discharge from ‘test based strategy to ‘symptom based strategy’ or ‘time based ‘strategy. A review of ICMR laboratory surveillance data also indicated that after initial rt-PCR positive results, patients became 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.

4. How then it will be established that a patient is cured of the disease?
Being cured of a disease may have different connotations for general public, treating doctors and the virologists. Unless there is a fear of resurgence of infection and subsequent transmissibility of an infection, resolution of clinical manifestation is usually taken as an evidence for cure.

5. Is there a risk of transmission from patients discharged based on the revised criteria?
Available evidence 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 will follow home isolation for a further 7 days.

6. What precautions the patient should undertake during home isolation?
It has to be remembered that provision for home isolation of pre-symptomatic/very mild/mild confirmed cases of COVID-19 has been made, provided that such patients are assessed to be eligible for the same in terms of their clinical status and feasibility to successfully isolate in home environment settings. This should be done after signing a self-declaration form by the patient.

Such patients (with no co-morbidities) should at all times use triple layer medical mask. Patient must stay in the identified room and away from other people in home, especially elderlies 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 and report promptly if develops any deterioration of symptom.

7. Is there a need to get tested after the home isolation period is over?
No. As per the latest revised discharge policy, there is no need for testing prior to discharge all presymptomatic/very mild/mild confirmed cases of COVID-19 after 10 days of symptom onset and no fever for 3 days. Therefore it stands to reason, that no testing is also needed for patients undergoing home isolation (pre-symptomatic/very mild/mild confirmed cases) after the home isolation period is over.

8. What does the current discharge policy mean for patients who are being home isolated?
As detailed above, as far as testing is concerned, there is no need for testing after the home isolation period is over. However, (as the current discharge policy advises patients to remain in home isolation for a 7 days period after discharge), the period of home isolation would end after 17 (10+7) days of symptom onset and no fever for 10 (3+7) days. The Home Isolation Guidelines available on ministry’s website should be strictly followed.

9. Does this policy apply to those undergoing home or facility quarantine?
Discharge policy is meant for patients (symptomatic/pre-symptomatic) diagnosed (using rt-PCR testing) to be suffering from COVID-19. Quarantine (home or facility) is meant for asymptomatic/healthy persons who may have been exposed to the COVID-19 infection but are not manifesting any symptoms. Therefore there is no question of discharge of such persons. However their stay under quarantine period will remain 14 days from the date of last exposure.