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On Friday, May 8, the Union Ministry of Health and Family Welfare (MoHFW) released its revised policy for the discharge of patients with the COVID-19 coronavirus. The revised policy was prepared in consultation with the Indian Council for Medical Research and is in line with the ministry’s guidelines on patient categorization.
based on clinical severity and its management in COVID 3-level facilities.
These are the frequently asked questions (FAQ) about the revised registration policy:
1. What was the previous criterion for the discharge of patients with COVID-19?
The previous criteria for downloading positive rt-PCR were (a) the chest radiograph was deleted and (b) two consecutive negative results on rt-PCR.
2. What is the new discharge policy for patients with COVID-19?
For mild / very mild / pre-symptomatic cases
– The patient can be discharged after 10 days of symptom onset and without fever for 3 days.
– It is not necessary to carry out tests before discharge
– The patient will be advised to follow the isolation at home for another 7 days after discharge.
For moderate cases
– The patient can be discharged (a) if he is asymptomatic for 3 days and (b) after 10 days of the onset of symptoms
– It is not necessary to carry out tests before discharge
– The patient will be advised to follow the isolation at home for another 7 days after discharge.
For severe cases
– Clinical recovery
– The patient tested negative once by RT-PCR (after resolution of symptoms)
3. Why was the registration policy changed?
Several countries have changed the criteria for discharge from “evidence-based strategy” to “symptom-based strategy” or “time-based strategy”. A review of ICMR laboratory surveillance data also indicated that after initial positive rt-PCR results, patients became negative after a median duration of 10 days. Recent studies have also suggested that viral load peaks in the pre-symptomatic period (2 days before symptoms) and decreases in the next 7 days.
4. How then will it be established that a patient is cured of the disease?
Being cured of a disease can have different connotations for the general public, the treatment of doctors and virologists. Unless there is fear of re-emergence of infection and subsequent transmissibility of an infection, resolution of the clinical manifestation is generally taken as evidence of cure.
5. Is there a risk of transmission of patients discharged according to the revised criteria?
The available evidence does not indicate any increase in the risk of transmission of patients discharged according to the revised discharge criteria. The revised criteria also specify that such patients will continue isolation at home for another 7 days.
6. What precautions should the patient take during isolation at home?
It should be remembered that home isolation of confirmed / very mild / mild cases of confirmed COVID-19 has been planned, provided that such patients are evaluated as eligible for it in terms of their clinical status and the feasibility of successfully isolating in the home environment settings. This must be done after signing a patient self-declaration form.
Said patients (without comorbidities) must wear a triple layer medical mask at all times. The patient should stay in the identified room and away from other people in the home, especially the elderly and people with comorbid conditions such as hypertension, cardiovascular disease, kidney disease, etc. They must maintain strict personal hygiene and monitor their health daily. Temperature monitoring and report immediately if you develop any deterioration of symptoms.
7. Do I need to be tested after the period of home isolation ends?
No. According to the latest revised discharge policy, it is not necessary to perform tests before discharge for all confirmed cases of presymptomatic / very mild / mild COVID-19 after 10 days of symptom onset and no fever for 3 days. Therefore, it stands to reason that tests are not needed for patients undergoing home isolation (pre-symptomatic / very mild / confirmed mild cases) after the period of home isolation ends.
8. What does the current discharge policy mean for patients who are isolated in their home?
As detailed above, when it comes to testing, there is no need for testing after the period of home isolation ends. However, (as the current discharge policy advises patients to remain in isolation in the home for a period of 7 days after discharge), the period of isolation in the home will end after 17 (10 + 7) days of Symptom onset and fever free for 10 (3+ 7 days). House insulation guidelines available on the ministry website should be strictly followed.
9. Does this policy apply to those who are quarantined in the home or facility?
The discharge policy is intended for patients (symptomatic / pre-symptomatic) diagnosed (using rt-PCR tests) suffering from COVID-19. Quarantine (home or facility) is intended for asymptomatic / healthy individuals who may have been exposed to COVID-19 infection but who do not have any symptoms. Therefore, it is not about the discharge of those people. However, your stay under the quarantine period will remain 14 days from the date of the last exposure.
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