A leap in the dark is how one can define the newly revised discharge policy of the Ministry of Health, Family Welfare, India. As it is based on studies conducted outside the nation and is still an evolving science. Just to get rid of ‘patient pressure’, the ministry enforced this policy in a hurry. Punjab adopted it and discharged 500 patients without conducting the RT-PCR Double Negative Test. Hence, the future of these patients is uncertain because the study on which this discharge policy is based is unsure if a discharged patient would infect others or not? Notably, many international journals are opposing such a 10-day discharge policy of asymptomatic or mildly symptomatic patients.
However, in Chandigarh, PGI has stuck to the previous strategy of conducting the Double Negative Test after 14 days of hospital isolation for every patient. When asked about the Revised Discharged Policy, Director PGI Dr Jagat Ram said, “We have checked 20 asymptomatic patients of Bapu Dham after 14 days; they were still positive. So, it’s common sense that if a positive patient is discharged, it will create havoc although the Chandigarh Administration is yet to take a call on this. On the other hand, Dr. Rajesh Bhaskar, Nodal Officer of COVID-19 Punjab, shared, “They have discussed the 10 days without test discharge policy with ICMR. As per ICMR, It could be a dead virus that a patient can shed after 3 or 7 days of hospital isolation. That dead-virus won’t spread further. So, there’s no need of the test and the discharge is safe, yet a patient has to isolate himself at his or her home.”
Whereas Dr Raman Gangakhedkar, Head, Epidemiology and Communicable Diseases, National Institute of Virology, ICMR, said, “The studies that I referred to were done out of India. These criteria are currently being followed in Europe and USA. This is an evolving science. ICMR is initiating a study by next week. We will also monitor it as required based on the emerging evidence.”
What does this policy say?
Covid-19 patients with mild and moderate symptoms need not be tested before discharge, according to India’s revised discharge policy. It allows for mild and moderately ill patients to be discharged from hospital 10 days after the onset of symptoms, if there is no fever and no need for oxygen therapy for three days.
Severely ill patients should test negative after clinical recovery. While this will reduce the strain on health facilities, the ‘infectiousness’ of patients after symptoms subside is uncertain, experts warn.
What does the study say?
Releasing COVID-19 patients from isolation relying on symptom checking, instead of testing, may result in patients returning to their communities too soon, according to a letter from researchers in the Journal of Infection.
The CDC’s non-test strategy recommends that COVID-19 patients discontinue self-isolation when they have not had a fever for 72 hours without the use of medications; have shown improvement in respiratory symptoms; and have gone at least 10 days since the start of symptoms. The test-based strategy makes the same recommendations as the symptom-based strategy, but also recommends that the patient have two consecutive negative COVID-19 tests, conducted more than 24 hours apart, before discontinuing isolation.
The researchers assessed both strategies among COVID-19 patients at Mayo’s COVID Virtual Clinic in Jacksonville, Fla.
Of the 92 patients studied, 72 patients met the criteria for release from self-isolation using the non-test strategy. They were all tested, and researchers found that a majority of the patients (69.9 percent) tested positive for the new coronavirus. “This data shows that the CDC non-test-based strategy may cause the early release from isolation for COVID-19 patients and result in additional community transmission,” the researchers wrote.