Corona Revised Discharge Policy Circular

Corona Revised Discharge Policy Circular

The Ministry of Health and Family Welfare (MoHFW) on Friday issued revised guidelines on discharge of coronavirus (Covid-19) patients. In mild and pre-symptomatic cases, hospitals can discharge patients only after 10 days of symptom onset and there is no fever for three days, according to the new guidelines.
Moreover, the circular also states that there will be no coronavirus testing at Covid-19 facilities prior to discharge, and patients will be advised to follow home isolation for seven days. The policy is aligned with the guidelines on the three-tier Covid-19 facilities and the categorisation of patients based on clinical severity.

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

1. What were the earlier pre-existing criteria for discharging COVID-19 patients?

The earlier criteria which were required to be fulfilled for discharging rt-PCR positive patients were (a) chest radiograph has been cleared and (b) 2 consecutive negative test results on rt-PCR.

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

According to the new discharge policy, the COVID-19 patients have been categorised into different subgroups based on the severity of their cases, for easier assessment and discharge. Here's the gist of it:
For mild / very mild / pre-symptomatic cases:
The patient can be discharged after 10 days of symptom onset and after displaying no fever for three days.
There is no need for testing prior to discharge.
The patient will be advised to follow home isolation for a further seven days after discharge
For moderate cases:
The patient can be discharged (a) if asymptomatic for three days and (b) after 10 days of symptom onset
No need for testing prior to discharge
The patient will be advised to follow home isolation for a further seven days after discharge
For severe cases:
Clinical recovery
The patient tested negative once by RT-PCR (after the 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 the ICMR laboratory surveillance data also indicated that after the 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 (two days before symptoms) and go down over the next seven days.

4. How, then, will it be established that a patient is cured of the disease?

Being cured of a disease may have different connotations for the general public, treating doctors and the virologists. Unless there is a fear of a resurgence of infection and subsequent transmissibility of an infection, resolution of clinical manifestation is usually taken as evidence of 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, which also specifies that such patients will follow home isolation for a further seven days, for additional safety.

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 inside 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 a triple-layer medical mask. Patient must stay in the identified room and away from other people at 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 for all presymptomatic/very mild/mild confirmed cases of COVID-19 after 10 days of symptom onset and no fever for three 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 the testing is concerned, there is no need for it after the home isolation period is over. However (as the current discharge policy advises patients to remain in home isolation for a seven 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 the 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 the quarantine period will remain for 14 days from the date of the last exposure.

Health Ministry issues revised discharge policy for COVID-19 patients; Very mild, mild and moderate patients can be discharged without test

The patient can be discharged after 10 days of symptom onset and no fever for 3 days. There will be no need for testing prior to discharge. The patient will be advised to follow the home isolation for further 7 days. If they develop symptoms of fever, cough or breathing difficulty again, they must contact the COVID Care Centre or State helpline or 1075.

As per the revised policy, the moderate cases will undergo monitoring of body temperature and oxygen saturation. If the fever resolves within 3 days and the patient maintains saturation above 95 percent for the next 4 days, the patient will be discharged after 10 days of symptom onset provided there is no fever or breathlessness.

Patients on oxygenation whose fever does not resolve within 3 days and demand of oxygen therapy continues will be discharged only after resolution of clinical symptoms and ability to maintain oxygen saturation for 3 consecutive days. Discharge criteria for severe cases will be based on clinical recovery and testing of patient by RT-PCR.