NEW DELHI: In a major policy shift, the Centre has said that COVID-19 patients with mild and moderate infection will no longer be tested for the presence of the pathogen before discharge from hospitals. And in severe cases, the pathogen test will be done only once before discharge, not twice as has been the norm till now.
So far, all patients of the novel coronavirus were being discharged from hospital only after testing negative for SARS CoV-2, the virus behind COVID-19, twice within 24 hours. The method of Covid-19 testing involves a gene diagnostic test, called RT-PCR, which detects the presence of the pathogen in infected persons.
In the guidelines issued late on Friday, the Union health ministry said there will be no need for testing prior to discharge for "mild/very mild/pre-symptomatic" cases of COVID-19. Such patients can be discharged after 10 days of symptom onset and absence of fever for the last three days. "At the time of discharge, the patient will be advised to follow the home isolation for further seven days."
In all cases, patients will be required to be isolated at home for seven days. The move, said health ministry officials, is aimed at saving crucial testing resources as every RT-PCR test costs Rs 3,500-4,000 and good quality tests are limited.
The development comes amidst reports from Dharavi, Mumbai that some Covid patients died a few days after "discharge and recovery". Patients classified as "moderate" will be discharged after 10 days of symptom onset if there is "absence of fever without antipyretics, resolution of breathlessness and no oxygen requirement". These patients, too, will not undergo the RT-PCR test before discharge.
For patients who continue to have fever beyond three days and need oxygen therapy, discharge will happen only after clinical symptoms are resolved and they are able to maintain oxygen saturation for three consecutive days. For Covid patients classified as severe, such as HIV cases, transplant recipients and those with malignancy, the guidelines mandate discharge only after clinical recovery and after they test negative in RT-PCR test.
Some experts welcomed the new protocol, underlining that even though testing every patient could be desirable, it might not always be pragmatic in a huge country like India with limited health resources.
"Also RT-PCR test has its limitations. For example, it can sometime show somebody with dead viruses in the body as positive, which may be false positive. Therefore it’s good to not let very sick patients go home without testing," said Dr Shikha Panwar, a critical care specialist from Faridabad.
"Of course, these patients should be followed up and report to hospitals in case of any worsening of condition," she added. The changes in discharge policy come days after the Centre allowed patients with mild symptoms to stay at home under certain conditions.
Moderate
If fever subsides within three days and no oxygen support is required, discharge after 10 days of symptom onset. No RT-PCR test required before discharge. Home isolation for next 7 days
If symptoms not resolved and oxygen support continues, discharge only after symptoms subside and patient is off oxygen support for 3 consecutive days. No RT-PCR test required before discharge. Home isolation for next 7 days
Severe
Discharge only after clinical recovery and patient tests negative once on RT-PCR after symptoms subside
RT-PCR stands for reverse transcription–polymerase chain reaction, which is an accurate method to test Covid-19