As the number of Covid-19 infections in India near the 60,000 mark, the Centre on Saturday revised its policy on the discharge of Covid-19 patients and most crucially said that only severe cases will now be tested, that too only once, before being discharged.
Until now, patients were discharged only if two of their specimens tested negative for Covid-19 in RT-PCR swab tests after a gap of 24 hours. The changed guidelines for hospitalisation come into effect as India is bracing for a spike in the number of infections, with mathematical modeling predicting that the peak could be in June-July.
In the last week, India has added nearly 20,000 cases of Covid-19 and the doubling rate has also worsened, leading to concerns that the healthcare infrastructure could be overwhelmed soon and hospitals may run out of beds.
The ministry of health and family welfare, in its revised guidelines, said that mild/very mild/pre-symptomatic cases admitted to a Covid-19 care facility will undergo regular temperature and pulse oximetry monitoring.
The patient can be discharged after 10 days of symptom onset and no fever for three days. “There will be no need for testing prior to discharge,” the revised guidelines said. It added that at the time of discharge, the patient will be advised to follow home isolation for seven days.
The revised policy further said that patients admitted to Covid-19 health centres, whose symptoms resolve within three days and who maintain oxygen saturation above 95 per cent for the next four days, will be clinically classified as “moderate cases”.
They will undergo monitoring of body temperature and oxygen saturation. If the fever resolves within three days and the patient maintains "saturation above 95% for the next four days, without oxygen support", they will be discharged after 10 days of symptom onset in case of – absence of "fever without antipyretics, resolution of breathlessness and no oxygen requirement," the guidelines said.
It added that there will be no need for testing prior to discharge in such cases as well.
The new guidelines are a major departure from established norms for treatment of Covid-19 patients as discharge policies in most countries is also two consecutive negative tests.
The US Center for Disease Control (CDC) notes that while the decision to discharge has to be supported by negative RT-PCR results from swabs collected at least 24 hours apart along with a resolution of fever and an improvement in signs of illness and symptoms. European countries also have similar policies.
Even for severe coronavirus cases and those who are immunocompromised, the discharge criteria will be a single negative test and not two in addition to clinical recovery.
Immunocompromised include those with HIV, transplant recipients and patients with malignancy.
For patients on oxygen support, whose fever does not resolve within three days and demand of oxygen therapy continues, the ministry of health and family welfare has instructed hospitals to discharge such patients only after the resolution of “clinical symptoms and ability to maintain oxygen saturation for three consecutive days,” the guidelines said.
Experts have, however, expressed caution on discharging patients too early as it remains unclear till how long patients can continue to shed the virus even after recovery.
The health ministry has said that India's recovery rate stands at 30 per cent with 17,846 Covid-19 recovered till now out of the 59,662 cases.