Every disease has a treatment protocol that is almost universally accepted and followed. However, Covid-19 is a new disease and such a protocol is yet to be universally formulated. Different affected countries have adopted slightly different protocols to recommend discharge of a novel coronavirus patient.
Having largely contained the coronavirus pandemic in the country, China – the source of the contagion – released a discharge protocol last week. It has now formally recommended the procedure the country was largely following for discharging coronavirus patients since January.
China recommends discharging Covid-19 patients if they don’t have fever for three days, show improved respiratory symptoms, reduced inflammation in respiratory tracts and test negative twice in consecutive samples taken at least 24 hours apart.
These discharged patients are to stay in isolation – no contact with family members, separate dining and no outdoor activity — for 14 more days. It is mandatory for them to wear a face mask and live in a room with good ventilation.
They have to visit a hospital for re-checkup after two weeks and then again four weeks. The Chinese protocol calls for setting up a separate or especially designated hospital facility for cured Covid-19 patients’ return visits and re-testing for novel coronavirus.
The Chinese experience was followed up everywhere in the world for treatment of Covid-19 patients with countries altering the protocol depending on their own clinical experience.
In India, hospital care begins from identification of a suspect case. Isolation begins with sample being taken for Covid-19 testing. Even if the patient’s sample test negative, the person is discharged from the hospital only on the basis of clinical symptoms. Doctors take a call on individual cases.
If the laboratory test is positive for Covid-19, the patient is kept in hospital till key symptoms – fever, respiratory difficulties and coughing — disappear, two consecutive tests return negative within 24 hours, and chest radiograph shows signs of clearance for the virus.
India too recommends a 14-day isolation process for cured patients, like in China. Italy, rest of Europe and the United States too have slightly altered the Chinese protocol for discharging cured Covid-19 patients.
Usually, discharging a Covid-19 patient should be a simple matter, like in the cases of any other disease. But China and South Korea – the country of origin and one of the first to receive imported cases respectively – have now cautioned that many patients who had been discharged from hospital after having been confirmed as “cured” coronavirus patients have tested positive again, in some cases, weeks after their discharge from hospital.
A study in China found close to 15 per cent patients were found positive for novel coronavirus after they were duly discharged from a Covid-19 hospital. The researchers said there is “need for additional measures to confirm illness resolution in Covid-19 patients”.
South Korea has reported more than 90 patients as “positive again” for novel coronavirus after they had been cleared for discharge following treatment protocol for Covid-19.
Does this mean all such persons are still Covid-19 patients and infectious?
The jury is still out on this question. Measures being taken by China and South Korea are being closely monitored by health experts around the world.
As a matter of rule, viral RNA – the one like novel coronavirus — can persist over long periods of time in bodily fluids. This does not necessarily mean that the person is still infectious, says the technical report on Covid-19 by the European Centre for Disease Control and Prevention, the top health agency of the European Union. Isolation of viruses in virus culture is needed to show the infectivity of the virus, it recommends
In some other cases, patients have been found to have contracted Covid-19 again, showing that if a person is infected with the novel coronavirus once, it does not necessarily leads to perfect immunity against the pathogen.
Periodic testing is required for every cured and discharged Covid-19 patient for some time. But in private labs, these tests cost a lot. As noted by the Supreme Court, the government’s intervention is required. Also, the cured patients of Covid-19 should wear masks as precautionary measure as long as possible, maintain social distancing and follow basic hygiene rules religiously.