With the number of cases increasing and the need to conserve both hospital beds and testing kits becoming urgent, Kerala government has decided to do away with a rigorous condition that a person can be discharged only if two back-to-back tests, 24-hours apart, show negative.
From July 1, an individual will be discharged even if the first follow-up test turns negative. The decision will also improve the recovery rate considerably.
There are patients in Kerala who have been in the hospital for even one-and-a-half months and whose samples were taken over 15 times, and have still not been able to get two back-to-back negatives.
In between, one or two of these tests would have thrown up a negative result but since they had happened only once or not consecutively, these patients were asked to remain in the hospital.
For instance, a COVID-19 patient in Palakkad has been in the hospital for 50 days and still has not been discharged. His samples were taken 15 times and, except for once, none of the tests threw up a negative test. The man is free of all symptoms and is healthy.
Earlier, a 62-year-old woman had been in Kozhenchery District Hospital in Pathanamthitta for 42 days and had to undergo 17 tests to finally manage a double positive in quick succession. Her symptoms, too, had dried up quite early during her hospital stay.
Such a cautious COVID-19 discharge regimen was stretching the state's health infrastructure at a time when beds and testing kits were threatening to fall into short supply.
A top health Department source said the Reverse Transcription - Polymerase Chain Rection (RT-PCR) tests were highly sensitive and would pick up even the lingering viral litter or debris in the patient's samples. "After about a fortnight the virus becomes inactive. The remnants that remain are non-infective and would have lost all its potency. A person will generally cease to be non-infective if the first follow-up test turns negative," the source said.
The time of the first follow-up test, discharge and quarantine norms for four types of COVID-19 patients have also been clearly laid down in the Revised Discharge Guideline' issued by the Health Department today (July 2).
Asymptomtic patients: Their follow-up test will be done on the 10th day after they first tested positive. If the test turns negative, they can be discharged. If the first follow-up test is positive, the test will be repeated every alternate day till it turns negatve for discharge.
Category A (persons with mild symptoms): Their first follow-up test can be done on the 10th day since the onset of symptoms provided they have no symptoms at that time. If symptoms persist, the test can be done the very next day the symptoms have gone.
Even if negative, they will be discharged only on the 14th day after the onset of symptoms. Whether on the 14th day or later, they should be without symptoms for at least three days before the day of discharge.
If positive, the test will be repeated every alternate day till it turns negative for discharge.
Category B (persons with severe symptoms): Their first follow-up test can be done on the 14th day since the onset of symptoms, that too only if there are no symptoms. If symptoms persist, the test can be done the very next day the symptoms have gone.
They, like Category A patients, can be discharged on the 14th day if tests are negative. But whichever the day of discharge, the individual should be without symptoms for at least three days before the discharge date.
If positive, the test will be repeated every alternate day till it turns negative for discharge.
Category C or disease in immunocompromised (HIV positive, transplant recipients, malignancy): Here also, the first follow-up test can be done on only on the 14th day since the onset of symptoms, and only if there are no symptoms.
If symptoms persist, the test can be done one day after the resolution of symptoms or as per the doctor's orders.
Patients in this category, too, can be discharged on the 14th day if tests are negative. But the individual should be without symptoms for at least three days before the discharge date. The person should also be clinically stable.
If positive, the test will be repeated every alternate day till it turns negative for discharge.
Quarantine: All of them will have to avoid non-essential ravel and social contact (family visits, marriages, functions or work) for seven days after discharge.
