With beds in short supply, Kerala amends discharge norms for patients with severe symptoms

With beds in short supply, health department amends discharge norms for patients with severe symptoms
From now on, Category B patients can be discharged on the 10th day if they turn negative and have no symptoms. Representative image
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Two-and-a-half months after withdrawing the 'two positives' norm for the discharge of COVID-19 patients, the Health Department has come up with yet another amendment to the discharge policy that, though a minor tweak, could considerably increase the daily recovery rate.

The change is only for Category B patients (those with severe symptoms). Till now, such patients has to be in the hospital for at least 14 days. The first follow-up test could be done on these patients only on the 14th day since the onset of symptoms. From now on, Category B patients can be discharged on the 10th day if they turn negative and have no symptoms. The first follow-up test can be now be done earlier, on the 10th day of the onset of symptoms.

This amendment to the discharge policy is expected to increase daily recovery to nearly 10,000. At the moment, the average recovery rate is around 7,500. The move is also expected to free more hospital beds and reduce stress on the system. The evolving scientific understanding, too, supports such a change. It says that Sars-CoV-2, even if it keps on shedding, ceases to be infective after eight to ten days.

The recovery rate had in fact shot up quite commendably after the 'two negatives' norm was scrapped. The original condition was that a person can be discharged only if two back-to-back tests, 24-hours apart, showed negative. This led to patients having to remain in hospital long after they had turned clinically stable. There were patients who had been in the hospital for even one-and-a-half months and whose samples were taken over 15 times, and still had not been able to get two back-to-back negatives.

Even in July, when daily cases where in the 150-200 range, the health system was feeling the pinch.

On July 1, when the 'two negatives' norm was shelved, the daily recovery was in the 150 range. By the end of July, the recovery shot up to 800. Now, the recovery is in the 8000 range but confirmed cases are invariably higher.

Here are the new guidelines issued on October 14. Except for Category B patients, the discharge policy remains intact.

Asymptomatic 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 10th 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 10th 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 travel and social contact (family visits, marriages, functions or work) for seven days after discharge.

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