Discharge criteria of asymptomatic Covid-19 patients revised

The Health Ministry has revised the criteria of discharging Covid-19 confirmed patients from isolation based on growing evidence and global recommendations.

Accordingly, Covid-19 infected patients can be discharged from isolation facilities/intermediate Care Centres or Hospital without subsequent testing if all of the criteria recommended are fulfilled.

A patient can be discharged from the isolation facility/intermediate Care Centre after at least a period of 14 days following diagnostic PCR tests and the patient has remained asymptomatic throughout the period without developing symptoms.

Also mild symptomatic patients can be discharged, after at least a period of 14 days from the onset of illness/point of positive PCR test and absence of fever and respiratory symptoms (Cough, sore throat, SOB) for at least 3 days. At present discharge of Covid-19 patients from hospital requires a combinations of SAARS-CoV-2 PCR+ antibody testing. In a circular to Directors of all Hospitals, Provincials and Regional Directors of Health Service, Health Ministry Secretary Dr. S.H Munasinghe stated that the current practice of discharging of Covid-19 patients from hospital “may lead to practical difficulties in the future if the current trend in Covid-19 caseload continues, overwhelming laboratory and hospital capacities”.

“Furthermore, most individuals, despite being non-infectious, continue to test positive for Covid-19 by PCR and also take longer to develop antibodies, resulting in prolonged hospital stay which can negatively influence the patient as well as the healthcare delivery system,” it said.

Therefore, based on growing evidence and global recommendations, criteria for discharge of Covid-19 confirmed patients are revised as below.

A; Discharge of asymptomatic individuals-from isolation facility/intermediate Care Centres.

Both of the following should be present

1) At least a period of 14 days has passed from diagnostic PCR test and

2) Patient has remained asymptomatic throughout the period.

B; Discharge of mildly symptomatic patients-from isolation facility/hospital.

All of the following should be present

1) At least a period of 14 days from onset of illness/point of positive PCR test

2) Absence of fever AND respiratory symptoms (Cough, sore throat, SOB) for at least 3 days. In both the above categories, patient can be discharged from isolation facility/intermediate Care Centres or Hospital without subsequent testing if all of the criteria recommended above are fulfilled.

C Discharge of patients with moderate/severe illness-treated at hospitals With complete resolution of symptoms-the patient can be discharged from hospital of the following are fulfilled.

1. At least a period of 14 days has passed from onset of symptoms/diagnostic PCR test and

2. Absence of fever AND respiratory symptoms (cough, sore throat, SOB) for at least 3 days.

3. Two consecutive PCR tests performed 24 hours apart, the first of which is taken at least 11 days after onset of symptoms are negative or if the Covid-19 antibody test (IgG) is positive using ELISA/immune chemiluminescence test standardized and locally validated for Sri Lanka (and not rapid tests) Without complete resolution of symptoms-the patient can be discharged from hospital if ALL of the following fulfilled

1. At least a period of 14 days has passed from onset of symptoms/diagnostic PCR test

2. Afebrile for 3 days.

3. Clinical improvement of symptoms (cough, sore throat, SOB) for at least 3 days

4. Two consecutive PCR tests performed 24 hours apart, the first of which is taken at 11 days after onset of symptoms are negative or if the Covid-19 antibody test (IgG) is positive using ELISA/immune chemiluminescence test standardized and locally validated for Sri Lanka (and not rapid tests)

The circular also stated that all Covid-19 positive patients should undergo strict hoe quarantine for further 2 weeks following discharge from isolation facility/hospital. “In case of category A or B above, if strict home quarantine is not possible, such patients should be kept in isolation facility/hospital for further one week. For them an additional 1 week of self-quarantine is required,” it added. (Sunil Jayasiri)