The health authorities of Bangladesh are easing the discharge guidelines for coronavirus infected patients foregoing the option of testing the recovered patients.
While more countries are emphasizing on re-testing the recovered patients after a required period, as incidents of finding recovered patients positive for coronavirus again is increasing, the health authorities of Bangladesh are considering discharging recovered patients without doing any further tests.
Additional Director General (Administration) of Directorate General of Health Services (DGHS), Nasima Sultana disclosed the matter at the daily press briefing on Friday while giving clarification about who will be discharged after recovery.
Quoting the national technical committee on Covid-19, she said the criterion for being declared recovered is, that a person must be fever-free without fever-reducing medications for three consecutive days, and shows significant improvement in major respiratory symptoms of Covid-19 including sneezing, coughing, acute respiratory problems.
She also mentioned the results of two consecutive tests conducted in a 24-hour interval should be negative for nasopharyngeal and throat swab samples.
At the same time she kept the option open for not conducting tests, saying if two consecutive tests could not be done in any case, but the criterion - one and two remain constant for 72 hours the patient would be released.
After being discharged, the patients have to follow the rules of institutional quarantine or self-isolation and they have to stay at the place for 14 days from the day of release.
Later the patients’ sample might be collected if possible from the place they are staying at or they could travel to the directed places, she said.
She, however, did not mention if these would be applicable for all regardless of symptomatic and asymptomatic cases.
What other countries are doing
According to the US Centers for Disease Control and Prevention (CDC) guidelines, a person must be tested for the virus twice using nasopharyngeal and throat swabs, with the samples taken at least 24 hours apart.
The patient will be released only if he is found negative in both the tests along with reducing signs of the disease and it must be at least seven days since the symptoms began.
And for asymptomatic infection the patients will be announced recovered only after obtaining negative results in four tests and if they show no symptoms of infections.
According to a protocol published by China on April 9, recovered Covid-19 patients should stay in quarantine for 14 days either at home or in an isolation centre for medical observation, reported the state-run Xinhua news agency.
Designated hospitals should make plans for patients’ return visits and re-testing for the next two or four weeks following their discharge, it said, adding that sputum samples are more reliable and should be the first choice for testing.
The National Centre for Infectious Diseases (NCID) Singapore guideline says discharged patients should go for advisory and clinic follow-ups and daily wellness calls till day 14 after the last possible exposure, under the following conditions:
Reducing symptoms, two respiratory samples testing negative for SARS CoV-2 by PCR in 24 hours, at least six days from the onset of the illness, if alternative aetiology found (e.g. influenza, bacteraemia) and have no close contact with a Covid-19 patient.
According to Ministero della salute (health ministry), Consiglio Superiore di Sanità Italy, a Covid-19 patient can be considered cured after the resolution of symptoms and two negative tests for SARS CoV-2 at 24-hour intervals.
For patients who clinically recover earlier than 7 days after onset, an interval of 7 days between the first and the final test is advised by the European Centre for Disease Prevention and Control (ECDC).
For asymptomatic cases, it requires SARS-CoV-2 RNA test to be negative at least 14 days after the first test.
