Doctors apprehensive about issuing ‘Covid-19 recovery’ certificates

Doctors have expressed reservations about issuing Covid-recovery certificates as mandated by the state government — the certificates state that a person “does not pose a risk to the community” — while discharging them from Covid-19 hospitals.

Doctors have expressed reservations about issuing Covid-recovery certificates as mandated by the state government — the certificates state that a person “does not pose a risk to the community” — while discharging them from Covid-19 hospitals. The certificates,the Delhi government says, will help in countering the stigma that’s become attached to the disease.

Health workers setup before conducting Covid-19 Ag rapid antigen tests at a dispensary in Mehrauli, in New Delhi, India, on Monday, June 22, 2020. (Sanjeev Verma/HT PHOTO)

According to the June 15 order by the Delhi government, the certificate must mention, “This is to certify that I have examined …. He/She has recovered from Covid and does not pose a risk to the community. He/ She is asymptomatic at the time of discharge.”

Under the Union health ministry’s discharge policy, those with mild to moderate symptoms can be discharged without testing after 10 days of symptoms appearing and/or being symptom free for three days.

“How can a doctor certify whether a person is infectious or not without testing them? Although collective evidence from the cases, which have been treated so far, show that after 10 days the virus does not usually transmit the disease, but a microbiologist has to do a test in order to verify this,” said Dr Neeraj Gupta from the department of pulmonary medicine at Safdarjung Hospital.

Even for those who stay at the hospital for longer, there is no way health care experts can determine whether or not patients will transmit the infection.

“I can say a patient is free of symptoms at the time when he/she was examined. But, how can I say that they pose no risk to the society, especially when we are not even testing them at the time of discharge? The science on whether an asymptomatic person can transmit the infection is still unclear. Governments are going back and forth on what the ideal isolation or quarantine duration should be. In such a scenario, how can I issue such a certificate?” asked Delhi-based neurologist Dr Amit Shrivastav. “This is a legal document and doctors might be held liable in case even one of the discharged patients passes on the infection to their families or co-workers.”

Issuing false medical certificate is an offence under the Delhi Medical Council Act, punishable by striking a doctor’s name from the state’s medical register and barring them from practicing medicine for a given period. “This is such a novel issue, there is no clarity on the rules about anything. However, if the doctors are following the government guidelines there shouldn’t be any reason for taking action against them,” said Dr Girish Tyagi, registrar, Delhi Medical Council.

The government hoped that the certificate would reduce stigma against those who recovered from the disease. “People living in the same (housing) society and resident welfare associations become apprehensive, after a person living among or near them is discharged from the hospital. The certificate will help ease such situations,” Dr Suresh Kumar, medical director of Lok Nayak hospital, said on June 15 when the order was issued.

Some officials also said that the certificate would help facilitate the rail and air travel of recovered patients. This is along the lines of immunity certificate, which the World Health Organisation warned against in April-end stating that there was no evidence to show that people who have recovered are protected from getting the infection a second time. Allowing immunity certificates for easing out of strict social distancing norms might fuel continued spread of the infection, WHO said then.

Contacted, the Delhi government did not comment on the issue.