Covid-19 update: Revised govt policy specifies when to discharge a positive patient

Government’s revised discharge policy is a set of instruction for government covid medical mangement system and patients clarifying when a case is fit for discharge from medical care.

The union ministry of health on Saturday issued revised discharge policy for patients admitted to the government’s three-tier Covid medical management system, clearly listing out conditions for discharging mild, moderate and severe cases.

The government has divided the covid care facilities into three categories for treatment of mild, moderate and severe cases. (PTI Photo/Representative)

For the first category of mild and very mild cases or pre-symptomatic cases at a Covid Care facility, the revised guideline sets the requirement of spending three days without fever and passage of 10 days since the onset of symptoms for discharge. Such cases do not need to be tested for a negative finding for Covid-19 virus before they are discharged, the revised policy states. However, such mild and very mild cases must be kept under regular temperature and pulse oximetry monitoring at the Covid Care facility during their stay and should follow home isolation for 7 days as per the relevant guidelines issued by the health ministry after their discharge.

The revised guidelines add that a mild or very mild patient needs to be moved to a dedicated Covid Health Centre (DCHC) if the oxygen saturation dips below 95% at any point of time prior to the discharge from the CCC.

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If the patients in the above category (mild/very mild/ pre-symptomatic) again develop symptoms of fever, cough or breathing difficulty after the discharge from CCC, then they will need to contact the CCC or the state helpline or 1075 for revaluation. Such cases will again be followed up through a tele-conference on 14th day, says the guideline.

The second category of patients that fall under moderate classification are described as those whose symptoms resolve within three days and oxygen saturation levels are maintained above 95% for the next four days.

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The revised guideline says that such cases will undergo monitoring of body temperature and oxygen saturation at the Covid Health Centres (CHC) that have the facility for oxygen beds.

If the fever resolve within 3 days and the patient maintains saturation above 95% for the next 4 days without oxygen support, then the moderate patient can be discharged but not before 10 days have passed since the onset of symptoms

Additionally, the following three conditions must also be met for the discharge of patients in the above category.

1. Absence of fever without antipyretics

2. Resolution of breathlessness

3. No oxygen requirement

Even in moderate cases, there will be no need for testing prior to discharge, and the patient will be advised to be in home isolation for 7 days as per the guidelines issued by the health ministry in this regard.

For patients who are on oxygenation and whose fever does not resolve within 3 days and demand of oxygen therapy continues, the revised guidelines say that such patients will be discharged only after the resolution of all clinical symptoms of coronavirus and the ability to maintain oxygen saturation for 3 consecutive days.

And finally for patients classified as ‘severe’, including immunocompromised patients--HIV patients, transplant recipients, malignancy--- the discharge criteria will be based on clinical recovery, confirmatory RT-PCR test after resolution of symptoms.