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Discharge of Covid-19 patients under ICMR’s policy can increase spread, claim experts

By Rupsa Chakraborty, Mumbai
PUBLISHED ON MAY 15, 2020 12:22 AM IST

The relaxation in the discharge policy directed by the Indian Council of Medical Research (ICMR) may not be suitable for the country’s most populated city, where 42% of its population dwells in slums, experts claimed. However, the state health department said that citizens should believe in administration’s dexterity.

Recently, ICMR released a new discharge policy for Covid-19 patients, which stated that mild and pre-symptomatic patients will be discharged from Covid-19 centres if they do not develop fever in three days. HT reported on Thursday that with the ICMR’s new policy coming into effect, the Brihanmumbai Municipal Corporation (BMC) would have to release around 2,500 asymptomatic patients from the Covid Care Centres-2 (CCC-2). These patients are carriers of Sars-Cov-2 that causes novel coronavirus.

The government’s previous rule stated that Covid patients can be released only if their swab test reports came negative twice in two consecutive tests. But as per the new rule released on May 9, very mild, mild and pre-symptomatic patients will be discharged without any test.

An analysis of BMC data revealed that G North ward (Dharavi, Dadar and Mahim) has the highest number of asymptomatic patients at 529, followed by the G South ward (272), which is among the worst-affected wards with multiple containment zones and a large number of slum pockets. The 121 asymptomatic patients at CCC-2 facilities in M East wards (Govandi, Deonar and Chembur) will also be discharged.

At a time when the state health department has confirmed signs of community spread in the state, the release of these patients can further increase the number of Covid cases, claimed experts.

“Despite so many hassles, we conducted the contract tracing and isolated the asymptomatic patients from the slums so that they don’t spread the infection. But with the release of these patients, we will be back to square one,” said a civic official from G North ward which comprises of Dharavi — the biggest slum in Asia with a population of 8.5 lakh.

Doctors also claimed that ICMR needs to be more rigid to the largest city in India due to its demographic differences. “The new policy states that mild patients can be discharged after 10 days of the onset of the symptoms. But in several cases, we have seen that patients remain positive even on the 25th day. Premature discharge will further spread the infection among people living in small-sized households,” said Dr Vijay Natarajan, chief executive officer, Symbiosis University Hospital and Research Centre.

Data procured by HT shows that there are also several discrepancies in the screening of high-risk contacts of Covid patients from the most-infected wards. Wards such as G North and South, D and F North, which recorded the maximum number of coronavirus cases have quarantined one of the lowest number of high-risk patients in CCC-1 (type 1 Covid care Centres) facilities, which highlights that a large vulnerable group of people are yet to be identified and isolated as high-risk patients.

“Areas such as Govandi, Bandra (East) and Dadar have a large number of tuberculosis (TB) patients. If Covid patients get discharged without getting cured, those with compromised lungs can contract the infections,” said Dr Ravikant Singh, a health activist from Doctors For You.

“Hospitals are running on limited resources and the rules are being changed keeping mind that if the number goes up further as predicted by the Health Ministry. But we also need to understand that policies need to be formulated on scientific evidence not on administrative requirements,” said Anant Bhan, a global health expert. “We need to keep a check if the discharged person actually turned negative through tests,” he added.

The Centres for Disease Control and Prevention in the United States also revised its guidelines on May 6 and stated that no negative test for the virus if required for discharge.

Dr Pradeep Awate, state surveillance officer said that depending on the impact and demographic spread of the virus, all the affected countries changed their policies, including China and Italy. He urged people to believe in experts from ICMR who have years of experience in the field and run several research before making policy changes.

“When we say that a person is positive, it doesn’t mean he is still a spreader. He is just a carrier. Studies have shown that after ten days of the disease onset, the virus may not be infectious,” said Dr Awate. “Also, asymptomatic patients are not active carriers. They don’t sneeze or cough so the chance of infection spread is extremely limited,” he added.

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