With the increasing number of patients in the second wave of COVID threatening to breach the health system’s surge capacity, the State government has taken a long-pending decision to discharge COVID-19 patients from hospitals without insisting that they test negative in a rapid antigen test.
In the initial days of COVID, a patient could be discharged from hospital only after he tested negative in two consecutive RT-PCR tests between a fixed interval.
But in June last, the Indian Council of Medical Research (ICMR) revised its guidelines that patients with mild/moderate disease could be discharged after 10 days of symptom onset if there was no fever for three days, without a COVID test.
Somehow, the State which seemed to look up to the ICMR for everything else, continued to insist on a negative antigen test on the 10th day, prior to discharge.
Even though all clinicians as well as the expert committee pointed out that this was unnecessary and a waste of resources, the State refused to change the discharge guidelines. The argument was that it was important to reassure the patient that he was no more infectious, before letting him into the community.
Faced with the prospect of hospitals getting choked with COVID patients, the government has now relented to revise the guidelines.
The new guidelines say that patients with mild and moderate COVID disease can be discharged to home isolation, if they have been symptomless for the past 72 hours, without an antigen test.
Moderate cases should be haemodynamically stable, should not require supplementary oxygen, and there should be no breathlessness or excessive fatigue.
These patients will continue to watch out for red flag signs while in home isolation and perform the six-minute walk test daily to pick up exertion desaturation signs (defined as fall in oxygen levels below 3% of the baseline after the six-minute test).
Public health experts point out that the total subsiding of clinical illness is usually taken as an indication that the virus is no longer active. The government’s decision to do away with the antigen test will thus help clinically stable patients to be released early, freeing up hospital beds faster.
However, they also point out that it makes no sense that in the case of patients who are seriously ill, the State is continuing to insist on a negative antigen test 14 days from symptom onset before discharge, even if they are clinically stable. If they are antigen positive on day 14, the test will be repeated every 48 hours, the guidelines say.