Thursday, March 19, 2020

Discharge Policy of nCoV Case: does it need a change

Discharge Policy of nCoV Case: does it need a change

Dr K K Aggarwal
President CMAAO, HCFI and Past National President IMA

Current Policy: In case the laboratory results are positive for SARS CO 19 virus, the case shall be managed as per the confirmed case management protocol. The case shall be discharged only after evidence of chest radiographic clearance and viral clearance in respiratory samples after two specimens test negative for virus within a period of 24 hours.

Policy change required in the discharge policy
The study explains why some people become positive again after they get cured

Reuters Excerpts: The SARS COV2 virus is more readily detected in induced sputum than in throat swabs of patients recovering from COVID-19, according to preliminary research from China published in the in The Lancet Infectious Diseases.

Viral RNA tests of induced sputum - not throat swabs - should be assessed as a criterion for releasing COVID-19 patients as per the study.

Detection of SARS-CoV-2 RNA in throat swabs is the most common method of diagnosing COVID-19 in China. But this method has a rate of false-negative results that could allow patients recovering from COVID-19 to meet criteria for discharge from hospital and release from quarantine, fueling spread of the disease.

Dr. Han and colleagues induced sputum production in two patients with COVID-19. To induce sputum, the patients inhaled 10 mL of 3% hypertonic saline through a mask with oxygen at a flow rate of 6 L/min for 20 min or until sputum was produced.

The first patient was a 54-year-old man with a three-day history of fever who was admitted for treatment and quarantine on February 1. On February 3, an approved viral RNA detection kit confirmed mild COVID-19. The patient's fever and symptoms resolved after treatment with oxygen, lopinavir/ritonavir and moxifloxacin.

Beginning February 13, three consecutive throat swabs performed at least 24 hours apart and one anal swab tested negative for viral RNA. One week later, induced sputum was positive for viral RNA.

The second patient was a 42-year-old woman who was admitted on January 27 with a four-day history of fever. The next day, viral RNA was detected in a throat swab, confirming a mild case of COVID-19. The patient's fever subsided following treatment with oxygen, lopinavir/ritonavir, and moxifloxacin, and her symptoms gradually resolved.

Beginning February 10, three consecutive throat swabs over three days and one anal swab tested negative for viral RNA. On February 21, viral RNA was detected in induced sputum.

These results suggest that induced sputum "might be more helpful than throat swabs for the detection of SARS-CoV-2 RNA in convalescent patients,"

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