The Centre issued the guidelines on January 9, days after it revised its guidelines regarding home isolation. According to the new discharge policy, Covid-19 facilities and hospitals may discharge patients seven days after testing positive provided they have had no fever for three consecutive days. There is no requirement to repeat the test before discharge.
According to the new guidelines, moderate patients too can be discharged after seven days of a positive report, if their oxygen saturation is above 93% for three consecutive days and they have not needed any oxygen support during this period. The discharge criteria for severe patients should depend on the clinical recovery and discretion of the treating doctors, according to the revised guidelines. The basis of the guidelines seems to be to ensure that hospital beds are not taken up by non-serious patients.
Experts said that since little is known about how infectious a person is even if they don’t exhibit symptoms such as a fever for three consecutive days after seven days of treatment, people must continue to wear masks when they step out.
On Monday, 29,671 patients, including 27,214 from Mumbai were discharged from public and private in the state. On Tuesday, 18,967 patients, including 14,980 in Mumbai, were discharged. In all, 48, 638 patients — 42,194 from Mumbai alone — have been discharged in the state over the past two days.
State Covid task force member Shashank Joshi said that the new policy was similar to the guidelines of the Centers for Disease Control and Prevention (CDC), the American nodal public health agency. “Once patients turn asymptomatic, they should strictly follow Covid appropriate behaviour and use double masking. For instance, a healthcare worker who has recovered from a recent infection can resume work with proper masking. If patients follow strict masking protocol after turning asymptomatic, they can simply resume their activities and not worry about passing on the infection to others,” said Dr Joshi.
Doctors said that little is known about how long a person can be infectious, however, when patients don’t have symptoms, they don’t expectorate the virus as much as compared to a symptomatic person.
“Before this policy came in, we were discharging patients only after their repeat tests came negative,” said Dr Rajesh Dere, dean of the jumbo Covid-19 facility at Bandra Kurla Complex (BKC).
Dr Neelam Andrade, dean of the NESCO jumbo Covid-19 facility in Goregaon said that the new policy will open up beds sooner. “Previously, we used to take the samples of admitted patients on the fourth day. If they tested negative, we discharged them immediately and if they tested positive, we kept them under treatment for longer. Now, we can send them home after being symptom-free for three days.”
According to Andrade, the new policy will reduce the burden on testing machinery as patients no longer have to undergo repeat tests before discharge.
The policy signals the changing course of the pandemic where experts are saying that the focus no longer should be on every positive case, but rather on hospitalisations and people in need of prolonged oxygen support.
The current occupancy rate of oxygen beds in Mumbai is 26% — a week ago, it was 13%.
On the ground, the decision to discharge a patient has depended on the doctor treating them. However, the policy will largely be applicable to government Covid facilities that stick to rules mandated on paper.
“When to discharge a patient is a decision that has to be made on clinical judgement,” said Dr N Santhanam, chief executive officer of Breach Candy Hospital. “It good to have a policy but ultimately, we have gone by the clinician’s decision always when it comes to discharge,” he said.
Joshi added that the nature of the Omicron wave is such that 80% of the people are going to be asymptomatic with invisible infections. “The 20% patients with symptoms should be our focus, and we have to red-flag those patients who might progress to severe disease,” he said.