A discharge policy that misleads

The policy that guides the discharge of Covid-19 patients has been a key factor in determining the progress of the disease, assessing its spread, and implementing strategies to contain it. The policy is about when a person who has tested positive or is suspected to be infected can be discharged from a Covid-19 care facility, where the patient can be shifted to and, most importantly, when the patient can be declared as having recovered from the disease. The central government recently told state governments that mild, very mild and pre-symptomatic patients should be assured of proper facilities before being sent into home isolation. The policy has changed over the weeks on the basis of the experience of dealing with the disease and the availability of the facilities for treatment. With the steady increase in the number of patients, the facilities have become increasingly stretched, and the policy has got diluted.

In the beginning, all patients had to be declared negative before being discharged. The present position is that the patient should be diagnosed as pre-symptomatic or having mild symptoms and there should be facilities for self-isolation at home. With the implementation of the new discharge policy, the officially reported ‘recovery rate’ has improved but this may not mark a real recovery. The rate is above 54%, but it includes asymptomatic and positive patients who are not in hospitals and mild and very mild cases who have not tested negative. They may be positive or negative, and the problem is that this misrepresents the recovery rate and the state of incidence and spread of the disease. There are cases of death of such persons who have been discharged from hospitals with mild symptoms. There have also been sudden upsurges in cases because of poor isolation facilities or weak enforcement of quarantine when Covid-positive people have been allowed to stay at home. This has happened in Delhi.

A generous discharge policy poses a serious danger in a country with a large number of people in vulnerable groups like senior citizens and those with co-morbidities. The entire community may be at risk if asymptomatic persons are allowed to go out before they test negative. Kerala has done well to ensure that patients are not discharged before they test negative. Tamil Nadu, even with a high case load, does not declare the recovery of patients in home isolation before they test negative. The best discharge policy is one that declares every asymptomatic patient as ‘recovered’ only after the patient tests negative, either in hospital or at home.