CDCP guidelines: Kashmir health experts caution against discharging COVID patients before testing negative

Srinagar: Health experts in Kashmir have cautioned against discharging patients with mild to moderate Covid-19 infection without testing negative.

As per the recently revised guidance by the Center for Disease Control and Prevention (CDCP), increasing evidence shows that most people are no longer infectious 10 days after they begin having symptoms of Covid-19.

“As a result, the CDC is discouraging people from getting tested a second time after they recover. For most persons with COVID-19 illness, isolation, and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with the improvement of other symptoms,” the CDCP said

The guidelines pointed out that for people who have tested positive but don’t have symptoms, “isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.”

However, in the absence of a well-established health infrastructure, doctors in Kashmir fear that such early discharge will lead to a greater spread of disease as people are less likely to be monitored.

Professor of Surgery, Government Medical College, Srinagar, Dr Iqbal Saleem said there is no advanced post-discharge support system of medical authority in Kashmir.

“We have to analyze the healthcare system of the western countries and our region. They have an after-discharge support system wherein a health worker will talk to the patient after they are discharged and go to the patient’s home if the need arises. Also, an ambulance can come in minutes and do the needful in their case,” he said.

He pointed out that on the contrary, the situation is completely different in Kashmir. “It is better to make patients wait till they are completely asymptomatic, and continue to monitor them for six to seven days. Otherwise, what will happen, they might still be positive, and transmit the virus to others,” he said.

Associate Professor of GMC Srinagar Dr Muzaffar Maqbool said that ideally CDCP guidelines should be applied in letter and spirit so that the burden on hospitals is reduced.

“But the issue is that as of now we are trying to strictly adhere to the guidelines issued by the ministry of health and family welfare according to which a negative test is mandatory before discharging patients. We are now trying to follow a protocol by shifting those patients, who become stable after treatment, to COVID care centers where they will be discharged,” he said.

President Doctors Association of Kashmir, Dr. Suhail Naik said first patients were discharged on test-based strategy and it was mandatory to get repeat RTPCR COVID negative before discharge from the hospital.

“But later on several countries changed their discharge policy from ‘test-based strategy to ‘symptom-based strategy’ or ‘time based ‘strategy,” he said.

Dr. Naik noted that a review done by the ICMR also indicated that after initial RT-PCR positive results, most patients became negative after a median duration of 10 days.

“But the question remains how then patients know that they are cured of the disease. Being cured may have different connotations for the general public and treating doctors. But research shows that patients who have a resolution of clinical symptoms can be taken as evidence that the patient is cured and available evidence does not indicate that such persons can transmit disease in the family,” he said.