GUWAHATI, June 30 - Amidst the debate whether asymptomatic patients require hospitalization, the Assam government has revised the COVID-19 management and discharge protocol, paving the way for discharge of positive asymptomatic patients after 14 days.
According to the revised protocol, “if a COVID-19 positive patient has completed 14 days in hospital from the date of collection of his/her first swab sample, then such person should be released for 14 days strict home quarantine.”
However, the protocol entails a condition – that the individual is afebrile (not having fever), is asymptomatic and his or her oxygen saturation is not below 95 per cent.
“The district administration will ensure that the home quarantine in such cases is strictly enforced for the entire period of 14 days, following the discharge,” the protocol further stated.
Until now in Assam, all positive cases are being managed in hospitals and confirmatory tests to check whether the patient had fully recovered from the infection were mandatory. A patient is retested on seventh or tenth day of the first positive report and if this second sample is also positive, then they are retested after three days again. Only after two successive negative tests, the patients were discharged.
The Union Health Ministry in May had issued guidelines stating that a patient can be discharged after 10 days of symptom onset and no fever for three days. “No need for testing prior to discharge. Patient will be advised to isolate himself/herself at home and self-monitor his/her health for further seven days,” the MoH&FW guidelines had stated.
Some states have been following the guidelines reducing pressure on Covid designated hospitals and also to ensure critical cases get access.
Following the revised guidelines of ICMR, in Gujarat’s Surat, 93 COVID-19 positive patients, clinically categorized as having very mild or pre-symptomatic coronavirus disease, have opted for home quarantine where they are battling the virus in isolation under monitoring and surveillance of health teams.
Senior doctors here admit that asymptomatic COVID-19 positive cases do not require hospitalisation as they do not need any special care. “The only point that needs to be taken care is that asymptomatic COVID-19 positive cases don’t spread the virus. For this strict home quarantine of asymptomatic patient with self monitoring and reporting of symptoms are sufficient,” they felt.
Stating that the measures taken by the Assam government were exemplary even though they were upsetting the life of citizens, eminent oncologist Dr Tapan Kumar Saikia also felt “home quarantine (of asymptomatic patients) was an appropriate measure if the patient follows the guidelines, especially seeking further medical help the moment symptoms appear.”
Asymptomatic patients also don’t require any specific drug,” he added.
“The incidence of mortality (of co-morbid patients) is curious. Ongoing studies will make the issue clearer. The repeated positivity of the virus in some individuals is another subject of study,” Dr Saikia said.
A senior government doctor, however, said that the decision to treat positive patients at home will depend on the State government. “It also depends on population behaviour. Eventually, with rising number of cases that is the only solution but institutional admission is needed for our population, a chunk of which has showed irresponsible behaviour in recent past. They won’t follow rules of self isolation and eventually vulnerable population will suffer,” he added.