Guyana has adopted the updated World Health Organization (WHO) recommendations on the release of asymptomatic COVID-19 patients from isolation while still testing positive.
This was disclosed by the Deputy Chief Medical Officer Dr Karen Gordon-Boyle, who recently told this newspaper that asymptomatic patients will be discharged from isolation at least 10 days after their first positive test. She disclosed that this new protocol is keeping with the updated recommendations from the WHO for discharging patients from isolation. The updated recommendation came into effect on June 17 and a number of asymptomatic patients from the Moruca sub-district and Diamond isolation facilities have since been discharged as a result. It is unclear whether those persons are being regarded as recovered patients.
Previously, the recommendation for releasing COVID-19 patients required patients to be fully clinically recovered from the virus and to have two negative RT-PCR results on sequential samples taken at least 24 hours apart. The initial recommendation was based on the WHO’s knowledge and experience regarding coronaviruses such as SARS and MERs
However, according to the WHO, recent findings show that patients whose symptoms have resolved may still test positive for the COVID-19 virus (SARS-CoV-2) by RT-PCR for many weeks and despite the positive test result, those patients are not likely to be infectious and therefore are unlikely to be able to transmit the virus to another person. According to the WHO: “Based on evidence showing the rarity of virus that can be cultured in respiratory samples after 9 days after symptom onset, especially in patients with mild disease, usually accompanied by rising levels of neutralizing antibodies and a resolution of symptoms, it appears safe to release patients from isolation based on clinical criteria that require a minimum time in isolation of 13 days, rather than strictly on repeated PCR results.”
As a result of this and several other factors, the WHO and member states have decided to update their criteria for releasing patients from isolation.
The updated criteria states that asymptomatic patients can be released 10 days after their first positive for COVID-19 while symptomatic patients can be released after their symptoms subside but they would have to spend an additional three days in isolation without fever and respiratory symptoms.
In this regard, the WHO research document explains that if a patient shows symptoms for two days, then that patient can be released from isolation after 10 plus 3 days from date of symptoms onset and regarding a patient with symptoms for 30 days, the patient can be discharged 33 days (30+3) after symptom onset.
WHO also states that countries have the option of using testing as part of release criteria and Dr Gordon-Boyle confirmed that the Ministry of Public Health is still doing so except in asymptomatic cases. However, asymptomatic patients are still to be tested twice 24 hours apart before being released and even if the patient test negative once and then receives a positive result from the second test, they will be discharged once they have completed the 13 required days.
“Based on evidence showing the rarity of virus that can be cultured in respiratory samples after 9 days after symptom onset, especially in patients with mild disease, usually accompanied by rising levels of neutralizing antibodies and a resolution of symptoms, it appears safe to release patients from isolation based on clinical criteria that require a minimum time in isolation of 13 days, rather than strictly on repeated PCR results. It is important to note that the clinical criteria require that patients’ symptoms have been resolved for at least three days before release from isolation, with a minimum time in isolation of 13 days since symptom onset,” the WHO document says.
Meanwhile, WHO explained that the updated criteria is based on the feedback it has received regarding the initial recommendation of two negative RT-PCR tests at least 24 hours apart. Member states have complained that due to limited laboratory supplies, equipment, and personnel in areas with intense transmission, it has been extremely difficult to sustain the requirement of two tests, especially outside hospital settings. In addition, patients having negative results followed by positive results are placing an unnecessary strain on their laboratory systems. It should be noted that many countries possess insufficient testing capacity.
However, WHO cautioned that the updated criteria for discharge from isolation balances risks and benefits and that no criteria that can be practically implemented are without risks. It therefore encouraged countries to continue testing patients, once they have the capacity to do so.
