Discharge from healthcare following treatment for
COVID-19
Current practices
Globally, the approach to managing patients leaving healthcare following
COVID-19 is variable. In the US and Japan, patients are expected to be
symptom free for a period of at least 10 days; in Germany, patients must
have a Ct value <30 for discharge to nursing homes; in Italy,
the absence of symptoms and a negative NAAT are the requirements for
discharge.74-76 Other countries only require a
negative NAAT if the patient was severely unwell (e.g. receiving
supportive oxygen).74 In China, patients are
discharged if they are no longer symptomatic and have a repeated
negative NAAT for COVID-19 within 24 hours.74 Chinese
patients are then required to isolate for a further 14 days and may be
discharged to an interim/recovery hospital for further isolation and
monitoring before returning home.70 These stringent
criteria are due to reports of relapsing infection and aim to prevent
transmissions in these cases.77
Key considerations
Patients are tested prior to discharge to ensure they are not
infectious. Particular patient populations, such as post-transplant
and/or immunocompromised patients, stay PCR-positive for a longer time
period.78 Ct values can provide a guide to infection
status – a recovered patient with a high Ct corresponds with a low
viral load, where a patient is unlikely to be
infectious.79,80 However, Ct values need to be
standardized as there is variability between platforms, between labs,
and between reagent lots within a single lab.79 As
such, they can provide clinical guidance only once the standardization
practices for estimating viral concentration from Ct values is in place.
Ct values are not routinely standardized against viral concentration
ranges and, additionally, not all NAATs provide a Ct, meaning Ct values
currently have limited clinical utility.8079 In the future, quantification of viral load and
standardization of Ct values may be widely applicable, aiding
determination of infectious periods and possibly reducing the duration
of hospitalization for some patient populations. In patients who remain
NAAT-positive for a prolonged time period, antigen testing may better
reflect if a patient is still infectious, as previously described above.