COVID-19: Govt brings changes in recovery criteria

The health directorate has brought about change to the criteria to declare of coronavirus patient recovered. A patient will no longer have to wait for the results of laboratory tests to be released from hospital.

Public health experts have said that now it is even more important to strictly follow health rules after leaving hospital.

Previously after two tests in 24 hours, if coronavirus was not detected in a patient’s body, he would be declared recovered and would be released from hospital. Now it is being said that there is no need for these tests at all. A patient will be declared recovered and can be released on the basis of his symptoms.

Additional director general of the health directorate, Nasima Sultana, on Friday announced this new treatment protocol at the regular press briefing. She said that the protocol had been prepared by the technical committee on coronavirus.

A letter in this regard, signed by director (hospitals and clinics) of the health directorate, Md Aminul Hasan, was sent to the concerned hospitals and various offices. The letter, dated 5 May, listed five criteria required to issue a patient’s release order. The criteria include: If a patient’s fever goes down without paracetamol or similar drugs, if there is significant improvement in breathing problems or coughing, and if the results of two consecutive RT-PCR tests in 24 hours are negative. If it is not possible to carry out those tests for any reason, then the patients can be released if the first two criteria are met in three days, that is, 72 hours. Also, the patient must remain in isolation at home or in a government-designated place for 14 days and, if possible, undergo tests.

According to sources in the health directorate, it is not possible to test all patients twice in the hospitals due to the increase in the number of patients and that is why this new protocol has been adopted. Help and support in this regard has been taken from the US Centre for Disease Control and Prevention (CDC). According to CDC, a patient can be declared recovered by his symptoms, even without testing.

The World Health Organisation (WHO), however, has not changed its stance. It says a patient can only be declared recovered if the virus is not detected in his body after two tests in a span of 24 hours.

Former director general of the health directorate and principal of Dhaka Medical College, MA Faiz, said, “After leaving hospital, the patient must stay for 14 days in isolation at home, wearing a mask and following all isolation rules.” Faiz is a member of the national technical advisory committee.

On Friday, 191 persons returned home from government and private hospitals after being declared recovered. This brings the total number of recovered persons to 2,101. The number of recovered cases suddenly spurted up from 4 May, when 886 persons were declared recovered. Yet from when patients began to be admitted to hospital on 8 March till 4 May, 177 persons had recovered and returned home in 56 days, that is 3 recoveries on average per day.

A patient was admitted to Mugda Medical College Hospital on 20 April. On 25 April, health workers of the government Institute of Epidemiology, Disease Control and Research (IEDCR) took samples from his to check whether he was free of the virus. They did not give the test results nor did they come for a second sample in 24 hours. They took the second sample on 1 May and provided the results that night. But the patient had been aware that only if two tests taken in 24 hours were negative, then he could be declared recovered.

The hospital released the patient on 2 May and the physicians said that two tests were not required. He was being released as he had no fever for three consecutive days.

Principal of Mugda Medical College Hospital, Golam Nabi, told Prothom Alo, “Symptoms can determine if a person is well, but it not possible to say he is free of the virus unless tests are carried out. That is why we have decided to carry out the tests.” He said that many tenants needed certificate to prove they were free of the virus. This was necessary for many stigmatised persons too. He said at least 40 per cent f the patients would need such certificates.

The first coronavirus hospitalisation in the country was recorded on 8 March. After that, IEDCR director Meerjady Sabrina repeatedly told the media at the press briefings that a patient would be declared recovered only after testing negative twice in 24 hours.

The national guidelines for coronavirus treatment and management, prepared by the health directorate’s department of disease control, have seven criteria for the release of a coronavirus patient from hospital. One of these is two tests to be taken in 24 hours.

These guidelines were based on the WHO guidelines on 13 March. The guidelines state that hospital patients will be tested, depending on the situation of the infection in the country and the availability of resources. Two RT-PCR rests will have to be carried out in 24 hours and the patient will be released if the results are negative. WHO has not changed these criteria.

Member of the technical committee and secretary general of Bangladesh Medicine Society, Ahmedul Kabir, told Prothom Alo, “We have now agreed to follow the US CDC guidelines.” CDC posted its amended guidelines on its website on 30 April.

Former chief scientific officer of IEDCR, Mushtaq Hossain, speaking to Prothom Alo, said the government is using a definition to carry on the work. It must be made clear that, according to this definition, a person released from hospital does not mean he is free of coronavirus. He must follow the 14-day isolation rule.

Public health experts say that the isolation can be at home or in a government-designated place. And everyone must wear masks in isolation.