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New policy explained: There is no need to repeat RT-PCR test after 14 days of quarantine

 By Dr Sandeep Patil

With the rising number of COVID cases in India, there has been a huge burden on diagnostic centers. Due to the drastically increased demand, RT-PCR results are taking longer time to process than usual. In such circumstances, the most impacted are the group of people waiting for confirmation of COVID19 to start medication, and those who have been in isolation to get back to normal life. Well, the good news is that many COVID19 experts now suggest that after 14 days of quarantine people with mild to moderate COVID19 infection do not need to get re-rested to ensure a negative report. This might create doubt among people, but it has a plausible scientific explanation.

WHY IS THERE NO NEED FOR AN RT-PCR TEST AFTER 14 DAYS OF QUARANTINE?

Most people argue that ever since the pandemic hit us, patients with COVID19 were not discharged until their chest radiograph has cleared and the patient had two consecutive negative test results on RT-PCR. That’s true until last year as the virus was new and our Epidemiologists were still understanding the effects of the virus on humans. Although the virus has mutated, its infectiousness and impact have now been well established. Therefore, the Ministry of Health and Family Welfare has come up with new criteria.

For mild/ very mild/ pre-symptomatic cases:
  • The patient can be discharged after 10 days of symptom onset and no fever for 3 consecutive days
  • No need for testing before discharge
  • The patient will be advised to isolate himself/herself at home & self-monitor his/her health for further 7 days
For moderate cases:
  • The patient can be discharged (a) if asymptomatic for 3 days and (b) after 10 days of symptom onset
  • No need for testing prior to discharge
  • The patient will be advised to isolate himself/herself at home & self-monitor his/her health for further 7 days
For severe cases:
  • Patient can be discharged after complete clinical recovery and after they have tested negative once by RT-PCR (after resolution of symptoms)

Now,in most of the mild and asymptomatic COVID19 cases, the virus dies after the 7th or the 8th day. At that time, it can’t be transmitted to another person. But the dead virus, or the particles of the dead virus, can be picked up by the RT-PCR test and a positive report still may come, when a person has become free from COVID. That may increase your isolation time and can cause unnecessary stress and panic.

Other countries too have changed the discharge and isolation policies. Several countries have changed the criteria for discharge strategy from ‘test-based’ to ‘symptom-based strategy’ or ‘time based ‘strategy. An ICMR review and laboratory surveillance data also indicated that after initial RT-PCR positive results, patients became negative after a median duration of 10 days.

SO, CAN ONE ESTABLISH THAT HE/SHE IS FREE OF COVID?

The connotation for recovery is different for a treating doctor, Cirologist, and the general public. From the doctor and the virologist, the definition for mild to moderate is 14 days depending on patient’s recovery rate. For severe patients, it may take a little longer. However, the fact reminds us that even after the virus is dead and ineffective in the body, some may experience it’s after-effects. But that does not mean that these people can transmit the virus.Masking, social distancing and handwashing will continue to be ‘must’ for months to come, our guards cannot be down.

About the AUTHOR

Dr Sandeep Patil, Chief Intensivist, Fortis Hospital, Kalyan

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