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.