The current discharge policy states that, “In case the laboratory results are positive for SARS CO 19 virus, the case shall be managed as per the confirmed case management protocol. The case shall be discharged only after evidence of chest radiographic clearance and viral clearance in respiratory samples after two specimens test negative for virus within a period of 24 hours.”

A change in policy is required as a study has shown how some patients become re-infected even after getting cured.

A preliminary research from China published in the Lancet concluded that the SARS COV2 virus is more readily detected in induced sputum than in throat swabs of patients recovering from COVID-19. Hence, viral RNA tests of induced sputum and not throat swabs should be assessed as a criterion for releasing COVID-19 patients as per the study.

Even though detection of SARS-CoV-2 RNA in throat swabs is the most common method of diagnosing COVID-19 in China;  this method comes with a high rate of false-negative results that could allow patients recovering from COVID-19 to meet criteria for discharge from hospital and released from quarantine, triggering further the spread of the disease.

Dr. Han and colleagues induced sputum production in two patients with COVID-19. To induce sputum, the patients inhaled 10 mL of 3% hypertonic saline through a mask with oxygen at a flow rate of 6 L/min for 20 min or until sputum was produced. The first patient was a 54-year-old man with a three-day history of fever who was admitted for treatment and quarantine on February 1. On February 3, an approved viral RNA detection kit confirmed mild COVID-19. The patients fever and symptoms resolved after treatment with oxygen, lopinavir/ritonavir and moxifloxacin. From February 13, three consecutive throat swabs performed at least 24 hours apart and one anal swab tested negative for viral RNA. One week later, induced sputum was positive for viral RNA.

The second patient was a 42-year-old woman who was admitted on January 27 with a four-day history of fever. The next day, viral RNA was detected in a throat swab, confirming a mild case of COVID-19. The patients fever subsided following treatment with oxygen, lopinavir/ritonavir, and moxifloxacin, and her symptoms gradually resolved.

Beginning February 10, three consecutive throat swabs over three days and one anal swab tested negative for viral RNA. On February 21, viral RNA was detected in induced sputum.

These results reflect the fact that induced sputum “might be more helpful than throat swabs for the detection of SARS-CoV-2 RNA in convalescence patients.”

 What is coronavirus in Hindi

Symptoms coronavirus in India

  Coronavirus in India

 Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA