Novel coronavirus (SARS-CoV-2) - Discharge criteria for confirmed COVID-19 cases
This document suggests criteria to be considered when deciding whether a confirmed COVID-19 case can be safely (i.e. without being infectious) discharged from hospital or released from home isolation.
Cites research funded by
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National High-tech Research and Development Program
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Youth Innovation Promotion Association of the Chinese Academy of Sciences
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National Natural Science Foundation of China
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Ministry of Science and Technology of the People's Republic of China
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National Science and Technology Major Project of China
Citations
Cited by 35 other policy documents
(27 of them are from other policy sources)
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Clinical Infectious Diseases (Oxford University Press (OUP))
Jun-Yang Tay et al. 2020
National Centre for Infectious Diseases (NCID) Singapore De-isolation of COVID-19 suspect cases: link https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa179/5758073
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European Centre for Disease Prevention and Control
Link in text to https://www.ecdc.europa.eu/sites/default/files/documents/RRA-outbreak-novel-coronavirus-disease-2019-increase-transmission-globally-COVID-19.pdf
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Russian Council
SARS-CoV-2 virus can initially be detected 1–2 days prior to symptom onset in upper respiratory tract samples; the virus can persist for 7–12 days in moderate cases and up to 2 weeks in severe cases (WHO mission to China Report) [1].
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1. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID- 19). Geneva: WHO; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/whochina-joint-mission-on-covid-19-final-report.pdf.
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JAMA (American Medical Association (AMA))
Barnaby Edward Young et al. 2020
Prolonged viral shedding from nasopharyngeal aspirates – up to at least 24 days after symptom onset – was reported among COVID-19 patients in Singapore [2].
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2. Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. 2020.
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New England Journal of Medicine (Massachusetts Medical Society)
Camilla Rothe et al. 2020
Researchers from Germany also reported prolonged viral shedding with high sputum viral load after recovery in a convalescent patient [3].
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3. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an asymptomatic contact in Germany. New England Journal of Medicine. 2020;382(10):970-1.
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Clinical Infectious Diseases (Oxford University Press (OUP))
Jiehao Cai et al. 2020
Prolonged virus shedding has been observed among convalescent children after mild infections, in respiratory tract samples (22 days) and faeces (between two weeks and more than one month) [4].
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4. Cai J, Xu J, Lin D, Yang z, Xu L, Qu Z, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clinical Infectious Diseases. 2020.
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Emerging Microbes & Infections (Informa UK Limited)
Wei Zhang et al. 2020
A shift from positive oral swab samples during early infection to positive rectal swab samples during late infection was observed on Chinese patients; the authors raised concerns about the fact that COVID-19 patients were discharged from hospital on the basis of negative oral swabs [5].
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5. Zhang W, Du R-H, Li B, Zheng X-S, Yang X-L, Hu B, et al. Molecular and serological investigation of 2019- nCoV infected patients: implication of multiple shedding routes. Emerging Microbes & Infections. 2020 2020/01/01;9(1):386-9.
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New England Journal of Medicine (Massachusetts Medical Society)
Lirong Zou et al. 2020
Discharge criteria for confirmed COVID-19 cases ECDC TECHNICAL REPORT Researchers from China report that in upper respiratory specimens, the pattern of viral nucleic acid shedding in SARS-CoV-2-infected patients resembles that of patients with influenza; it also appears to be different from the pattern seen in patients infected with SARS-CoV-1 [6].
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Zou et al. 2020 report that the viral load of asymptomatic patients was similar to symptomatic patients, indicating a transmission potential of asymptomatic or pre-symptomatic patients [6].
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The study reports that patients with few or no symptoms had modest levels of detectable viral RNA in the oropharynx for at least 5 days [6].
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6. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 Viral load in upper respiratory specimens of infected patients. New England Journal of Medicine. 2020.
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The Lancet Infectious Diseases (Elsevier BV)
Xingfei Pan et al. 2020
Pan et al. report on a family cluster where a mother and a child were both asymptomatic but had positive RT-PCR results [7] .
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7. Pan X, Chen D, Xia Y, Wu X, Li T, Ou X, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. The Lancet Infectious Diseases. 2020 2020/02/19/.
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New England Journal of Medicine (Massachusetts Medical Society)
Sebastian Hoehl et al. 2020
Pan et al. report on a family cluster where a mother and a child were both asymptomatic but had positive RT-PCR results [7] . Hoehl et al. (2020) also report that two out of 114 Germans WHO were evacuated from Hubei province on 1 Feb 2020 tested positive in two throat swab specimens by RT-PCR and presented no symptoms [8].
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Hoehl et al. (2020) also report that two out of 114 Germans who were evacuated from Hubei province on 1 Feb 2020 tested positive in two throat swab specimens by RT-PCR and presented no symptoms [8].
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8. Hoehl S, Rabenau H, Berger A, Kortenbusch M, Cinatl J, Bojkova D, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. New England Journal of Medicine. 2020.
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JAMA (American Medical Association (AMA))
Yan Bai et al. 2020
She remained asymptomatic for the entire duration of laboratory and clinical monitoring (19 days) [9].
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9. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed Asymptomatic carrier transmission of COVID-19. JAMA. 2020.
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