The government modified the discharge policy of COVID-19 positives and issued revised guidelines recently. Here is a look at those guidelines and discharge guidelines in a few other countries. Post treatment discharge of COVID-19 infected patients is as important as identification of the infected ones. An effective discharge policy ensures that the infected persons are treated well and also helps in mitigating any scope of re-admission and further spread. Hence it is important that the discharge policy & the relevant strategies are comprehensive enough to cover all types of patients. The policies should also facilitate determination of the time when it is safe to discharge a particular case. Discharge of the treated & recovered patients also reduces the burden on the healthcare system freeing up the available beds for other needy ones. The Ministry of Health and Family Welfare (MoHFW) issued a revised discharge policy for COVID-19 cases on 11 May 2020. This policy replaces MOHFW’s earlier discharge policy. Revised policy marks a shift from ‘Test-based’ discharge strategy As per the press release on the revised discharge policy, the Health Ministry has stated that the policy was revised in line with revisions in several other countries who have changed their discharge criteria. The earlier policy for discharging COVID-19 patients was based on a test-based strategy. As per this policy, a COVID-19 case was discharged when the person satisfies each of the following two criteria: Most of the countries have changed discharge policy from a ‘Test Based’ strategy to ‘Symptom Based’ or ‘Time Based one’, as mentioned by the MoHFW. In the FAQs released by MoHFW about the revised policy, it is stated that a review of ICMR laboratory surveillance data indicates that after an initial RT-PCR positive results, the patients became negative after a median duration of about 10 days. Speaking on the revised Discharge policy, experts at ICMR stated that as per studies, the virus is said to be deactivated in case the patient does not show symptoms for three days. It is also highlighted in the reasons backing up the revised discharge policy that there are chances where tests can detect the virus even after it becomes in-active. Based on this, a revised discharge criterion is implemented which will do away with the need for conducting the tests before discharge. This would also help in saving valuable test kits, which could then be used for other identification of COVID-19 in suspects. Revised discharge policy aligned with severity-based categorization of cases The revised discharge policy uses ‘Time’ and ‘Symptoms’ as the criteria instead of testing to determine if particular COVID-19 case can be discharged. However, the time taken to recover from the infection and the symptoms vary depending on the severity of the infection. Hence the revised discharge policy provides for different criteria for different cases of severity. MoHFW had earlier issued guidelines to categorize the COVID-19 cases based on the clinical severity into – mild, moderate & severe. The revised discharge policy is also based on this categorization. The time frames to discharge and the symptoms to be looked for each of these three categories of patients have been specified. Post discharge, the patients (those with mild and moderate severity) are required to be under self-isolation for period of 7 days. During this period, they are required to ensure: No testing needed for Home isolation patients as well Cases with clinical severity of mild/very mild or which are pre-symptomatic are also provided the option of being under home isolation right from the beginning without having to get admitted to a COVID facility. However, this is possible only if the facilities at home are in line with the specified criteria. Factly has written a story on these conditions and other criteria. As per the revised discharge policy, even such patients under home isolation are not required to take any tests prior to being declared discharged (cured). The criteria remain the same as in the case of patients in COVID Care centres i.e. 10 days post the onset of symptoms & no fever for 3 days. They are also required to self-monitor further for a period for 7 days i.e. the criteria for home isolation would be: For those who are under self-quarantine because of exposure to COVID-19 positive patients but are asymptomatic, the discharge policy does not apply. They continue to be in quarantine for a period of 14 day. The approach of dealing with COVID-19 cases has varied across countries. This is also true in the case of discharge policies. There is still a debate whether testing needs to be carried out to discharge COVID-19 patients.