Singapore revises discharge criteria for Covid-19 patients

SINGAPORE: Singapore has revised the discharge criteria for Covid-19 patients.

Those assessed to be clinically well by Day 21 of the onset of illness will be discharged without the need for further polymerase chain reaction (PCR) tests.

“The revision takes off with immediate effect,” said the city-state’s Multi-Ministry Task Force at a virtual press conference today.

The task force said it has studied and evaluated the latest local and international clinical and scientific evidence which show that viable virus was not found in Covid-19 patients after the second week of illness despite the persistence of PCR detection of ribonucleic acid (RNA).

“This means that Covid-19 patients are not likely to be infectious after Day 14 of illness and are not infectious by Day 21 of illness,” it said.

According to the task force, scientific evidence strongly supports the time-based discharge.

There is consensus amongst infectious diseases experts based on the clinical data presented locally and internationally that the risk of secondary transmission of Covid-19 is unlikely by Day 14 of the onset of illness, it said.

In clinical practice, the task force said, the onset of illness is defined as the date when the symptoms are reported by symptomatic patients or the date of first positive PCR test or seven days before first positive serology test for asymptomatic patients.

Covid-19 patients are usually most infectious one to two days before the onset of symptoms and the infectivity declines thereafter, it said.

After Day 14, while PCR tests may pick up minute fragments of the Covid-19 virus RNA, these RNA fragments are no longer transmissible and infective to others and the virus is no longer viable, it added.

“This means the patient is no longer infectious beyond this period,” the task force said.

According to the task force, the majority of Covid-19 patients in Singapore have mild or no symptoms, and the majority are admitted to a community care facility where most recover with minimal intervention.

However, the task force said this revised discharge criteria will not be applied to patients who have a history of being immuno-compromised.

Such patients will still require two negative PCR tests before discharge, as they may still continue to shed viable virus for prolonged periods because of their impaired immunity, it said.

The task force said it will continue to review the latest evidence with medical experts as the situation evolves, and make evidence-based adjustments to Singapore’s medical plan for Covid-19 patients, to ensure the well-being of all patients.

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