What are the discharge precautions for patients recovering from COVID-19 (Coronavirus disease 2019)?

Discharge Precautions for COVID-19 Patients

COVID-19 patients should be kept in isolation for at least 14 days from their first positive RT-PCR test, with isolation ending earlier only if symptoms have resolved for at least 3 days and a negative RT-PCR test is obtained. 1

Clinical Criteria for Hospital Discharge

Hospital discharge should be considered when the patient meets the following criteria:

• Normal temperature for >3 days without fever-reducing medications
• Significantly relieved respiratory symptoms (if symptomatic)
• Substantially improved acute exudative lesions on chest CT
• Two consecutive negative RT-PCR tests with at least 1-day interval 1, 2

Home Discharge Requirements

Patients can be discharged to home if:

• Appropriate caregivers are available (especially for elderly patients)
• The patient can be isolated to limit exposure risk to household members:
  • Single room with good ventilation
  • Face mask use
  • Reduced close contact with family members
  • Separate meals
  • Good hand sanitation
  • No outdoor activities
• No household members at increased risk for COVID-19 complications (e.g., people >65 years, young children, pregnant women, immunocompromised individuals)
• All household members can adhere to precautions to prevent virus transmission 1

Post-Discharge Isolation Strategies

Two main strategies exist for determining when to end isolation:

1. Test-based strategy: Requires negative RT-PCR tests after symptom resolution
2. Symptom-based strategy: Keeps patients on precautions until a fixed period has elapsed from symptom recovery 1

Isolation Duration Guidelines

• Confirmed asymptomatic COVID-19 patients: Should be kept in isolation for at least 2 weeks from their first positive RT-PCR test 1
• Symptomatic patients: Isolation until symptoms resolve for ≥3 days and at least 10 days have passed since symptom onset 2
• Immunocompromised patients: Require multidisciplinary approach for discharge decisions due to potential prolonged viral shedding 1, 2

Important Considerations

• After 5-9 days of infection, approximately 54.3% of patients may still have a positive antigen test result, with positivity declining over time 3
• Positive tests after recovery (5-13 days post-discharge) have been reported, but patients typically remain asymptomatic with unchanged chest CT findings 1
• A positive COVID-19 test 3 weeks after initial infection likely represents persistent viral RNA shedding rather than ongoing infectiousness 2
• PCR tests can remain positive for up to 30 days after infection without indicating infectiousness 2

Common Pitfalls to Avoid

1. Misinterpreting PCR positivity as ongoing infectiousness: PCR can detect non-viable viral fragments long after infection has resolved 2

2. Insufficient home isolation instructions: Clear guidance must be provided on how to avoid transmission to household members 1

3. Overlooking special populations: Immunocompromised patients may require extended isolation periods and specialized discharge planning 1

4. Relying solely on testing without considering clinical improvement: Both symptom resolution and testing should guide decisions 1, 2

5. Premature discharge of patients with household members at high risk: Careful assessment of the home environment is essential 1

By following these evidence-based guidelines, healthcare providers can ensure safe discharge of COVID-19 patients while minimizing transmission risk to others.