Singapore

Covid-19 patients can be discharged after 21 days if clinically well

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But they must remain at home or in dormitories for another 7 days as a precaution

Coronavirus patients who are clinically well by the 21st day of their illness will be discharged, as scientific evidence shows they are no longer infectious.

But as a precaution, these people will have to stay at home or in their dormitories for another seven days, Health Minister Gan Kim Yong said yesterday.

They will be allowed to return to work after 28 days.

"This revised approach will allow recovered patients who are well and no longer infectious to return to the community in a timely manner," Mr Gan said at a press conference, adding that the change will take immediate effect.

However, this will not apply to patients with weakened immune systems, who may continue to shed viable virus for a prolonged period.

The Ministry of Health (MOH) had previously required patients to test negative twice over 24 hours before they could be discharged, even if they had not been ill for some time.

But local and international scientific evidence has since shown that the virus is no longer viable after the second week of illness, even though tests may pick up traces of the virus' genetic material and therefore yield a positive result.

Patients are not likely to be infectious after day 14 and are not infectious by day 21, MOH said.

STUDIES

Professor Leo Yee Sin, executive director of the National Centre for Infectious Diseases, also highlighted three local studies on the subject.

The first study, involving 18 people, showed that virus shedding is highest during the early onset of clinical illness.

Another study showed that seven in 10 patients test negative for the virus by day 21, with more than nine in 10 testing negative by day 33.

This shows that a very small number of patients continue to test positive for a long time, Prof Leo said.

The final study found that once the viral quantity in a patient's respiratory sample dropped to a certain level, the virus could no longer be cultured. This happens around the 10- or 11-day mark.

"So if we were to take all this scientific information together, we are confident to say that by the time (patients) reach day 11, and by the time they reach two weeks of their clinical illness, we no longer have any viable virus that we can culture from the respiratory sample," Prof Leo said.

The World Health Organisation recommended on Wednesday that it is safe to discharge coronavirus patients 10 days after their symptoms first appear, if they remain symptom-free for at least another three days after that.

Singapore is requiring that patients stay isolated even longer than that, said Associate Professor Kenneth Mak, MOH's director of medical services.

"So it's really with an abundance of caution that we have put together a protocol that allows us now to safely move away from needing to test every individual before we discharge them," he said.

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