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Transmission risk of patients with COVID-19 meeting discharge criteria should be interpreted with caution
Jun-Wei Su1, Wen-Rui Wu1, Guan-Jing Lang1
1Department of Infectious Diseases, State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
Insights
Discharged coronavirus disease 2019 (COVID-19) patients may still shed virus despite negative nucleic acid tests. This study highlights inconsistencies between RT-PCR results and clinical findings, impacting patient care.
Area of Science:
- Infectious Diseases
- Medical Diagnostics
Background:
- The COVID-19 pandemic has led to over 2.4 million cases and 169,151 deaths globally as of April 22, 2020.
- Current discharge guidelines for COVID-19 patients rely heavily on negative real-time polymerase chain reaction (RT-PCR) tests from respiratory specimens.
Observation:
- This study examines two cases where patients' nucleic acid test results contradicted their clinical and radiological presentations.
- These discrepancies led to suboptimal care for the patients involved.
Findings:
- Nucleic acid test results may not always align with a patient's overall clinical status in COVID-19 recovery.
- Inconsistent diagnostic markers can complicate the determination of patient recovery and readiness for discharge.
Implications:
- Rethinking COVID-19 discharge criteria to incorporate a broader range of clinical and radiological assessments is crucial.
- Ensuring accurate patient assessment beyond RT-PCR is vital for preventing suboptimal care and managing the pandemic effectively.
Abstract:
As of Apr. 22, 2020, the World Health Organization (2020) has reported over 2.4 million confirmed coronavirus disease 2019 (COVID-19) patients and 169 151 deaths. Recent articles have uncovered genomic characteristics and clinical features of COVID-19 (Chan et al., 2020; Chang et al., 2020; Guan et al., 2020; Zhu et al., 2020), while our understanding of COVID-19 is still limited. As suggested by guidelines promoted by the General Office of National Health Commission of the People's Republic of China (2020) (from Versions 1 to 6), discharged standards for COVID-19 were still dependent on viral real-time polymerase chain reaction (RT-PCR) tests of respiratory specimens, showing that recovered COVID-19 patients with twice negative RT-PCR could meet discharge criteria. Here, we examined two cases in which nucleic acid test results were inconsistent with clinical and radiological findings, leading to suboptimal care.
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