Advisory allows asymptomatic COVID-19 patients to end isolation on 11th day

People who have tested positive for the novel coronavirus and are asymptomatic, which means showing no symptoms of the disease, or having mild symptoms can end their isolation periods at their homes or isolation centres on the 11th day of their PCR test as they would not require another test to prove themselves to be free of coronavirus, officials and experts said on Wednesday.

Similarly, all those people who have not tested positive for COVID-19 but remained isolated at their homes or isolation centres due to the onset of illness after getting in contact with any COVID-19 patient, can also end their isolation on the 11th day provided that they remained symptom free during the last three days of their isolation period.

“I can say that asymptomatic patients who test positive on the first of a month can end isolation on the 11th despite testing positive as they are not thought to be infectious or contagious,” said Prof Dr Faisal Mahmood, an infectious diseases specialist at the Aga Khan University Hospital (AKUH) and a member of the provincial task force on COVID-19 while talking to The News on Wednesday.

Prime Minister’s Focal Person on Coronavirus Dr Faisal Sultan also endorsed the advisory regarding the discontinuation of isolation for asymptomatic coronavirus patients on the 11th day, saying that after 10 days “the likelihood of being infectious is not zero, but very low” for such patients.

Testing positive for the presence of virus on the 16th or even the 21st day does not necessarily mean infectiousness, Dr Sultan said, adding that after 10 days, asymptomatic patients do not remain infectious or contagious for the healthy people.

Based on the recommendations of the provincial task force, the Sindh health department has also issued an advisory for ending the isolation period on the 11th day for the asymptotic COVID-19 patients or those who had developed symptoms of the disease but remained symptom-free for the last three days of their 10-day isolation.

These patients would not require another PCR test to prove that they are negative and can start their routine activities if they don’t have any complications, the advisory says.

There are a few exceptions to this rule as healthcare workers, cancer patients and immune-compromised patients including those who are receiving chemotherapy, people taking steroids and those living in crowded places such as jails and hostels are “not advised to end their isolation” in this manner. “For these patients, two consecutive negative PCR tests (at least 24 hours apart) would be required to discontinue isolation and to declare them cured,” the advisory said. Explaining the advisory, Dr Mahmood said: “The reason for this is that the PCR only detects parts of the virus and does not tell us if the virus is whole and alive. For that the test done is a viral culture [which only a few labs in the world do].

“Studies now show that by day eight, despite the fact that PCR test is positive, the cultures are negative. Hence both the Centre for Disease Control, USA, (CDC) and European Centre for Disease Control (ECDC) say that isolation can be discontinued after 10 to 14 days provided there is clinical improvement [in the condition of the patient].

“Secondly, this virus is new and recommendations change as new information is available. These recommendations are based on new research that is now coming out.”

Dr Mahmood, however, clarified that ending the isolation period on the 11th day for asymptomatic patients does not mean that the test is unreliable. “There is a lot of skepticism going around about the test validity. The test is still very good for the diagnosis and this has not changed,” he added.

He maintained that this is similar to influenza, where for diagnosis the PCR test is conducted but they do not check at the end to see if the patients are positive or negative. The health expert added that as soon as a patient is symptom-free, he is advised to end his or her isolation and start routine life.

Dr Mahmood said this is not a unique phenomenon as the same happens with tuberculosis where the PCR (done using the GeneXprt) test can be positive even after two months of treatment but the cultures are negative. “Which is why GeneXprt is used for the diagnosis but not to monitor the response,” he said.

But experts warned that even after ending their isolation, such patients needs to continue taking precautionary measures which include wearing masks, using hand sanitizers or frequent hand washing and practicing social distancing.