Debate Rages Over New NCDC Guideline On Discharge, Home Treatment Of Asymptomatic Patients

• Shedding Of Live Virus Not Viable After 10 Days – New Research • Medics Counsel Against Release Of Half- Recovered Patients, Urge Caution • ‘ WHO Inconsistencies Due To Pressure, Impatience’

THE Director General of the Nigeria Centre for Disease Control ( NCDC), Dr. Chikwe Ihekweazu, has explained that the newly introduced guideline for the discharge of COVID- 19 patients was based on emerging scientific evidence that shedding of live virus is not viable after about 10 days. This is just as the decision by the NCDC, Lagos State Government and Presidential Task Force ( PTF) on COVID- 19 to begin home isolation/ treatment and early discharge of asymptomatic patients, based on suggestions that asymptomatic patients do not transmit the virus or are not so infectious, continue to generate debates.

The new guideline, which was released this month, provides that symptomatic patients would now be discharged at least 10 days after symptom onset and at least three days without symptoms, while asymptomatic patients can be discharged 14 days after the first positive test and would no longer have to wait for a negative test to discharge.

Besides, the guideline recommended that discharged patients should continue self- isolation one week after discharge at home, should be followed up in the first week of discharge and monthly for the next three months, should ensure adequate hydration and rest, and should be put on multivitamin supplementation.

Ihekweazu, in answer to The Guardian inquiry, said because Nigeria is dealing with a pandemic caused by a new virus, there is need to continually review strategies based on emerging scientific evidence.

He said: “New evidence emerged that shedding of live virus is not viable after about 10 days. Following this finding, the World Health Organisation ( WHO) issued new guidance and subsequently, we did.

“This discharge criteria from clinical care will also take into account the patient’s condition, disease experience and other factors. The RT- PCR test may remain positive in some patients, detecting virus segments, however, these are not viable for transmission to cause disease in others. In deciding on the criteria for discharge of COVID- 19 patients, the most important factor is the patient’s clinical status and his/ her risk to others.”

He told The Guardian that while there is evidence that these patients may no longer transmit the virus to others, it is important that standard precautions are taken at all times, adding: “We advise Nigerians to continue adhering to public health and social measures in place.

“Please, wash your hands frequently with soap and running water, wear a face mask when outdoors and in public settings, avoid contact with sick people, maintain a distance of at least two metres between yourself and the next person.”

Additional information from the guideline said data from Singapore demonstrates that “viral RNA detected beyond 10 days is no longer infectious, as no viable virus is grown by viral culture.

“Also, re- infection cases who became PCR positive after discharge has shown no evidence of transmission to contacts and no detection of the viral replication through viral cultures. A negative PCR means that the virus can no longer be detected in the respiratory samples.

“A patient should be discharged by the managing clinician if the following criteria are met: Symptomatic 10 days after symptom onset, plus at least three days without symptoms ( fever and respiratory symptoms).

“Asymptomatic patient should be discharged from the COVID- 19 pathway 14 days after the initial positive result ( date of collection of sample). A negative laboratory test is no longer required to discharge a COVID- 19 patient.” On the NCDC’S target of increasing daily sample testing to 4,000, Ihekweazu said: “At the moment, we are testing an average of 1,500 samples daily across the country. “However, we have 33 molecular laboratories with the capacity to test a minimum of 10,000 samples everyday. We are supporting all states to rapidly increase sample collection. Some states have developed innovative methods, such as establishing sample collection booths and centres, which we applaud.

“However, we must work together to find and test more cases to know the true burden of COVID- 19 in Nigeria. COVID- 19 is not a myth; over 4,000 people have recovered in Nigeria. Therefore, a positive test result is not a death sentence. “We urge more individuals who have symptoms or may have been exposed to call their states for advice on testing, while we encourage states to rapidly scale up sample collection.”

The debate on whether patients who do not show symptoms or show only mild symptoms can transmit the virus to other people was fueled early this week by the comment by a WHO official that: “It is very rare for asymptomatic patients to transmit the disease.” But the agency was quick to walk back the comments the next day by saying: “Much is still unknown.” An asymptomatic person is someone with COVID- 19 who does not have symptoms and never develops symptoms. Both scientists clarified that it is not the same as someone who later develops symptoms, who would be classified as presymptomatic.

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