Chief Medical Officer, David Johnson explained that Dominica will be using a new discharge criteria moving forward. He said that since March 2020, Dominica has been using a discharge criteria developed by the World Health Organization(WHO) put out since January. He said that this is the same discharge criteria used in the management of other Coronaviruses such as SARS and MERS.
According to the criteria, an asymptomatic patient who has been asymptomatic after two weeks of initial diagnosis is subject to further PCR testing.
He explained, “Two PCR tests are done 24 hours apart. If both tests are negative, the patient is discharged. If however, one test is negative and the other positive, then two weeks must elaspe before retesting is done”.
Johnson continued, “For symptomatic patients, a period of 48 hours is allowed for a patient to become asymptomatic. After which two PCR tests, 24 hours apart are done. If both tests results are negative, the patient is discharged, however, if one of the tests are negative and the other positive, retesting occurs after two weeks”.He said that once the patient is discharged( whether asymptomatic or symptomatic), the Director of Primary Health Care is alerted and the district primary health care providers are responsible to follow up with the individual for a period of two weeks.
Johnson said that senior medical officials have been reviewing scientific research from around the world as well as publications from WHO.
This is in keeping with a review from the WHO put out in May, 2020 with regards to the discharge criteria from isolation as part of the clinical pathway of COVID-19 positive patients. Johnson said that the criteria refers to all COVID-19 patients regardless of isolation, location or severity of the disease.
Johnson explained that the reviewed criteria advises that ‘for asymptomatic patients 10 days after symptom onset plus at least 3 additional days before symptoms including without fever and without respiratory symptoms, WHO is not recommending further testing before these patients are discharged. For asymptomatic patients, WHO recommended, since May 27, 2020, ten days after positive test for COVID-19, no further testing is recommended’.
Johnson said that a WHO release in June on discharging patients from isolation, ‘after 9 days after symptom onset especially in patients with mild disease, it appears safe to release patients from isolation based on clinical criteria that require a minimum time in isolation of just 13 days rather than strictly on repeated, repeated PCR results’.
Johnson added that according to the WHO June review, the clinical criteria require patients symptoms to have been resolved for at least 3 days before releasing from isolation. Hence there will be a minimum of 13 isolation days since the onset of symptoms.
He said that of Dominica’s 33 positive patients, 50 % required a minimum of 28 days to be PCR negative before they could be discharged. Only 1 case required 37 days to get 2 PCR negative results and 1 case took 42 days.
He said that realizing the psychological stress which may be caused by prolonged periods of isolation, the Ministry has reviewed the isolation criteria for both isolation centers in Dominica.
Under the new criteria, asymptomatic patients require two consecutive negative PCR test results taken in 24 hours apart following 10 days of isolation. If the patient is not cleared by PCR testing, he will remain in isolation for a total of 3 weeks and then be discharged without further testing.
For mild symptomatic cases, two consecutive negative PCR results taken 24 hours apart after 14 days of isolation plus at least 3 additional isolation days without any symptoms. If a positive test is returned, the isolation will be extend to 7 more days after which the patient will be discharged with no further testing.
For severe symptomatic cases, those who require ventilation will complete two 14 day isolation cycles before being tested. If a positive test is returned, the patient will be discharged after a week following full recovery without further testing.
The new criteria has been endorsed by experts at the Caribbean Public Health Agency(CARPHA) and the Pan American Health Organization(PAHO) and is consistent with international recommendations.
