April 8, 2020

When can Covid-19 patients leave isolation? It's complicated.

Daily Briefing

    Determining when a patient with Covid-19 has fully recovered and is no longer contagious is difficult because so little is known about the new coronavirus—and that's leaving providers unsure of what advice to give patients recovering from the disease, Carmen Heredia Rodriguez reports for Kaiser Health News.

    How hospitals are communicating with patients and the community about Covid-19

    When is a Covid-19 patient recovered?

    Currently, scientists and providers don't fully understand how long a person infected with the new coronavirus is contagious, meaning providers aren't necessarily sure when a Covid-19 patient can leave isolation, Rodriguez writes.

    CDC's latest guidelines for providers highlight two methods providers can use to determine whether a patient is healthy enough to leave isolation. The first method requires a patient to test negative for the new coronavirus twice, from samples taken at least a day apart.

    However, Rodriguez reports that testing shortages persist in the United States, making them hard to come by in some parts of the country.

    Gary LeRoy, president of the American Academy of Family Physicians, told Rodriguez, "It's still kind of an Easter egg hunt for the availability of testing materials and test kits to do Covid-19 tests."

    CDC also states that a Covid-19 patient can leave isolation after a minimum of seven days after their symptoms started or they were diagnosed with the disease, or a minimum of three days after they're free of symptoms. However, CDC warns that method "will prevent most, but may not prevent all instances of secondary spread." Still, CDC states, "The risk of transmission after recovery is likely very substantially less than that during illness."

    Absent guarantees, providers are likely to tailor advice to individual patients

    But Rodriguez writes that, absent testing, providers are unsure whether they should advise recovered patients that they can go back to their daily routines—particularly in instances where the patient is more likely to transmit the new coronavirus to someone who has a higher risk of developing a severe case of Covid-19.

    As such, Kathryn Edwards, a professor of pediatrics at Vanderbilt University and an infectious disease specialist, said clinicians must balance the need to prevent the virus' spread with the benefits of the patient returning to their daily lives, especially in cases when the patient works in an essential industry, such as health care.

    But Marcus Plescia, CMO for the Association of State and Territorial Health Officials, acknowledged, "These are difficult questions that would likely be dealt with on a case-by-case basis."

    Rodriguez writes that CDC's recommendations do allow clinicians the flexibility to change their approach based on each patient.

    "The guidelines are guidelines," Edwards said, "But they're not the Ten Commandments."

    LeRoy suggested that providers could decide to advise a patient to remain in isolation for a longer period if they work with high-risk populations or if they live with an individual who has a medical condition that puts them at greater risk of developing a severe case of Covid-19.

    But, ultimately, the process "is still fraught with uncertainties," Rodriguez writes.

    Without clear evidence to support providers' decisions, "[w]e're always between a rock and a hard place," Edwards said (Rodriguez, Kaiser Health News, 4/6).
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