The Reason Why S’pore is Discharging COVID-19 Patients After 21 Days Even if They Are Still Positive Explained in Simple Terms

2020-05-29 , 9:57 am

Since forever, Singapore has been praised for detecting Covid-19 positive patients and keeping them away from the general public.

I mean, they even went so far as to stop the construction sector and place all foreign workers living in dormitories on lockdown.

Reader Bao: Yes, that was a tough decision.

So why, then, are they discharging Covid-19 positive patients?

MOH Changes Discharge Policy With Immediate Effect

On 28 May, Health Minister Gan Kim Yong announced at the daily press conference that Covid-19 patients no longer have to test negative twice (24 hours apart) before they are discharged from healthcare facilities.

Instead, they will be discharged after day 21, regardless of whether they test positive or negative.

After their discharge, Covid-19 patients have to be isolated at their dormitories or homes for a further 7 days before they are allowed to return to work.

“This revised approach will allow patients who are well and not infectious to return to the community,” he said.

The only exceptions are patients with weak immune systems who may be infectious for a longer period of time.

But why?

Position Paper States Covid-19 Patients No Longer Infectious After 11 Days

The National Centre of Infectious Diseases (NCID) and the Academy of Medicine’s Chapter of Infectious Disease Physicians released a position paper (an essay to argue for their stance) based on a local multi-centre study of 73 Covid-19 patients.

In the study, it was found that Covid-19 patients, no matter how old they are or how serious their disease is, are no longer infectious after 11 days.

The only exceptions, the paper revealed, are patients with weakened immunity systems, such as cancer patients receiving chemotherapy and transplant patients on immunosuppressant drugs.

This, they say, prove that Singapore can discharge Covid-19 patients on a “time-based” policy and free up spaces at the hospitals and Community Care Facilities (CCFs).

**A time-based policy means that instead of waiting for a patient to test negative before discharge, the patients can be discharged after X amount of days.

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Local Studies

NCID executive director, Leo Yee Sin, highlighted three local studies that contributed to their position paper:

Most Infectious At The Beginning

A study on 18 Covid-19 patients found that the highest virus shedding (most infectious period) of Covid-19 is when the clinical illness first sets in.

This is also why it’s important to isolate yourself if you experience even mild symptoms.

In addition, a small study in Germany showed that Covid-19 patients are the most infectious during the first week of infection.

However, on day 8, they stopped shedding the virus.

95% Of Covid-19 Patients Able To Clear Covid-19 Test By Day 33

After studying 766 cases, it was discovered that:

- three in 10 patients managed to clear the test by day 15
- seven in 10 managed to do so by day 21
- 95% able to clear the test by day 33

According to Professor Leo (in another article), she said that the PCR test is “very sensitive”.

The test detects “genetic fragments of the virus” so a positive result doesn’t represent the “full presence” of the virus, or show that it’s still viable (infectious).

Virus No Longer Able To Be Cultivated After Quantity Falls To A Certain Level

Researchers have found that once the amount of virus in a patient’s body has fallen to a certain level, it can no longer be cultured from a sample.

In a CNA article, it was said that samples of Covid-19 can no longer be cultured from samples starting as early as day 10.

This means that patients, while they test positive, are shedding “non-infectious or dead virus particles” and that from or after day 10, the likelihood of a person infecting another person is “extremely low”.

World Health Organisation (WHO) Guidelines

Malaysia has revised its discharge policy based on new information received from WHO and it seems like Singapore’s following suit as well.

Associate Professor Kenneth Mak said that WHO recommended that Covid-19 patients stay isolated for at least 10 days after symptoms start showing and be symptom-free for three days after.

Singapore, he pointed out, has decided to be “extra cautious” and isolate patients for 21 days.

This protocol, he added, was put together with “an abundance of caution”.

Other countries like South Korea, the United Kingdom, the United States, Estonia and Ireland are also starting to adopt time-based criteria for discharging Covid-19 patients.

What Are The Advantages Of Time-Based Discharge?

For one, it’ll help to free up spaces at the Community Care Facilities (CCFs) and give our healthcare capacity some breathing room.

For another, as infectious diseases specialists in Singapore has pointed out, resources can be diverted into other things, like carrying out more aggressive testing on the general community (like the pre-school staff) or on people with acute respiratory problems.

Earlier, the authorities have pointed out to more testing as a way to contain the Covid-19 while allowing Singaporeans to go back to (sort of) normalcy while waiting for the Covid-19 vaccine.

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