Should health authorities release COVID-19 patients even if they test positive on the PCR test after 14 days?
Let’s consider the implications, and what the latest COVID-19 research say about the risks.
Releasing COVID-19 Patients Even If They Test Positive After 14 Days?
On 27 May 2020, the Malaysian Ministry of Health announced that they will release COVID-19 patients after 14 days, even if they still test positive for COVID-19.
The Malaysian Director-General of Health, Datuk Dr. Noor Hisham Abdullah, explained the reasons behind the new protocol :
Kebolehanjangkitan itu masih ada tetapi mengikut laporan WHO, kalau mereka sudah melepasi tempoh 14 hari, kebolehjangkitan adalah sifar.
Protokol baharu itu selaras dapatan terkini Pertubuhan Kesihatan Sedunia (WHO) serta kajian Korea Selatan dan Taiwan mendapati kebolehjangkitan Covid-19 hampir sifar selepas 14 hari pesakit menerima rawatan.
Here is our English translation :
According to the WHO report, if they have gone past 14 days, the risk of infection is zero.
This new protocol is in line with the latest findings of the World Health Organisation (WHO) as well as South Korean and Taiwanese studies which found that the infectiousness of COVID-19 is almost zero after 14 days of treatment.
Is It Safe To Release COVID-19 Positive Patients After 14 Days?
This is the TLDR summary, for those who want the short and sweet answer.
So far, studies have shown that while COVID-19 patients are infectious BEFORE they exhibit symptoms, their infectivity drops rapidly roughly a week after symptom onset.
In fact, the studies seem to suggest that COVID-19 patients will no longer be infectious, as little as 5 days after symptom onset, and certainly after 10 days.
Studies have also shown that PCR tests may be returning false positives – detecting non-viable RNA from dead viral fragments still remaining in the patients.
Therefore, based on what we currently know – it is safe to let COVID-19 patients return home after 14 days, even if they continue to test positive on the PCR test.
What Do Studies Say About COVID-19 Positive Patients After 14 Days?
For those who want to take a look at the studies on the infectivity of COVID-19 patients after 14 days, including the studies Datuk Dr. Noor Hisham mentioned.
South Korea On COVID-19 Infectivity
Like China and Malaysia (earlier), South Korea adopted the policy of obtaining and testing repeated PCR tests to confirm that a patient is COVID-19 negative – two negative PCR tests 24 hours apart.
They found that some patients returned positive results after initial negative results, leading to initial worries about a “persistent carrier state” or “recurrent infections”.
However, based on a study of 180 of such negative-positive cases, the patients did not transmit their infections. Neither could they isolate any live virus from virus cultures.
Subsequently, the Korean CDC concluded that the positive PCR results were due to the detection of non-viable RNA from dead viral fragments still persisting in the patients.
Hong Kong On COVID-19 Infectivity
Hong Kong researchers studied 77 infector-infectee pairs, coming to these conclusions :
- the mean duration between the onset of symptoms in the infector, and the onset of symptoms in the infectee, is 5.8 days
- presymptomatic transmission was noted in 7.6% of cases – the infectee developed symptoms before the infector developed symptoms
- the COVID-19 infectious period was estimated to begin 2.3 days before onset of symptoms, peaking at 0.7 days and declining within 7 days.
Taiwan On COVID-19 Infectivity
Taiwanese scientists studied 100 COVID-19 patients and 2761 close contacts, identifying 22 infector-infectee pairs.
- in all 22 cases (of 1818 contacts), the infectee had contact with the infector within 5 days of symptom onset.
- none of the other 852 contacts tested positive, even after they had contact with the infector 5 days or later after symptom onset
Germany On Active Replication Of COVID-19
German scientists looked at the COVID-19 sgRNA (subgenomic messenger RNA) which are only present in actively-infected cells.
- sgRNA declined in sputum over 10-11 days after symptom onset
- sgRNA was no longer detected in throat swabs after 5 days
- infectious virus samples were cultured from throat and lung up to day 8, but none after that
- yet, high viral loads continue to be detected by PCR tests
For more information, and references to these studies, we recommend reading this position statement by the National Centre of Infectious Diseases and the Chapter of Infectious Disease Physicians, Academy of Medicine in Singapore.
COVID-19 : How To Keep Safe!
Here are a few simple steps to stay safe from COVID-19 :
- Stay at home or shelter in place
- Keep your hands clean with soap or hand sanitiser
- Keep your home, office, vehicle, etc. clean
- If you must go out, maintain a social distance of 6 feet (2 metres)
- Wear a surgical mask and make sure you put it on and remove it properly!
- Wash your food with water (and soap) after purchase and before preparation
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