Over 55% of people affected by the SARS-CoV-2 virus that causes COVID-19 have recovered in Tamil Nadu as of June 2. The discharge rate in the state has more than doubled since May 8 – when the Ministry of Health and Family Welfare (MoHFW) revised its discharge policy.
As per the revised policy, mild and moderate cases will no longer require to be tested prior to discharge. These two categories of COVID-19 patients can be discharged after 10 days of the onset of their symptoms, provided they are asymptomatic. Moderate cases can be discharged if their oxygen saturation is above 95% for four days. In severe cases, a patient can be discharged only after clinical recovery and based on one negative real-time reverse transcription polymerase chain reaction (RT-PCR) test.
Prior to May 8, all COVID-19 patients had to test negative twice within a period of 24 hours, in order to be discharged.
The change in discharge guidelines for COVID-19 cases came even as states like Tamil Nadu were witnessing sharp spikes in positive cases. TNM analysed data for four districts in the state from May 1 until May 29 to look at how the MoHFW’s revised policy impacted the state’s COVID-19 discharges. The four districts – Chennai, Chengalpattu, Kanchipuram and Thiruvallur – account for over 78% of Tamil Nadu’s total COVID-19 cases.
On May 1, Chennai had a discharge rate of 20.5%, with 1,082 confirmed cases of coronavirus. Over the course of the following week, the city on an average discharged 22 persons a day. On May 5, 52 persons were discharged from Chennai – the highest single day discharge between May 1 and May 8.
Significantly, however, by May 8, Chennai’s discharge rate had dropped from the previous week to 12.29%. This as the number of cases increased nearly threefold to 3,043 owing largely to the Koyambedu market cluster.
But on May 9, a day after revised policy, Chennai discharged 171 persons on a single day. An average of 58 persons were discharged between May 9 and May 15, more than double the numbers from previous week. The overall discharge in Chennai only marginally increased from May 8, to 13.16% due to a surge in new cases.
By May 22, Chennai’s discharge rate had climbed to 40.29%. Tamil Nadu’s capital discharged a whopping 2990 patients between May 16 and May 22 or an average of 427 persons per day. May 20 witnessed the highest single day discharges at 901.
Between May 23 and May 29, the city discharged an average of 446 persons a day. On May 29, Chennai had a total of 13,362 cases – an increase of 29.92% from May 22. However, the city’s overall discharge rate had also risen to 51.60%.
The neighbouring districts of Chennai also present with largely similar findings. Chengalpattu (55.81%), Kancheepuram (32.14%) and Thiruvallur (72.13%) had all posted decent recovery rates on May 1. However, the Koyambedu cluster hit Chennai’s neighbouring districts the hardest by the second week of May. All three districts saw a decline in their recovery rates by May 8, as the number of positive cases increased.
But following the revised policy, all three districts increased their discharges. This even as the number of persons diagnosed with COVID-19 had shot up. By May 29, Chengalpattu had a discharge rate of 44.3%, discharging an average of 30 persons per day the previous week. Compare this to the week prior to MoHFW’s discharge policy, when Chengalpattu was discharging an average of 2.17 persons per day.
On May 29, Kancheepuram had a discharge rate of 57.37% while Thiruvallur was 60.88%. Thiruvallur went from discharging an average of three persons per day between May 1 and May 8 to an average daily discharge of 41 persons between May 23 and May 29.
There’s no doubt that the revised policy helped reduce the strain on hospital resources with multiple reports emerging from Chennai of hospital beds fast filling up. However, the data for the month of May shows no clear pattern in discharges before or after the revised policy. An increase in new COVID-19 patients was not necessarily followed by a spike in discharges.
But concerns have been raised from several quarters as to whether discharged patients could still be infectious and transmit the virus to others. At least two studies – one from China and one from Germany -0 suggest that a patient is not infectious after eight days.
Speaking to TNM, renowned virologist Dr Jacob John, who is emeritus professor at Christian Medical College (CMC), Vellore, calls the revised policy tactical. “You don’t need to test for recovery. When they become asymptomatic, within a few days they will be negative. You don’t have to prove it,” says Dr Jacob. However, he points out that home quarantining is a must to limit the further spread of the virus.
The revised policy mandates that mild and moderate patients should undergo home quarantine for a further seven days following discharge and self-monitor their health during this period.