PHE guidelines on stepdown and discharge of COVID-19 patients

Public Health England (PHE) has published recommendations to guide the discharge of patients who have been hospitalised with COVID-19. Key recommendations include the following:

• Patients can and should be discharged before resolution of symptoms, provided they are deemed fit for discharge.
• Persistent cough is not an indication of ongoing infection when other symptoms have resolved.
• For hospitalised patients who are at least 14 days since a positive test, infection prevention and control (IPC) measures can be stopped if there is:

1. clinical improvement, with at least some respiratory recovery;
2. no fever (>37.8°C) for 48 hours; and
3. no severe immunosuppression.

• If viral clearance testing is available, it should focus on:

1. severely immunocompromised patients and
2. any testing that optimises patient flow through the hospital, for example, long-stay patients who are unable to otherwise be discharged and those being discharged to a household where an extremely vulnerable person is being shielded.

• Patients can be discharged to their own home when appropriate but should be given safety-netting advice on what to do if symptoms worsen.
• Discharged patients who required critical care or are severely immunocompromised should self-isolate for 14 days from their first positive test.
• Patients who did not require critical care and are not immunosuppressed should self-isolate for seven days from their first positive test.
• For all discharged patients, self-isolation at home should continue until fever has resolved for 48 hours consecutively, without antipyretic medication.
• For severely immunosuppressed patients, IPC should continue unless there has been virological evidence of clearance prior to discharge or there has been complete resolution of all symptoms.
• IPC measures should continue for hospitalised COVID-19 patients until 14 days have elapsed since their first positive SARS-CoV-2 test; this differs from community settings, where symptom onset is used.
• One negative test is acceptable for stepdown.
• If repeat testing remains positive after 14 days, and if testing capacity allows, patients should be tested after a further seven days if the patient remains in hospital or at intervals of two weeks in the community.