RCPath guidance: when to de-isolate and discharge COVID-19 patients?

  • Royal College of Pathologists

  • curated by Pavankumar Kamat
  • Clinical Guidance Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

The Royal College of Pathologists (RCPath) has issued new guidance with recommendations on de-isolation and discharge of patients with COVID-19. It is based on the documentation developed by East Kent Hospitals University NHS Foundation Trust on the lines of Public Health England guidance.

COVID-19 screen positive

  • Do not move the patient from isolation until discharge.
  • When medically fit, discharge the patient at the earliest when deemed safe.
  • For patients isolated for 14 days, the criteria for de-isolation is:
    • Clinical improvement with at least some respiratory recovery.
    • No sign of fever (>37.8°C) for 48 hours.
    • SARS-CoV-2 RNA reverse transcription-polymerase chain reaction (RT-PCR) may be repeated at day 14 for reassurance.
      • De-isolate after one negative screen.
    • For immunocompromised patients, check for negative SARS-CoV-2 RNA RT-PCR after a minimum of 14 days before de-isolation.
      • If positive, repeat the test every 48 hours until first negative screen.
  • For intensive care unit (ICU) and other critical areas that have limited bed capacity:
  • Transfer the patient to a COVID-19 area.
  • If no beds are available in COVID-19 area, de-isolate earlier if SARS-CoV-2 RNA RT-PCR screen is negative at day 8.
  • Intubated/tracheostomy patients need a negative SARS-CoV-2 RNA RT-PCR screen from lower respiratory tract sampling.

COVID-19 screen negative

  • If signs of respiratory infection are seen at admission:
    • Repeat SARS-CoV-2 RNA RT-PCR at least 48 hours after initial negative screen.
    • If the repeat screen is negative, request an extended viral respiratory screen to detect other pathogens (e.g., parainfluenza, enterovirus D68).
      • If an alternative pathogen is detected, de-isolate if asymptomatic for 48 hours.
      • If no alternative pathogen is detected, de-isolate if bacterial or atypical pneumonia is presumed.
  • If new-onset hospital-acquired COVID-19 infection is clinically/radiologically suspected:
    • Isolate patient presuming potential hospital-acquired COVID-19.
    • Collect test sample at least 72 hours after fever or respiratory symptoms:
      • Request an extended viral respiratory screen.
      • De-isolate after two consecutive negative SARS-CoV-2 RNA RT-PCRs 48 hours apart and no fever/respiratory signs or symptoms for 48 hours.