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

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.