Handbook of COVID-19 Prevention and Treatment-- Discharge Standards and Follow-up Plan for COVID-19 Patients

Handbook of COVID-19 Prevention and Treatment-- Discharge Standards and Follow-up Plan for COVID-19 Patients

  • 2020-03-26
XVII. Discharge Standards and Follow-up Plan for COVID-19 Patients

1、Discharge standards
(1) Body temperature remains normal for at least 3 days (ear temperature is lower than 37.5 °C);
(2) Respiratory symptoms are significantly improved;
(3) The nucleic acid is tested negative for respiratory tract pathogen twice consecutively (sampling
interval more than 24 hours); the nucleic acid test of stool samples can be performed atthe same time
if possible;
(4) Lung imaging shows obvious improvement in lesions;
(5) There is no comorbidities or complications which require hospitalization;
(6) SpO, > 93% without assisted oxygen inhalation;
(7) Discharge approved by multi-disciplinary medical team.
2、 Medication after discharge
Generally, antiviral drugs are not necessary after discharge. Treatments for symptoms
can be applied if patients have mild cough, poor appetite, thick tongue coating, etc.
Antiviral drugs can be used after discharge for patients with multiple lung lesions in the
first 3 days after their nucleic acid are tested negative.
3、Home isolation
Patients must continue two weeks of isolation after discharge. Recommended home
isolation conditions are:
(D Independent living area with frequent ventilation and disinfection;
@Avoid contacting with infants, the elderly and people with weak immune functions at
@ Patients and their family members must wear masks and wash hands frequently;
@) Body temperature are taken twice a day (in the morning and evening) and pay close
attention to any changes in the patient's condition.

A specialized doctor should be arranged for each discharged patient's follow-ups. The
first follow-up call should be made within 48 hours after discharge. The outpatient
follow-up will be carried out 1 week, 2 weeks, and 1 month after discharge.
Examinations include liver and kidney functions, blood test, nucleic acid test of sputum
and stool samples, and pulmonary function test or lung CT scan should be reviewed
according to the patient's condition. Follow-up phone calls should be made 3 and 6

months after discharg

5、Management of patients tested positive again after discharge
Strict discharge standards have been implemented in our hospital. There is no
discharged case in our hospital whose sputum and stool samples are tested positive
again in our follow-ups. However, there are some reported cases that patients are
tested positive again, after being discharged based on the standards of national
guidelines (negative results from at least 2 consecutive throat swabs collected at an
interval of 24 hours; body temperature remaining normal for 3 days, symptoms
significantly improved; obvious absorption of inflammation on lung images). It is mainly
due to sample collection errors and false negative testing results. For these patients, the
following strategies are recommended:
{1) Isolation according to the standards for C0VID-19 patients.
{2) Continuing to provide antiviral treatment which has been proved to be effective
during prior hospitalization.
(3) Discharge only when improvement is observed on lung imaging and the sputum and
stool are tested negative for 3 consecutive times (with an interval of 24 hours).
(4) Home isolation and follow-up visits after discharge in accordance with the
requirements mentioned above.

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