Discharge criteria and

quarantine discontinuation
COVID-19 INFECTION
Discharge criteria and quarantine
discontinuation
The China CDC discharge criteria state that all four conditions must be met to satisfy a discharge
from the hospital [35].
1. A patient must remain apyrexic for at least three consecutive days.
2. All respiratory symptoms (cough, dyspnea, sore throat, and nasal congestion) must be resolved.
3. Chest CT must demonstrate marked resolution of the exudative lesion.
4. Two serial RT-PCRs must be negative for SARS-CoV-2 RNA from the nasopharyngeal collection, these assays
must be spaced by 24 hours.
Quarantine discontinuation criteria
The CDC quarantine discontinuation criteria state that both conditions must be met to satisfy the
criteria [35].
1. At least two serial RT-PCRs must be negative for SARS-CoV-2 RNA. These swabs must be nasopharyngeal
collections, these assays must be spaced by 24 hours.
2. The patient must remain apyrexic for at least 72 hrs without antipyretic medication use, and resolution of
respiratory signs and symptoms. A minimum of seven days have passed since the preliminary symptom
appeared.
Discharge criteria and
quarantine
discontinuation

even if they continue to test positive in the

polymerase chain reaction (PCR) test, are
unlikely to be infectious beyond 14 days from
the onset of illness as the virus can no longer
be cultured from biological samples taken
from them
INACTIVE VIRUS CAN STAY IN
PATIENTS FOR MONTHS
• The inactive virus can remain in the respiratory tract for a long time,
sometimes for months, said Professor Leo Yee Sin, executive director of the
National Centre for Infectious Diseases.
• That is why some patients falsely test "positive" for the virus, even though
they are not infectious.
• The respiratory tract will shed its cells over time, like skin does, and some of
these cells on the surface - called epithelial cells - may contain inactive virus
fragments.
• Similar cases in China, Japan and South Korea, where recovered patients had
retested positive for the coronavirus, turned out to be false positives due to
faulty testing procedures.
• While it is possible that these patients may be 
shedding "dead" viral fragments, polymerase chain reaction tests,
which detect genetic sequences specific to Covid-19 and are widely
used in Singapore, are unable to distinguish between "live" and
"dead" viral fragments.
• But as scientists learn more about the virus, there is increasing
evidence now that most Covid-19 cases are 
no longer infectious two weeks from the start of their illness, Prof Hsu
said.
• "The kinetics of virus shedding is still being understood, but testing negative
twice over a time interval ensures that a productive infection is not ongoing,"
Associate Professor Richard J. Sugrue, from the School of Biological Sciences
at the Nanyang Technological University, told The Straits Times.
• Professor Shiv Pillai, a medicine and health sciences and technology professor
at Harvard Medical School, noted: "It is the safe thing to do. If you're negative
once, there is a possibility of a false negative and this chance goes down when
you are tested twice," he explained
• "In the US, if someone is tested positive but not hospitalised, they will have to
self-isolate for two weeks, and then have to test negative twice before they
are allowed back into the community."
Prolonged PCR positive is a commonly found
phenomenon
• Professor Leo Yee Sin, executive director of the NCID said the viral load is
higher at the start of illness and declines over the first week.
• By the 26th day of their illness, 90 per cent of patients will stop shedding the
virus. The remainder take longer to rid themselves of the live virus, or dead
virus parts.
• Singapore is taking the extra precaution of keeping patients still shedding
the virus in isolation because the polymerase chain reaction (PCR) test is
designed to only detect a certain segment of the virus gene. It is not able to
differentiate whether the virus is intact and alive, or dead and in fragments.
• "Prolonged PCR positive is a commonly found phenomenon," said Prof Leo.
• But as scientists learn more about the virus, there is increasing
evidence now that most Covid-19 cases are 
no longer infectious two weeks from the start of their illness, Prof Hsu
said.
• There is hope that a time-based rather than test-based discharge
policy may soon be viable - something which would 
provide relief to the nation's healthcare system, he said.
• "If we use a time-based discharge policy of two weeks from onset of
infection or first positive test, then the CCFs would be emptied out
faster. More healthcare workers and administrators can also be freed
up for other duties.“
• Professor Leo Yee Sin, executive director of the NCID, said the swab
samples from the 73 patients were tested in a high-security Biosafety
Level 3 laboratory. No matter whether a patient had a mild or a
severe form of the disease, none remained infectious by the 11th day
of their illness.
• An aggressive testing strategy will also speed up the detection of
cases and contact tracing, even during the pre-symptomatic phase,
helping to nip transmission, he added.