China doctors seek tougher discharge criteria

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    BEIJING. — Worrying cases of recovered coronavirus patients in China testing positive again for the infection have raised questions among doctors about the criteria being used for discharging people from hospital.

    China has seen 80,000 cases of the coronavirus since it was believed to have emerged in a market illegally trading wildlife in the central city of Wuhan late last year.

    While more than 3,000 people have died, more than 47,000 have recovered and been discharged from hospital. But weeks later, doctors in different parts of the country are reporting some people have tested positive for the pathogen again.

    This has raised disturbing questions about the true state of people’s recovery and their potential to spread the virus without showing symptoms and has led to calls for more stringent scrutiny of people being discharged.

    At the moment, patients in China are discharged after two negative nucleic acid tests, taken at least 24 hours apart, and indications of clinical recovery, including resolution of symptoms, according to the National Health Commission (NHC).

    That is in line with World Health Organization recommendations published in January.
    But Zhang Zhan, a doctor at Renmin Hospital of Wuhan University’s Department of Respiratory and Critical Care, said the requirement should be raised to three tests.

    Zhang said she and some fellow doctors recently decided to delay the discharge of 18 patients even though they had met the two-test requirement. Thirteen of them came up positive for the coronavirus when tested again, she said.

    “It’s more reliable to discharge patients after having three negative test results in a row,” Zhang said in a social media post.

    Qi Xiaolong, professor of medicine and assistant dean of the First Hospital of Lanzhou University, told Reuters one more additional test might still not be enough.

    “As far as I know, some hospitals in China have adopted three negative results as a discharge standard for a long time, but even so, there are currently cases of some of them testing positive,” Qi told Reuters.

    DORMANT
    OR DISCREPANCY?

    Experts say there are several ways discharged patients could fall ill with the virus again. Convalescing patients might not build up enough antibodies to develop immunity to the virus and are being infected again.

    The virus also could be “biphasic”, meaning it lies dormant before creating new symptoms.

    Some cases of “reinfection” have also been attributed to testing discrepancies.

    Guo Yanhong, an official at the China’s NHC, said on Friday recovered coronavirus patients who later tested positive again have been found not to be infectious.

    Nevertheless, he said there was a need to improve health tracking and management of recovered patients, and to deepen understanding of the virus.

    There are no precise figures for the number of people discharged from hospital who later test positive.

    A vice director of a disease control centre in Guangdong province told media last week that up to 14% of discharged patients in the province had tested positive again and had returned to hospital for observation.

    China is not alone in cases of re-infection.

    Last week, authorities in Japan said a tour-bus guide had tested positive for a second time.

    Following the reports of re-infection, Taiwan became the first region outside mainland China to raise the bar on when to release patients. It now requires three negative tests, rather than two, the island’s health minister said.

    In contrast, Singapore, one of the first countries outside China to have successfully controlled the spread of the virus within its borders, has not toughened its criteria for hospital discharge.

    Whether or not a patient is discharged is a decision solely taken at the discretion of doctors on a hospital-by-hospital basis, the Singapore health ministry told Reuters.

    BIOSECURITY LAW

    SYDNEY. – Australia will use a little-known biosecurity law to restrict the movements of people suspected of having coronavirus, its attorney-general said on Tuesday.

    Australia on Monday confirmed the first community transmission of coronavirus after a doctor contracted the virus. It is not known how the man in his 50s was infected.

    Amid fears of a widespread outbreak, Attorney-General Christian Porter said Australia will expand the use of a rarely used law that would either designate some places as out of bounds or place the patient in home detention.

    “Under the biosecurity act, you could have the prevention of movement from persons in and out of particular places,” Porter told the Australian Broadcasting Corp.

    “You might have a major sporting event where people would be in very, very close proximity to each other and… it might be determined that the risk of transmission at a venue like that was too high.”

    The law, enacted in 2015, has rarely been used outside Australia’s agricultural sector.Prime Minister Scott Morrison last week said a pandemic was likely and Australia has moved to try and prevent the virus from reaching its shores.

    Since Feb. 1 Australia has stopped any foreigner from entering directly from China – its largest trading partner. The move has prevented thousands of students and tourists from entering Australia.

    Australia has had one death, a 78-year-old man who was a former passenger on the Diamond Princess cruise ship which was quarantined in Japan.

    SEATTLE RESPONSE

    Seattle-area health officials confronting the nation’s first community coronavirus outbreak are planning new containment measures, ranging from possible school closings to temporary quarantine housing for mildly ill homeless patients.

    The shift in strategy, with an emphasis on enlisting the public at large to take a more active role in curtailing the spread of the virus, came as health authorities announced on Monday that 18 Washington state residents had tested positive, including six who died.

    “We’re pivoting to a more community-based approach, very similar to what we use for influenza epidemics, where we give people, and schools and businesses good advice on how they can reduce their risks,” Dr Jeff Duchin, health officer for Seattle and King County’s public health agency, told reporters.

    The Seattle-area deaths marked the first fatalities documented in the United States from a respiratory disease that has killed more than 3,000 people worldwide – the bulk of them in China – since it emerged there in December.

    All of Washington’s cases are clustered in two counties in the greater Seattle area, making it the largest concentration detected to date by the US public health system. Eight of those cases, and four of the deaths, were linked to a nursing care facility in the Seattle suburb of Kirkland, officials said.

    The US Centers for Disease Control and Prevention lists more than 90 cases across the United States, a large bulk of them patients who were repatriated from the Diamond Princess cruise liner that had been quarantined in Japan.

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