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Evidence showed the rarity of the virus that can be cultured in respiratory samples after nine days of symptom onset, especially in patients with mild disease, usually accompanied by rising levels of neutralizing antibodies and a resolution of symptoms, WHO said.

It thus appears safe to release patients from isolation based on clinical criteria that require a minimum time in isolation of 13 days, rather than strictly on repeated PCR results, it said.

Clinical criteria require that symptoms of patients are resolved at least three days before release from isolation, with a minimum time in isolation of 13 days since symptom onset, it said.

These modifications to the criteria for discharge from isolation in a health facility or elsewhere balance the understanding the risk of infection and the practicality of requiring repeated negative PCR testing, especially in settings of intense transmission or limited testing supplies, said the world body.

Graphic: Mint

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Graphic: Mint

“The risk of transmission after symptom resolution is likely to be minimal based on what is currently known but cannot be completely ruled out. However, there is no zero-risk approach and strict reliance on PCR confirmation of viral RNA clearance creates other risks such as straining resources and limiting access to health care for other patients with acute disease,” it said.

“In patients with severe disease who are symptomatic for prolonged periods of time, a laboratory-based approach might also aid decision-making on the need for prolonged isolation. Such a laboratory-based approach can include measuring viral load and neutralizing antibody, or proven equivalent antibody, levels,” it said.

The number of covid-19 cases in India crossed 432,189 on Monday. The number of deaths have crossed 13,808.

The Centre on Friday wrote to states urging them to follow the guidelines for effective home isolation issued in May, which state that very mild and pre-symptomatic covid-19 patients can opt for home isolation provided the patient has a room to himself or herself with toilet facility and has an adult attendant or caregiver.

On 27 May, WHO published updated interim guidance on the clinical management of covid-19 and provided updated recommendations on the criteria for discharging patients from isolation. The updated criteria reflected recent findings that patients who do not show symptoms any longer may still test positive for covid-19 by RT-PCR for many weeks. Despite this positive test result, these patients are not likely to be infectious and, therefore, are unlikely to be able to transmit the virus to another person, it said.

“The authorities need to find a delicate balance between home quarantine and institutional quarantine and use it to the fullest. The guidelines set by the government need to be followed with the physical and mental comfort of the patients in mind at both homes and institutions,” said Dr Suresh Sharma, head, Population Research Center, Institute of Economic Growth, Delhi University.

India has one of the lowest cases per lakh population despite its high population density, the WHO Situation Report dated 21 June shows, the Union health ministry pointed out. India has 30.04 cases per lakh population, while the global average is more than triple at 114.67. The US has 671.24 cases per lakh population while the figures for Germany, Spain, and Brazil are 583.88, 526.22, and 489.42 respectively.

A total of 241,140 patients have been cured of covid-19 in India. During the last 24 hours, a total of 9,440 covud-19 patients have been cured taking the rate to 55.77% among covid-19 patients.

At present, there are 177,241 active cases and all are under active medical supervision.

The total number of samples being tested per day is also steadily rising, as is the number of total samples tested. In the last 24 hours, 143,267 samples were tested, taking the total number of samples tested thus far to 6,950,493.

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