Preparing for Patients to Recover from COVID-19
Clinicians are calling for greater preparedness for post acute care of patients who recover from COVID-19
Patients testing positive for the SARS-CoV-2 virus after receiving ostensibly successful treatment of their acute coronavirus disease 2019 (COVID-19) has prompted their clinicians to question the present standards for patient discharge, and others to call for greater preparedness for post acute care of patients recovering from COVID-19.
"Previous studies on COVID-19 mainly focused on epidemiological, clinical, and radiological features of patients with confirmed infection. Little attention has been paid to the follow-up of recovered patients," observed Haibo Xu, MD, PhD, of the Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China and colleagues.
Xu and colleagues reported on 4 patients, all medical professionals, experiencing mild to moderate symptoms who were treated after reverse transcription polymerase chain reaction (RT-PCR) tests were positive for SARS-CoV-2 and CT imaging showed ground-glass opacification or mixed ground-glass opacification and consolidation. The time to recovery ranged from 12 to 32 days, and all 4 patients had 2 consecutive negative RT-PCR tests before discharge.
Despite continuing self-quarantine at home, however, each tested positive when rechecked 5-13 days after discharge. The positive results were confirmed using another manufacturer's test kit. In each case, the patients had taken particular care to adhere to quarantine protocols, and no family members were infected.
"Current criteria for hospital discharge or discontinuation of quarantine and continued patient management may need to be reevaluated," Xu and colleagues concluded.
Ting Cai, MD, of HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China, and colleagues described another patient testing positive after discharge from acute care, in this case from a COVID-19-designated hospital with a protocol requiring significantly improved symptoms, 2 consecutive negative tests, and normal body temperature for 3 days before discharge.
The hospital subsequently changed their protocol, for patients discharged after treatment of COVID-19 to be transferred to a designated medical unit for additional 14 days of quarantine and observation.
Daniel Grabowki, PhD, of the Department of Health Care Policy, Harvard Medical School, Boston, MA, and colleagues called for more attention in the US to providing appropriate post acute care of these patients, in their recent viewpoint column in JAMA.
"Many patients with COVID-19 will need post acute care to recuperate from their infection," Grabowksi and colleagues note. "However, post acute care facilities currently lack the capacity and capability to safely treat patients with COVID-19 as they transition from the hospital to other care settings or to their homes."
Their proposals included establishing specialized post acute care environments, possibly by adapting or expanding existing rehabilitation facilities, long-term care hospitals, and hospital-based skilled nursing facilities.
In addition, Grabowski and colleagues called for increasing the level of home health care that is now available, with investment in hospital-at-home models which could provide institutional-level services in the home. They noted the recent increase in Medicare reimbursement for telemedicine and suggest such technologies might be used to increase clinician access in both facility and home care settings. In considering relevant policies, they emphasized the importance of providing all posta cute care staff with paid sick leave, to encourage staff who are ill to stay home and not infect vulnerable patients.
"The US has been playing catch-up in its COVID-19 response in terms of testing, social isolation, and hospital capacity," Grabowski and colleagues said. "Making changes in post acute care delivery and policy today could help contribute to having adequate capacity and capability in the coming weeks and months."