‘Isolation time depends on symptoms’

PETALING JAYA: The quarantine period for a healthy individual remains at 14 days, but those tested positive for Covid-19 can be discharged on the 10th day from the onset of symptoms, say health experts.

Universiti Malaya public health medicine specialist Dr Victor Hoe said the quarantine of a healthy person and a patient tested positive being discharged from hospital were two different scenarios.

“The recommended 10 days for discharging a patient is based on the first day of diagnosis, whereas the quarantine period starts from the first day of exposure to a positive patient, so it is before the start of having an infection.

“The incubation period for the virus on an average takes five to six days and sometimes for as long as 14 days.

“This is why the quarantine period should be maintained as 14 days and not reduced to 10, ” he said when contacted.

Universiti Putra Malaysia medical epidemiologist and biostatistician Assoc Prof Dr Malina Osman concurred, saying that the quarantine of a healthy person exposed to a positive case and the treatment of symptomatic and asymptomatic individuals have different sets of management.

“The period of 14 days is determined for quarantine as the onset of infection is between two and 14 days. The incubation period equals the period of exposure until the virus is detected or the person develops symptoms.

“For the criteria of a discharge, the period is calculated from the day of the onset of symptoms until the patient shows no symptoms, ” she said.

As such, Dr Malina said the quarantine period for an individual who has been exposed to a positive patient but not shown symptoms yet “should remain at 14 days”.

According to the World Health Organisation’s (WHO) criteria, discharging patients from isolation without requiring re-testing for symptomatic patients is 10 days after symptoms onset, plus an additional three days for those without symptoms.

For asymptomatic cases, the WHO recommended that they be discharged 10 days after a positive test for the virus.

The United States Centres for Disease Control and Prevention (CDC) had also recommended for the isolation and precautions of positive Covid-19 individuals to be discontinued 10 days after the onset of symptoms.

Universiti Malaya virologist Prof Dr Sazaly Abu Bakar said the decision on whether to quarantine a person for 10 or 14 days was about “risk mitigation”.

“If a person turns out to be positive, it is better to err on the negative side because we don’t know when a person is exactly going to express enough virus to be detectable.

“By having a 14-day quarantine, you can be completely sure an individual is going to be negative once released, ” he said.

But Dr Sazaly said this was different from those who tested positive for the virus, adding that often times their virus load was already low and could be discharged.

“I won’t be surprised if we have more data in the future, the quarantine time will be reduced, ” he said, adding that with better testing, maybe the 14-day quarantine would no longer be needed.

Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud said it had been known for some time that patients with no symptoms or mild symptoms ceased being infectious about 10 or 11 days from the onset of the illness or the suspected date of infection.

“I generally support the 14-day quarantine despite what the CDC says but if we are following the CDC’s guidelines, this would follow the test-based strategy so probably yes (to discharge after 10 days), ” he said.

On Oct 30, Health director-general Tan Sri Dr Noor Hisham Abdullah said patients who tested positive for Covid-19 were discharged on the 10th day based on WHO guidelines.

He said the infectivity of pre-symptomatic cases could happen two days before they showed symptoms, adding that their infectivity was between five and seven days, with an average of nine days.

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