On April 3, Sen. Kai Kahele used Facebook to expressed concern over what the next steps are for patients who test positive for COVID-19 and when and how they are released from isolation. He posted a letter that he had sent to the heads of the Hawaiʻi health department, with the subject “URGENT Clarification on COVID-19 Patients’ Discontinuation of Home Isolation”:
I am requesting an immediate clarification on when a COVID-19 patient should discontinue home isolation. There is a lot of misinformation circulating in the community and conflicting views on this issue. Currently, we have individuals who have tested positive for COVID-19 that are, at the direction of the Department of Health (DOH), reintegrating themselves into our island communities.
We had difficulties finding an answer to this question on the DOH website. But after clicking on various links we were able to find this: What to Do If You Test Positive For COVIDI9. According to this document, the patient is to remain at home until a DOH Officer releases the patient from isolation, and a DOH staffer will call daily to monitor the patient. What is the DOH’s criteria for releasing a patient from isolation?
Is the recommendation to release a patient from home isolation based on guidelines from the Center for Disease Control and Prevention (CDC)? If so, we were able to find the following information on the CDC website, How to discontinue home isolation.
If you will not be tested, you can leave your home after:
You have had no fever for at least 72 hours (that is three full days of no fever without the use medicine that reduces fevers), AND
Other symptoms have improved (for example, when your cough or shortness of breath have improved), AND
At least 7 days have passed since your symptoms first appeared.
If you will be tested, you can leave home after:
You no longer have a fever (without the use medicine that reduces fevers), AND
Other symptoms have improved (for example, when your cough or shortness of breath have improved), AND
You received two negative tests in a row, 24 hours apart. Your doctor will follow CDC guidelines.
Can you also provide information on the “shedding period” of COVID-19 in symptomatic patients and how that factors into the criteria for a DOH Officer to release a patient that has tested positive for COVID-19 from isolation?
In addition, can you provide guidance for patients who have been tested but have not received any results yet? There are some people (including myself) who have been waiting for 14 days (test administered 3/21/2020) and have not received their results. We were able to find a DOH document, What To Do If You Have Been Tested For COVID19, but it does not mention what you should do if you do not receive your results in a timely manner.
I would also like to request that the information regarding the discontinuation of the home isolation be more easily accessible or prominent on the DOH website. As more and more patients are released from home isolation, it is important for people to understand the DOH criteria being used for the release of patients and to eliminate the fears and misinformation that is circulating throughout our communities.
The director of the Hawaiʻi Department of Health, Dr. Bruce Anderson, responded to Sen. Kahale’s letter, and as Sen. Kahele noted, Dr. Anderson’s response was prompt. Sen. Kahele also shared Anderson’s reply on Facebook:
April 4, 2020
Dear Senator Kahele:
In response to your request for clarification on when a COVID-19 patient should discontinue home isolation, the Department of Health (DOH) follows the Centers for Disease Control and Prevention’s (CDC) Interim Guidance “Discontinuation of Home Isolation for Persons with COVID-19” as outlined in your letter. We will apply these guidelines to persons who have tested positive for COVID-19 and have been reported to and monitored by DOH. DOH cannot provide guidance or recommendations for persons who received tests not approved by the Food and Drug Administration (FDA).
Information regarding the duration of shedding of the SARS-CoV-2 virus is limited at this time; however, viral shedding is thought to be greatest when patients are symptomatic. Viral shedding is greatest at the time of symptom onset and declines over the course of several days to weeks. The exact degree of SARS-CoV-2 viral RNA shedding that confers risk of transmission is not yet clear. Please note that in certain circumstances (e.g., hospitalized patients, immunosuppressed persons, persons being discharged to a long-term care facility), DOH will work with the clinician to determine when a person with COVID-19 should be released from isolation.
Results of COVID-19 tests are sent to the ordering clinician. The Department recommends persons awaiting results should check with the clinician who ordered the test if they have not received results in a timely manner.
Thank you for your suggestion regarding our website. DOH is continually evaluating communication efforts to improve accessibility and case of use. We will review DOH’s COVID-19 website to ensure that information regarding discontinuation of isolation is accessible to all interested parties.
If you have any further questions, please do not hesitate to contact me.
Dr. Bruce Anderson