Mild, asymptomatic cases as recovered patients? DOH says other countries follow same criteria

Kristine Sabillo, ABS-CBN News

Posted at Jul 31 2020 01:29 PM | Updated as of Jul 31 2020 01:41 PM

People under COVID-19 testing at a company, June 20, 2020. Jonathan Cellona, ABS-CBN News

MANILA — The Department of Health on Friday explained that the implementation of “time-based tagging” or “mass recovery adjustment” where mild and asymptomatic COVID-19 patients are declared recovered after 14 days of quarantine is at par with international standards.

This followed its announcement of record-high recoveries of some 38,075 coronavirus patients on Thursday, which prompted doubt and drew questions from the public on how DOH handles critical COVID-19 data. 

“'Yung clinical criteria hindi siya masyadong different from other criteria or countries,” Health Undersecretary Maria Rosario Vergeire told reporters during a virtual forum. “'Pag nakita ng physician na na-resolve ang symptoms we can already classify as clinically recovered.”

(Our clinical criteria is not that different from the criteria of other countries. If the physician sees that symptoms are resolved, we can already classify as clinically recovered.)

Vergeire said this a day after the DOH announced 38,075 additional recovered COVID-19 patients, of which 37,166 are from “Oplan Recovery” or the department’s data reconciliation efforts with local government units. 

The said campaign resulted in the re-tagging of mild and asymptomatic patients as recovered, based on the criteria that they have already spent at least 14 days in quarantine.

“Across countries, repeat testing is no longer required,” she added, responding to those asking why the Philippines stopped re-testing patients.

At the start of the outbreak, the Philippines required two negative tests from a patient before hospital discharge. However, as the number of cases grew, the protocol changed. 

In the table presented by Vergeire, it showed that the Philippines’ recovery policy requires a patient to be “clinically recovered” and completion of 14 days of isolation from onset of symptoms or swabbing date for asymptomatic cases. 

This is similar to the policy in the United States, although they only require 10 days of isolation. Only Vietnam requires 2 consecutive negative polymerase chain reaction (PCR) tests.

Vergeire said this is considering that Vietnam has been able to contain their cases. Vietnam currently has 459 cumulative confirmed cases compared to the Philippines’ 89,374 total cases.

“This (Vietnam's testing criteria) is what we were implementing before until we changed our protocol because of the evidence that after the 10th day, a patient is no longer infectious,” the health official added, reiterating their earlier statement.

She explained that clinically recovered refers to resolving symptoms or no longer experiencing symptoms associated with COVID-19.

Vergeire also pointed out that the “RT-PCR is a basis of infection but not a basis of recovery.” The PCR test is the gold standard for COVID-19 testing.

“The RT-PCR machine, it detects the virus but it doesn’t tell you if that virus is still infectious,” she added, explaining why other countries also removed testing as a requirement for recovery.

She said the sensitivity of the PCR tests would have recovered patients test positive because they still have “remnants” of the virus but are no longer infectious, requiring them to stay in the hospital longer than needed. 

Vergeire also reminded the public that their definition of recovered patients is not new. It was already mentioned in the May 29 Department Memorandum No. 2020-0258, which states that patients with mild or no symptoms are tagged as recovered 14 days from the date of onset of symptoms or by date of specimen collection, the DOH said.

However, “there were different interpretation(s) coming from our reporting units,” she said.

This is why the DOH also presented it to the Inter-Agency Task Force on COVID-19, which included the “time-based” tagging in its latest resolution.

Vergeire also showed the IATF what happened when they adopted the time-based tagging — from having only 30 percent of cases tagged as recovered to 72 percent.

She also assured the public that the patients were monitored by the local government. On top of that, a patient must also be assessed by a physician to be declared clinically recovered.