…Withdraws the use of antivirals in managing
patients
The Nigeria Centre for Disease Control (NCDC) on Thursday said
that a negative laboratory test is no longer required to discharge
a COVID-19 patient, as symptomatic patients will be discharged
earlier than usual after they have stop showing symptoms of the
disease – fever and respiratory symptoms).
Also, asymptomatic patients will now be discharge 14 days after
their first positive test to the virus.
This is based on new data from Singapore that shows that RNA
detected beyond 10 days is no longer infectious as no viable virus
is grown by viral culture. Therefore, such patients will be
discharged but advised to continue self-isolating at home one week
after discharge.
The Director-General of the NCDC, Dr. Chikwe Ihekweazu, who made
this known at the daily briefing of the Presidential Task Force on
COVID-19, in Abuja, said: “There have been new science emerging
about the duration of infectivity of individual patients. It led to
the WHO issuing new clinical guidelines.
“We then convened colleagues across our organisation, the
department of hospital services of the Federal Ministry of Health,
as well as other colleagues with whom we work, to review our
guidelines and issue new guidelines for the country and of course
adapting it to local circumstances.
“The key thing is that the management of COVID-19 will be made
primarily supportive; we don’t have any treatment so far that has
any proven impact on morbidity.
“One of the major changes that have happened is the discharge
criteria. While these guidelines are obviously and primarily
targeted at physicians managing patients, it is important that
patients and people know. There are two groups of patients –
symptomatic and asymptomatic patients.
“For symptomatic patients, they may now be discharged at least
10 days after symptoms onset and at least 3 days without symptoms.
If your symptoms last for longer, we will wait for longer managing
you supportively.
“If you are asymptomatic, you can be discharged 14 days after
your first positive test. So, we no longer have to wait for a
negative test to discharge. This way you can go home with
confidence that you are no longer infective and you’re not putting
your family and friends or anyone else at risk.
“We are not encouraging that people be discharged while they are
still symptomatic. We are talking about discharging people that are
asymptomatic and have recovered. That is, you are symptomatic and
have recovered or you are completely asymptomatic throughout your
clinical episodes.
“At that point you really don’t need more clinical
interventions, even at home; you just need time to recover. It is
just like you recover from any other illness. You don’t need any
special intervention once you have been discharged.
“Change is difficult because we have been saying you have to
have the negative test. Even though we have published these
results, many physicians are still not using them. We can assure
them and everyone managing cases that 14 days after, in fact, 10
days is what the evidence says.
“But we have added 14 days to make it two weeks for people to
then implement discharge for patients that are asymptomatic.”
He further added: “In addition, we have also removed the use of
antivirals from our treatment guidelines. The trial for Chloroquine
and Hydroxychloroquine will go on.
“We are asking that we limit the use of these medicines to those
trial settings and not use them casually around the country. Let us
reduce the use of Chloroquine and Hydroxychloroquine and all the
other antiviral previously on our guidelines to contexts where
clinical trials are going on.
“So, we have withdrawn them from the guideline from management.
However, we have kept them within the clinical trial so that we can
study and see whether they work or not. That is really the rational
approach to this.”
Concerning the use and availability of personal protective
equipment (PPEs), the NCDC boss urged both public and private
hospitals to procure their own PPEs and factor it into the cost for
healthcare delivery.
He said, “Our hospitals both public and private, really need to
include the purchasing of personal protective equipment in their
procurement plans. These are things that they have to buy to keep
their hospital going.
“What we are doing now is simply a response to an outbreak –
managing logistics, sending around PPEs across the country. This is
definitely not what we should be doing as a country. So, that has
to change as we refigure our health system to include this.
“Yes, these things are expensive but you have to include it.
Healthcare can become expensive but whatever the cost, it has to be
factored into the cost of delivering healthcare. There is no point
in having a doctor or a nurse working if they cannot have the
personal protective equipment that they need.
“We need to push harder as doctors, nurses, medical lab
scientists, to ensure that there is running water in our clinics,
and insist on these things.
“Patients are encouraged to ask questions of their doctors when
next he or she wants to attend to them without a face mask or hand
glove.”
…Withdraws the use of antivirals in managing
patients
The Nigeria Centre for Disease Control (NCDC) on Thursday said
that a negative laboratory test is no longer required to discharge
a COVID-19 patient, as symptomatic patients will be discharged
earlier than usual after they have stop showing symptoms of the
disease – fever and respiratory symptoms).
Also, asymptomatic patients will now be discharge 14 days after
their first positive test to the virus.
This is based on new data from Singapore that shows that RNA
detected beyond 10 days is no longer infectious as no viable virus
is grown by viral culture. Therefore, such patients will be
discharged but advised to continue self-isolating at home one week
after discharge.
The Director-General of the NCDC, Dr. Chikwe Ihekweazu, who made
this known at the daily briefing of the Presidential Task Force on
COVID-19, in Abuja, said: “There have been new science emerging
about the duration of infectivity of individual patients. It led to
the WHO issuing new clinical guidelines.
“We then convened colleagues across our organisation, the
department of hospital services of the Federal Ministry of Health,
as well as other colleagues with whom we work, to review our
guidelines and issue new guidelines for the country and of course
adapting it to local circumstances.
“The key thing is that the management of COVID-19 will be made
primarily supportive; we don’t have any treatment so far that has
any proven impact on morbidity.
“One of the major changes that have happened is the discharge
criteria. While these guidelines are obviously and primarily
targeted at physicians managing patients, it is important that
patients and people know. There are two groups of patients –
symptomatic and asymptomatic patients.
“For symptomatic patients, they may now be discharged at least
10 days after symptoms onset and at least 3 days without symptoms.
If your symptoms last for longer, we will wait for longer managing
you supportively.
“If you are asymptomatic, you can be discharged 14 days after
your first positive test. So, we no longer have to wait for a
negative test to discharge. This way you can go home with
confidence that you are no longer infective and you’re not putting
your family and friends or anyone else at risk.
“We are not encouraging that people be discharged while they are
still symptomatic. We are talking about discharging people that are
asymptomatic and have recovered. That is, you are symptomatic and
have recovered or you are completely asymptomatic throughout your
clinical episodes.
“At that point you really don’t need more clinical
interventions, even at home; you just need time to recover. It is
just like you recover from any other illness. You don’t need any
special intervention once you have been discharged.
“Change is difficult because we have been saying you have to
have the negative test. Even though we have published these
results, many physicians are still not using them. We can assure
them and everyone managing cases that 14 days after, in fact, 10
days is what the evidence says.
“But we have added 14 days to make it two weeks for people to
then implement discharge for patients that are asymptomatic.”
He further added: “In addition, we have also removed the use of
antivirals from our treatment guidelines. The trial for Chloroquine
and Hydroxychloroquine will go on.
“We are asking that we limit the use of these medicines to those
trial settings and not use them casually around the country. Let us
reduce the use of Chloroquine and Hydroxychloroquine and all the
other antiviral previously on our guidelines to contexts where
clinical trials are going on.
“So, we have withdrawn them from the guideline from management.
However, we have kept them within the clinical trial so that we can
study and see whether they work or not. That is really the rational
approach to this.”
Concerning the use and availability of personal protective
equipment (PPEs), the NCDC boss urged both public and private
hospitals to procure their own PPEs and factor it into the cost for
healthcare delivery.
He said, “Our hospitals both public and private, really need to
include the purchasing of personal protective equipment in their
procurement plans. These are things that they have to buy to keep
their hospital going.
“What we are doing now is simply a response to an outbreak –
managing logistics, sending around PPEs across the country. This is
definitely not what we should be doing as a country. So, that has
to change as we refigure our health system to include this.
“Yes, these things are expensive but you have to include it.
Healthcare can become expensive but whatever the cost, it has to be
factored into the cost of delivering healthcare. There is no point
in having a doctor or a nurse working if they cannot have the
personal protective equipment that they need.
“We need to push harder as doctors, nurses, medical lab
scientists, to ensure that there is running water in our clinics,
and insist on these things.
“Patients are encouraged to ask questions of their doctors when
next he or she wants to attend to them without a face mask or hand
glove.”