De-isolating COVID-19 Suspect Cases: A Treatment Algorithm

Clinicians from the National Centre for Infectious Diseases (NCID) emphasize in this correspondence that no single indicator may be effectively used to decide on de-isolation of a suspect case.

One suspect case only returned positive on the fifth repeated sample (nasopharyngeal swab), on the seventh day of clinical illness.

“Our suspect case was kept isolated because of a high index of clinical suspicion, with a clinically compatible illness and history of close contact with a laboratory-proven COVID-19 case. While multiplex respiratory virus panels, in general, may be helpful in the evaluation of other viral acute respiratory infections (ARIs), even the detection of an alternate respiratory pathogen may not definitively exclude COVID-19 infection. Dual infections can occur in 10- 20% of viral acute respiratory infections… In our case series, one patient with confirmed COVID-19 by nasopharyngeal aspirate also exhibited clinical symptoms compatible with dengue fever. This was laboratory confirmed by dengue NS1 antigen test.”

They provide a decision-making treatment algorithm for respiratory viruses to address the challenge of delayed positivity in coronavirus testing in relation to illness onset.

De-isolating COVID-19 Suspect Cases: A Continuing Challenge Clinical Infectious Diseases, ciaa179, Published 26 February 2020.

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