Clearing Up Released vs Recovered COVID-19 Patients

Health Department Director Sandra Villareal tried to explain to San Angelo Live the difference between recovered and released COVID-19 patients. Finding her explanation confusing I researched the difference.

Most communities are not classifying cases as recovered. Arizona will report recovered patients but the method for calculating the measure is unclear.  AZ Central reported:

Jessica Rigler, the Arizona Department of Health Services assistant director, elaborated on the complexity of defining “recovered,” saying there is no standard definition. The state initially took repeated tests of infected individuals to find out exactly when they tested negative, she said, but as case numbers increased and testing supplies fell short, that was no longer viable. 

The state considered an algorithm for identifying recovered cases by going back 30 days and comparing total cases with death certificates. By knowing the number of people who died in the past month, the state can estimate the number of people who have recovered, Rigler said.  

Minnick, the spokesman, did not answer a question about the final process the state used to determine who counts as recovered.  Only a handful of other states report on recovered cases.

Recovered patients should meet clinical criteria that is consistently applied.  COVID-19 is a tricky virus that can harm the body in multiple ways.  Clinicians do not know the long term implications of the disease so using the word recovered could be premature.

The City's website states the following on released patients:

The removal of positive cases from quarantine/isolation is based on guidance from the Texas Department of State Health Services (DSHS) and Center for Disease Control (CDC); therefore, the health department will report the number of positive cases that have been removed from isolation in adherence to these guidelines. Because removal from isolation is on a case-by-case basis, a cumulative count will be reported on a weekly basis every Friday. 

As a local health department, we are under the umbrella of DSHS. When it comes to case management, DSHS does not report on the medical management, recovery or follow-up of patients on any infectious disease. We follow suit.

DSHS and the local health department are focused on identification of infectious disease (in this case COVID-19) and the notification of contacts of said case(s), as well as providing and adhering to guidance issued by DSHS or CDC. The health department would also report any deaths associated with the disease. Medical management, follow-up and recovery information of patients are between the individual and their medical provider or physician. 

The CDC utilizes three different strategies to release patients from isolation.  They are:

1.  Symptoms based strategy
2.  Time based strategy
3.  Test based strategy -- A test-based strategy is contingent on the availability of ample testing supplies and laboratory capacity as well as convenient access to testing.

Sandra mentioned the first two strategies.  When asked Villareal said "they can retest" but framed it as a means to become a plasma donor.  I thought the test for antibodies after having the disease was different from the test indicating the presence of active COVID-19 virus.

San Angelo's Local Health Authority recently ordered citizens to wear masks in stores.  His order revealed the "length of time it takes to get a COVID-19 test result back has increased to seven days."  That may explain why the City is not using a test based strategy to release patients from isolation.   It simply takes too long.

Update 7-7-20:  The City of San Angelo informed the public of its testing strategy and its non-testing method for releasing positive patients.  Public information officials called it a clarification but it is the first communication the city had for citizens on its testing practices.  Today's City Council meeting revealed the city is not performing any tests.  Those are being done by area hospitals.