Emergencies preparedness, response

WHO hospital discharge and follow-up policy for patients who have been diagnosed with Severe Acute Respiratory Syndrome (SARS)

Revised 28 March 2003
This advice is updated regularly based on additional information

Convalescent Cases of SARS

We advise that the following criteria are considered prior to making a decision regarding discharge from hospital regarding a convalescent case:

Clinical symptoms/findings:

  • Afebrile for 48 hours
  • Resolving cough

Laboratory tests: if previously abnormal

  • White cell count returning to normal
  • Platelet count returning to normal
  • Creatine phosphokinase returning to normal
  • Liver function tests returning to normal
  • Plasma sodium returning to normal
  • C reactive protein returning to normal

Radiological findings:

  • Improving chest x-ray changes

Follow-up for convalescent cases:

Discharged convalescent patients should monitor and record their temperature twice daily. If they have an elevated temperature of 38 degrees Celsius or above on two consecutive occasions they should report to the health care facility from which they were discharged.

Until more is known about the aetiological agent, and the potential for continued carriage (and hence the risk of continuing transmission) a precautionary approach is warranted. Therefore, following discharge from hospital, convalescent cases should remain at home for 7 days. During this period they should stay indoors, keeping contact with others to a minimum.

Follow up should be at one week at which time they should have a repeat chest x-ray, full blood count and any other blood tests that were previously abnormal. The patient should be followed up by the health care facility from which they were discharged. Additionally, the clinician may decide that the patient needs to be followed up before one week.

At the one week assessment, a decision should then be made on whether or not further confinement is required. Further confinement would be recommended in those who are immunosuppressed. Subsequent follow-ups are recommended until the chest x-ray and patient’s health returns to normal.

As part of the follow-up, convalescent serology should be taken at 3 weeks after the date of disease onset and provided to the health care facility from which they were discharged.

Clear instructions should be given to convalescent cases to contact to the institution from which they were discharged if their condition deteriorates and any further symptoms develop.