13 days after recovery, Dr. Dawipayan Deb tests positive for COVID19 again; Relapse or flaws in discharge mechanism?

On July 26, Silchar’s Sonai Road resident, Dr. Dawipayan Deb had tested positive for COVID19. The medical officer at National Health Mission, Deb was tested using the RT-PCR as he came in contact with his father who had tested positive and was admitted at Silchar Medical College and Hospital.

As per the protocol followed in Assam, on the 9th day of admission, Deb was tested again using the Rapid Antigen Test Kit and on August 7, 2020, (10th day) the ‘discharge board’ deemed Deb to go back home from the hospital. He remained at home isolation for seven days and joined service back on August 17, after following all the guidelines.

However, while treating patients at Kalain Primary Health Care Centre, Deb started feeling uncomfortable. Soon he realised he is running a high fever, dry cough and a “terrible sore throat.”

“The next day I decided to go for necessary home quarantine. For 3 long days, I have been fighting to keep my symptoms down with oral medications. But, unfortunately, I couldn’t. The pain was excruciating and cannot be described in words. Last night gave up and got myself tested at SMCH,” wrote Dr. Dawipayan Deb on his Facebook account.

He has tested positive again and is now being treated at Silchar Medical College and Hospital. So, is that reinfection?

A senior ICMR surveillance group member told to Times of India that there has been no evidence proving relapses in the country. “To establish SARS-CoV-2 reinfection, one needs to show a positive live virus in a BSL – 3 level lab. World over, epidemiologists have a similar view,” Giridhara Babu, a member of the ICMR’s surveillance team was quoted by TOI on August 20.

He further said, “The supposed cases of repeat infection from some states may be post-viral symptoms of COVID19 that still need to be studied thoroughly.”

But then isn’t Dr. Dawipayan Deb’s case an exception? The principal of Silchar Medical College and Hospital, Dr. Babul Bezbaruah explains. “There are two chances – reinfection or relapse. Chances of reinfection are very rare and we feel it could be an issue of relapse. When he was admitted earlier, he was asymptomatic and hence may be the development was delayed. Now probably the viral load has increased and he became symptomatic.”

Dr. Bezbaruah added, “We have discussed the same with higher authorities and are treating him accordingly.”

So, if there is a possibility of delayed reaction then should the SMCH reconsider its discharge policy? “The discharge policy remains the same. On the ninth day you have to be negative, 10th-day discharge,” reiterated Dr. Bezbaruah.

Adding, “The policy will not be changed as these are very rare cases and mostly limited to healthcare workers. We had a couple of such instances in Guwhati Medical College earlier and Dawipayan is the first case here (in Silchar). We are observing him and can share more updates later.”

Associate professor, department of microbiology, SMCH, Dr. S Sen believes it is too soon to reach a conclusion. “The virus is new and its testing process is complex. Different people have different virus loads, so we can’t be one hundred percent sure about anything. After someone is positive, he is treated according to the guidelines, after a while he is tested again and after measuring at a certain scale, he is said to be negative. This level is different in the body of a different person. As a result, it would not be right to reach a conclusion right now. We are examining the report of Dr. Dawipayan Deb,” said Dr. Sen.

Other officers in Silchar Medical College and Hospital believe that there might be more such cases that went unreported. “Dr. Deb is a trained healthcare professional. He could study his symptoms and take a well-informed step. What if he was a farmer in the outskirts. While it is an exceptional case, it would be premature to conclude by saying this is the only exceptional case. The solution is to remain careful and follow the protocols even after testing negative. He should also get the family tested again,” said another doctor of SMCH.

Should ICMR reconsider its position on relapse and reinfection as the health minister of Maharashtra has also raised similar concerns. Though the Principal suggested there is no need to change the discharge policy, it remains uncertain if a RAT test on 9th day is safe to assume recovery. It is worth recalling, the first patient in Assam was tested 14 times before discharge. Dr. Dawipayan Deb’s case has given the virologists and epidemiologists a lot to ponder.