18 Covid-19 patients who have tested positive for the virus have been discharged from Pasir Ris D'resort as they are "shedding dead viral components" of the virus and "are no longer transmissible and infective to others", the Ministry of Health (MOH) said in response to Mothership's queries on discharged patients who continued to test positive for Covid-19.

The ministry further noted that the Medical Review Committee has deliberated on each of these cases individually and that these 18 cases were "clinically very well" but "persistently" tested positive for Covid-19.

The Committee came to the conclusion that they were shedding dead components of the virus that were detectable through the Polymerase Chain Reaction (PCR) swab test, but which are no longer transmissible and infective to others.

As an added precaution, MOH noted that these patients are required to be home quarantined for a further seven days.

One case shares his experience of being discharged

One case, nicknamed S, reached out to Mothership to share his experience of being discharged.

He had stayed at D'resort for 56 days.

In describing the lead-up to his discharge despite his positive status, S said that he was subjected to a swab test on Wednesday, May 13.

He was then informed by Woodlands Health Campus on Thursday, May 14, that he had tested positive and that he had been scheduled for testing again on Sunday, May 17.

However, he was informed by the front desk of D'resort on May 15 that he had been discharged from the facility.

In response, S told the front desk that he still tested positive.

S added that the front desk was "shocked" and that they proceeded to call MOH for clarification on whether he should be discharged.

Was not issued a Stay-Home Notice

Subsequently, when D'resort returned his call, they stated that the information for his discharge was accurate and that an official email had also been sent to them by the MOH.

S added that he was also provided with a copy of the following document at the counter, enclosed in a Certis Cisco envelope and stating that his quarantine/isolation order had been revoked.

He was not issued a Stay-Home Notice in the letter.

Called MOH himself for clarification

S then proceeded to call MOH himself for clarification on the matter and claimed that the people he spoke to were also apparently unsure of the procedure.

As such, he was told that they "had to check with their superiors" and would get back to him.

When asked about whether transport was provided for him back to his place, S said that no transport was provided and that he had been picked up his father from the facility.

He was then called by MOH while on the way home, who informed him about discharging all patients who had been in the facility for at least 28 days.

S added that he intends to continue self-isolating for the time being.

MOH response

In response to Mothership's query, MOH replied:

"The Ministry of Health noted that 18 patients had stayed for prolonged periods (38 to 51 days) at the community care facility at D’Resort, were clinically very well but persistently test positive for COVID-19, and decided to refer their cases to a Medical Review Committee.  The Committee deliberated on each of these cases individually, and determined that the patients are shedding dead viral components, detectable through the PCR test, but which are no longer transmissible and infective to others.  After careful consideration, the Ministry of Health decided that these individuals can be cleared for discharge. As an added precautionary measure, they are required to be home quarantined for a further seven days.

Infectious Diseases experts have advised the Ministry of Health that patients are unlikely to be infectious beyond 14 days from their onset of illness, as the virus could no longer be cultured from biological samples taken from these patients, even if they continue to test PCR positive. However, we will adopt a cautious approach, while continuing to consult with local and international experts.  Meanwhile, we will review the status of COVID-19 patients with prolonged stays at our community care facilities and consider if they need to remain in isolation, on a case-to-case basis."

Discharging patients who test positive but are well has been raised as a possibility before

Discharging patients who test positive but are well has been raised as a possibility previously by Health Minister Gan Kim Yong however.

Earlier, at a press conference on March 13, Gan said that should there be large numbers of patients, it is important to strategise the approach to Covid-19 by focusing on cases that "really need hospital care."

At that time, Singapore had reported 200 cases of Covid-19.

During the press conference, Gan also talked about how research had shown 80 per cent of the patients had "very light to mild symptoms" and that they only needed to be monitored in the event that their condition deteriorates.

As such, medical facilities will be focused on those requiring medical support.

His statement was further echoed by the Director of Medical Services, Kenneth Mak at the same press conference, who added that as a better understanding of Covid-19's natural history developed, they had come to realise that there was a definitive group of Covid-19 patients who were in fact quite well, and had no need for significant nursing care or treatment in the hospital.

Here, Mak said that while such patients were currently being kept in the hospital on the basis of making sure they tested negative, the possibility of having to "return these patients to the community" had to be considered in the event that numbers went up.

Measures were therefore being on worked on, regarding how such mild cases could isolate themselves from the community, in the event that numbers increased, necessitating the need to maximise the potential cases in the hospitals and ICUs.

Mak said:

"Some attention that needs to be paid is how would we allow them to isolate themselves in community, or if they are not able to do so in their homes, then provide them with an option where they can safely stay in the community without any risk of spread to others. These are measures that we are working on."

Test could be detecting dead fragments of the virus

In addition, the possibility of dead fragments of the virus being detected by the Covid-19 swab test, also known as the polymerase chain reaction test, has also been raised.

According to The Straits Times, the executive director of the NCID, Leo Yee Sin, stated that the swab test is designed to detect a particular segment of the Covid-19 virus gene.

However, it is unable to distinguish if the virus is still alive or dead and fragmented.

Leo also highlighted that about 90 per cent of Covid-19 patients stop shedding the virus by the 26th day of their illness, with the remaining 10 per cent taking a longer period to get rid of either live or dead viruses.

As such, "prolonged PCR positive" is not an uncommon occurrence.

Are you one of the 17 Covid-19 positive patients who are discharged from D’ resort? Share your story with Mothership at [email protected].

Top image collage left photo courtesy of S, right photo from Trivago.sg website