We sincerely thank Dr. Williams1  for his interest in our article2  and for his provocative question. As the world passes five million recorded cases of coronavirus disease 2019 (COVID-19) and the number is still rising, we also recognize the importance of developing management strategies for COVID-19 patients after the initial discharge home. As of May 25, 2020, more than 79,000 patients, or 94% of all registered cases in China, have been discharged home from either designated facilities or hospitals. The discharge criteria for COVID-19 patients include (1) body temperature return to normal for more than 3 days, (2) oxygen saturation measured by pulse oximetry (Spo2) at or greater than 94% on room air, and (3) two consecutive negative nucleic acid tests.3  However, data have shown that with the current discharge criteria, 38 (29%) of 131 discharged patients, half of whom were severe cases of COVID-19, still had one or more symptoms including cough, fatigue, expectoration, and chest tightness in the second week after discharge.4  There is no significant difference in the profile and severity of the symptoms between the patients in severe and nonsevere COVID-19 categories.4  It had been reported that several cases whose nucleic acid test was negative at discharge had reappeared positive afterward.4,5  Therefore, we routinely follow up on these patients 2 to 4 weeks after discharge, and quarantine either at home or a designated facility is often required during the follow-up.

If a COVID-19 patient after being discharged home is readmitted for surgery or anesthesia care, precautions in perioperative settings should be taken. However, standardized protocols have not yet been well defined. In most hospitals in China, the nucleic acid tests are done at readmission. A patient is usually considered a non–COVID-19 patient if she or he has two consecutive negative nucleic acid tests within the past 7 days with an interval of more than 24 h. In some patients having symptoms or signs indicating a possible recurrence of COVID-19, the additional nucleic acid test is performed even if there are two negative results. If the patient’s surgery or intervention is emergent and the results of the nucleic acid tests remain unavailable, she or he is treated as a suspected patient. The protective measures for a suspected or confirmed patient in perioperative settings are the same as those described in our recent article.2 

We hope that we have answered adequately the question posed by Dr. Williams. However, at present, rehospitalization for surgical treatment after the recovery of critically ill patients with COVID-19 infection is rare. The best strategy of follow-up and long-term care of this population remains to be determined. We are keen to work with our international colleagues to address this issue in the future with scientific evidence.

The authors declare no competing interests.

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