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Our Ministry of Health and the regional sanitary inspectorates operate according to the old rules of the World Health Organization and do not want to hear arguments at all. They are like horses with caps: “it was fine” and that’s …
These are the angry conclusions of a reader of “Dnevnik”, who wrote to the newsroom that he was infected with a coronavirus. Petar Stoychev explains that he had mild symptoms, and only for the first four days. He was quarantined for 14 days, which was then extended due to a positive PCR test at the end, even though he had not felt ill for a long time.
He says that “a person is interested when it comes to mind” and thus discovers the updated criteria of the World Health Organization (WHO) on how long the quarantine should last in COVID-19. They were published on June 17 (Originals are from January – author’s note)But they have not been publicly debated in Bulgaria, and the country’s authorities have so far implemented stricter measures since the start of the pandemic for increased security.
Today, the National Operations Headquarters announced that they are changing the rules and that PCR tests will no longer be mandatory for quarantine. This means that anyone who has been registered as infected with the virus and is subjected to home isolation will be released within two weeks without the need for further testing. Details have yet to be fully clarified, as the Health Minister’s order to introduce the new rules has yet to be released.
In practice, therefore, Bulgaria is moving one step closer to the updated WHO criteria, according to which coronavirus patients can now come out of isolation without being examined and in a shorter time. “This reflects recent findings that patients whose symptoms have remitted are likely to test positive for the COVID-19 disease virus (SARS-CoV-2) for many weeks. Despite the positive result, these patients are unlikely to are contagious and therefore it is not possible to transmit the virus to another person “, indicated the instructions of the WHO.
What are the current recommendations
In a June statement, the World Health Organization stated that updated criteria for “coming out of isolation” without testing apply to both COVID patients treated in hospital and those in home isolation. They are:
For infected without symptoms: ten days after a positive SARS-CoV-2 test (The virus that causes COVID-19 disease – author’s note)
In explaining the criteria, the WHO gives the following examples: “If a patient has had symptoms for two days, he should be” released from isolation “after 10 days + 3 = 13 days from the onset of symptoms; A patient with symptoms for 14 days can be “discharged” after (14 days + 3 days =) 17 days after the onset of symptoms; a patient with symptoms for 30 days can be “discharged” (30 + 3 =) 33 days after the onset of symptoms.
The organization clarifies that countries can decide to continue using the tests as part of the criteria for ending isolation. If this is the case, again the rule is that both negative PCR results should be obtained in at least 24 hours.
Why the WHO decided to lower the criteria
The World Health Organization has received feedback from member states and experts that implementing the January recommendations for two negative PCR results in at least 24 hours is extremely difficult, especially in light of limited laboratory resources in the areas where the virus circulates. intensely.
However, the WHO notes that the updated criteria “balance risks and benefits” and warns:
There is a minimal residual risk of transmitting the virus using these criteria, which do not include testing.
World Health Organization
The organization reports that there are situations in which even the minimal risk of transmission of the infection is unacceptable, for example in vulnerable groups. “In such circumstances, as in patients who have had symptoms for an extended period of time, the laboratory testing approach may still be helpful,” wrote the World Health Organization. Therefore, he said, he encouraged countries to screen patients whenever they had the capacity to do so.
How to “get rid of isolation” in Bulgaria
The WHO recommendations from January, when the first cluster of SARS cases were reported in the Chinese province of Wuhan, continued to apply in Bulgaria until today. Initial instructions for “clearing” the virus, and thus “releasing it from isolation,” included keeping the patient clinically healthy (ie, no visible signs of disease) and performing two negative PCR tests within at least 24 hours. hours between each other. “This recommendation was based on our knowledge and experience with similar coronaviruses, including those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS),” the WHO publication said. (About the diversity of coronavirus, here).
The difference between the most current WHO recommendations and the ongoing practice in Bulgaria is that in the country the quarantine start day is considered to be the one on which the positive PCR test was taken, not the one on which they appeared the first symptoms. They may be different if the person did not take the test on the day they were unhealthy, as was the case with “Dnevnik” reader Petar Stoychev.
So far two negative CRP tests taken on “two consecutive days” have been required for discharge from hospital. Today, the Minister of Health, Kostadin Angelov, explained that from now on the decision of whether and how many tests to carry out will depend on the treating doctor.
With home isolation, the reduction in quarantine will be significant: it will disappear on day 14 if there are no symptoms. The director of the Sofia Regional Health Inspectorate (SRHI), member of the coronavirus headquarters Dancho Penchev, pointed out that the approach will not be universal for all patients, but has a protocol of “not a few pages” and for example pointed out with COVID-19 in the family, and if the patient has comorbidities.
“We are not saying imperatively that absolutely everyone who leaves on the fourteenth day will not be tested. We say that the majority will not be tested: those who do not have symptoms, those who do not have concomitant diseases, those who are not at risk. groups, “said Dancho Penchev.
Until now, the mandatory period of 14 days had to expire, but also to have a negative PCR test. However, the ordinance on the subject does not specify when a follow-up examination is carried out, in case the result is positive. In other words: it is not specified for how many days the quarantine extends. It only says that “the isolation of the person at home is prolonged until a negative result is obtained.”
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Is another change coming?
A few days ago, Dnevnik’s chief state health inspector and member of the national operational headquarters for coronavirus, associate professor Angel Kunchev, confirmed to Dnevnik that the Bulgarian health authorities were discussing a change in criteria. According to him, the main argument is that there is “much evidence that in the massive case a person is more contagious in the first five or six days, then the contagion decreases and after the tenth it is already an exception.”
Kunchev stressed that so far no more than four countries have reduced the duration of the quarantine, but in the European Union countries adhere to the 14-day quarantine. He said tests to end the quarantine are no longer being conducted in many places, but Bulgaria has yet to take this approach in the name of greater security. Today Angel Kunchev pointed out that there are countries around the world that have reduced mandatory isolation to 10 days, and some even to a week.
