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Under the new procedure in force since Monday, without a positive PCR test, the doctor still cannot detect the coronavirus infection, only his suspicion, but is now obliged to report these suspected cases to the National Center for Public Health within 24 hours. hours, Zsigri told hvg.hu. Szabolcs is a general practitioner, who says that in this way, suspected cases come more quickly to the attention of the authority, which may be important due to the investigation of contacts.
Until now, doctors have only had to report positive cases, suspects were not mandatory, and we spoke with a GP who said that he, for his part, has not reported any suspected cases so far, as it involves a lot of what which he believes is an unnecessary administration, “a million papers. and a questionnaire must be completed.”
We asked the operational staff why this change was necessary, and Mecler Cecília responded on Wednesday that it is not a new phenomenon that infectious diseases are reported, the data of suspected cases “coincide” with the confirmed cases of the laboratories. The National Center for Public Health operates a nationwide infectious disease monitoring system to see where outbreaks develop and how many patients there are in the country. They act based on the data received from the system.
Cecília Müller also said that testing of suspected cases is “desirable”, as it may not be a coronavirus, other pathogens can cause the disease, we are also entering the flu season. The medical director also spoke about ordering contact research only for confirmed infected people and 10 days of epidemiological observation in case of close contacts.
All of this is interesting because the procedure is contradictory, so epidemiological surveillance should also be applied to those who have only been in close contact with a person suspected of being infected. The rule is exactly the following:
The district / district office public health department will search for individuals who have been in contact with the probable / confirmed case during the epidemiological investigation and who have been in close contact for 10 days prior to the onset of symptoms in the patient with COVID-19 confirmed or probable and with the utmost caution. under epidemiological surveillance.
But according to the interpretation described by Müller, all this applies only to confirmed infected people. At a minimum, it is clear that those subject to epidemiological surveillance (whether returning from abroad or asymptomatic in close contact) will be subject to epidemiological surveillance for 10 days and will not be able to escape even two negative PCR tests before that.
With this, they adjusted to the situation, due to the load on the system, there is not much chance of getting rid of the quarantine sooner, because it is feared that the laboratory test results of the two tests will not be completed in such a long time. The rules of procedure, of course, do not state this, but the intention to alleviate the system can be seen in action. Removing the opportunity has been written to reduce the risk of potentially infectious individuals being transported, individuals do not have to pay procedural fees, and designated authority and laboratories are exempt from “the need for multiple intervention.” In addition, it is easier to monitor compliance with epidemiological rules.
In return, no laboratory tests are required at the end of epidemiological surveillance. The situation is different if the patient shows symptoms in the meantime, because then the other procedure becomes suspicious and begins.
But how does everything look in practice?
As Cecília Müller said, any other pathogen can infect, so it is difficult to decide who could be suspected of being a coronavirus. The procedure lists clinical symptoms (cough, fever, dyspnea, sudden loss of smell, lack of taste, or abnormalities), but a patient with other symptoms can be considered suspicious. In your case, the test is justified according to the procedure, but it is mandatory only for those who meet criteria other than symptoms (for example, they have been abroad, have known a confirmed coronavirus, are in a hospital, nursing home or job).
The family doctor, Szabolcs Zsigri, already quoted at the beginning of our article, says that there is much talk in medical circles about what to do with unclear patients, whether to ask for a test or not, whether or not to prescribe them due to illness and, of be so, with what encoding.
It would have been easier to determine when to test and when to ban. There are many symptomatic complainers, we could ask for a test for almost every shift. Also for someone who has had a fever due to a urinary tract infection.
He alone does not ask for a test for a “borderline symptom” like a runny nose, but it is always a matter of individual evaluation, as it can only be guessed if they are facing a mild infection or a coronavirus. There is this intuition of the doctor -for the telephone conversation- deceives. A GP who requested anonymity said there were those whose symptoms required a qualified test, but turned out to be infected, and at other times he thought they were dealing with a certain coronavirus, which the test did not prove. You can only recommend symptomatic therapy to patients with suspected infections – a local disinfectant for sore throats and an antipyretic in case of fever.
Zsigri says it’s also a matter of individual decision whether to keep someone at home with mild symptoms. If, on the contrary, the patient worsens or presents any clinical symptoms, he will request a test. An infected person can come out of quarantine at 14 days if they remain asymptomatic for 3 days, in which case they do not need a negative PCR test, as there is no risk of infection. Employees of health and social institutions are currently an exception to this, they have to take a repeat test before starting work.
Szabolcs Zsigri says that with any infection you can stay home, which is a daily practice, but it is also mandatory if you have a suspected coronavirus infection. However, it is a question of who controls this, as even with confirmed infections the system does not work well.
Called the cop once, didn’t speak to nobody else
One of our readers, who chose the pseudonym Boldizsár, said that he requested a private test last Tuesday after noticing symptoms in himself (4-5 days after cold-like symptoms, his sense of smell and taste disappeared, then realized it was probably coronavirus). He did not want to wait for the state testing procedure, so he learned on Wednesday from a service provider that he was infected with a coronavirus for 32 thousand guilders. He has only spoken to a police officer since last Friday and to no one else. The police officer searched due to contact investigation, asked who he lived with and if he was abroad in two days. Boldizsár works among many people, but the policeman did not ask his co-workers.
Boldizsár, for his part, also tested his family members, which had negative results. They were then also contacted, but were not required to be quarantined. The man says he has not been wanted for the epidemic since then and has not received a red note that he could put on his door. Since then, the police have not asked whether or not to comply with the mandatory quarantine.
I have no idea what is allowed and what is not.
His GP said he was only infected with the virus the moment the symptom appeared, so once the symptoms were gone, he could safely leave the house.
our picture illustration
© AFP / Karl-Josef Hildenbrand
He saw the opposite instruction in a scanned July decision he had received from an acquaintance, also infected with a coronavirus, with whom he had spoken about his situation. There was more to it. The first is that you can leave home 10 days after the first symptoms, and then you must stay home for 10 days after the test result. The two are not related, on the other hand, her acquaintance went to get tested two weeks after the first symptom and tested positive, so she is still in quarantine. According to him, the acquaintance had been tested around 10 o’clock and had just been called from ÁNTSZ to give him a decision.
There is a lot of confusion about who is quarantined and who is not
In addition, there is a lot of contingency with confirmed infections: a doctor in the capital said that different epidemiological units say different things to their patients. In one case, only the confirmed coronavirus was required to be quarantined, her husband was able to move freely, and in another district, her parents (who moved at the time of illness) also had to be quarantined without evidence.
our picture illustration
© MTI / György Varga
The GP said that he could not force anyone to stay home, he could only ask his patients, who were suspected of doing so. It may not even make sense to check if you are actually staying home until the test result comes in. All you can do is admit the patient with a viral infection, but due to the precarious situation, you can also discharge the patient with cold-like symptoms for a week and keep in touch. Other GPs we spoke to are not as permissive, one of them said that you should not allow anyone to receive sick pay based on symptoms reported over the phone.
Szabolcs Zsigri says that in the absence of a positive test, they can be admitted into an incapacitated population, it is not clear to doctors on what basis asymptomatic contacts with sick pay are maintained or in what period and for what reasons they can admit a person certified infected receiving a retrospective decision. According to the GP, after a sharp increase in the number of infected people, he considers it realistic not to allow a confirmed infected person and a person suspected of having a coronavirus near people who are probably not infected, and trusts that all who have come into contact with an infected person are in contact.
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