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The Institute of Public Health on Friday updated the case definitions of Acute Respiratory Syndrome with the new coronavirus and the recommendations to prioritize testing for COVID-19. The notion of “probable case” has been introduced, which refers to people who have come into contact with a confirmed case, those who lose their taste or smell, but also to patients with a lung image suggestive of COVID- 19.
Suspicious case
Anyone with a fever and sudden cough
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OR
Anyone with the sudden onset of ANY 3 OR MORE of the following signs and symptoms: fever, cough, asthenia, headache, myalgia, sore throat, coryza, dyspnea, anorexia / nausea / vomiting, diarrhea, deterioration of mental status .
OR
Anyone with pneumonia, bronchopneumonia +/- pleurisy
OR
Anyone with a severe acute respiratory infection (SALT) (fever or a history of fever and cough and shortness of breath (shortness of breath) and requiring overnight hospitalization)
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Note:
In children up to 16 years of age with gastrointestinal manifestations (vomiting, diarrhea) not associated with food, a SARS-CoV-2 infection may be suspected.
Probable case
A. A patient who meets the above clinical criteria and is in contact with a confirmed case or has an epidemiological link to an outbreak with at least one confirmed case.
B. Suspicious case with pulmonary image suggestive of COVID-19:
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• Lung X-ray: opacities unclear, often round, with less peripheral distribution;
• Lung CT: multiple bilateral crushed-glass opacities, often round, with less peripheral distribution;
• lung ultrasound: thickened pleural lines, B lines (multifocal, discrete or confluent), consolidation patterns with or without bronchograms;
C. A person with a recent onset of anosmia (loss of smell) or ageuzia (loss of taste) in the absence of an identified cause
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D. An adult who died without an unexplained cause of respiratory failure prior to death AND who was in contact with a confirmed case or who had an epidemiological link to an outbreak with at least one confirmed case.
Confirmed case
A person with laboratory confirmation of SARS-CoV-2 infection, regardless of clinical signs and symptoms.
Direct contact is defined as:
– Person who lives in the same home as a COVID-19 patient;
– Person who has had direct physical contact with a COVID-19 case (for example, handshake without subsequent hand hygiene);
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– Person who has had direct unprotected contact with infectious secretions from a COVID-19 case (for example, by coughing, touching handkerchiefs with unprotected gloves);
– Person who has had face-to-face contact with a COVID-19 case at a distance of less than 2 m and with a duration of at least 15 minutes;
– Person who was in the same room (for example, classroom, meeting room, hospital waiting room) with a COVID-19 case, for at least 15 minutes and at a distance of less than 2 m;
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– Medical personnel or other person providing direct care to a patient with COVID-19 or laboratory personnel handling samples collected from a patient with COVID-19 without the proper use of protective equipment.
The epidemiological link may have occurred in the 14-day period prior to the start date.
Anyone who has worn appropriate protective equipment / masks and has observed physical distance IS NOT CONSIDERED DIRECT CONTACT.
Definitions of COVID-19 or IAAM community
A case of COVID-19 can be of community origin or associated with health care (IAAM), depending on:
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– the number of days before the date of start or confirmation in the laboratory, after the date of admission to a health unit (hospital, dialysis center), residential center for long-term stay (day 1);
– The arguments of the epidemiological investigation on the community origin or IAAM (pertaining to the case of outbreaks of infections with one or the other of the origins)
The following situations may occur:
Community case COVID-19
– symptoms present at admission or at onset in the first 48 hours after admission;
– onset on days 3 to 7 after hospitalization and a strong suspicion of community transmission (pertaining to a community case outbreak);
COVID-19 Healthcare Associated (IAAM) case
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– onset after 48 hours of hospitalization and a strong suspicion of transmission associated with medical care;
– cases of medical and auxiliary personnel, if there are no strong arguments in favor of community transmission;
Cases with onset in the first 14 days after discharge from a health unit can be:
– IAAM, if the onset occurs in the first 48 hours after discharge;
– of uncertain origin, in the case of onset 3-14 days after discharge, if there are no solid arguments in favor of a community origin or IAAM Assignment of one category of transmission or another should be done after careful evaluation of each case .
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Patient death confirmed with COVID-19
Death from COVID-19 is defined as the death of a patient confirmed with COVID-19, unless there is another clear cause of death that cannot be related to COVID-19 (eg, trauma, major acute bleeding, etc. .) and in which there was not a complete recovery period between illness and death.
Death in a confirmed COVID-19 patient cannot be attributed to a pre-existing disease (e.g. cancer, hematological conditions, etc.) and COVID-19 must be reported as the cause of death, regardless of pre-existing medical conditions suspected to have favored the severe evolution of COVID-19.
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COVID-19 must be mentioned on the death certificate as the cause of death for all deceased individuals whom COVID-19 caused or allegedly caused or contributed to death.
Criteria for initiating the SARS-CoV-2 test
Prompt confirmation of the suspected case is necessary to ensure, quickly and efficiently, the epidemiological surveillance of contacts, the implementation of infection prevention and control measures, as well as the collection of relevant epidemiological and clinical information.
Testing Prioritization Recommendations for COVID-19:
1. Symptomatic persons, including medical and auxiliary personnel, according to the case definition;
2. Symptomatic close contacts of confirmed cases;
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3. Patients up to 48 hours before the transplant procedure (asymptomatic) and donors of organs, tissues and hematopoietic stem cells before donation; hematopoietic organ, tissue and stem cell transplant patients undergoing immunosuppressive therapy, before each hospitalization during the post-transplant follow-up period: 2 tests at 24-hour intervals;
4. Medical teams for organ transplants that are transferred from the transplant center to the sampling centers, every 2 weeks;
5. Asymptomatic patients with immunosuppression in the context of disease or drug-induced, no later than 48 hours before hospitalization;
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6. Asymptomatic cancer patients undergoing chemotherapy and / or radiotherapy:
– Patients with asymptomatic cancer undergoing chemotherapy, with a maximum of 48 hours before each treatment, respectively each presentation in the hospital for follow-up;
– Asymptomatic cancer patients undergoing radiotherapy – before the first session and then after 14 days, until the end of treatment;
7. Asymptomatic cancer patients before surgical interventions or invasive maneuvers, with a maximum of 48 hours before the intervention / operation;
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8. Asymptomatic hemodialysis patients: twice a month;
– Asymptomatic hemodialysis patients in contact with a confirmed case, 2 tests with an interval of 6-7 days between them; During this period they will be dialysed in separate sessions from the rest of the patients;
9. Symptomatic hemodialysis patients;
10. Asymptomatic institutionalized people – 2 times a month;
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11. Attention personnel in residential centers: twice a month;
12. Asymptomatic pregnant women who are in home quarantine / isolation or who have been in direct contact with a confirmed case, on day 14, if they have not presented symptoms;
13. Direct contact of asymptomatic medical and medical personnel with a confirmed case, within 6-7 days after the last possible infectious contact.
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