Case definitions for Covid-19, updated by INSP. What changes have been made

Thus, among the symptoms for a person to be considered a suspicious case were introduced loss of smell or taste, makes up News.ro.

Among the 14 categories of people for whom testing is recommended to prioritize are patients who test positive for SARS-CoV-2 antigen.

Who is a suspected case of Covid-19

– Anyone with a fever and sudden cough

– Anyone with a 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, impaired condition mental, recent onset of anosmia (loss of smell) or ageuzie (loss of taste) in the absence of an identified cause

– Anyone with pneumonia, bronchopneumonia +/- pleurisy

– Anyone with a severe acute respiratory infection (SARI) (fever or history of fever AND cough AND shortness of breath (difficulty breathing) AND requiring overnight hospitalization)

Note: For 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.

Note: In accordance with the COVID-19 Testing Prioritization Recommendations, all symptomatic direct contacts of confirmed cases should be analyzed. Sorting in probable case for variant A. will be done only in case the test strategy changes.

B. Suspicious case with pulmonary image suggestive of COVID-19:

• Lung X-ray: unclear opacity, often round, with less peripheral distribution;

• Pulmonary 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. 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 by RT-PCR of SARS-CoV-2 infection, regardless of clinical signs and symptoms.

Direct contact Is defined as:

– Person living in the same household as a COVID-19 patient;

– Person who has had direct physical contact with a COVID-19 case (for example, handshake without subsequent hand hygiene);

– 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;

– 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 before the start date.

Anyone who has worn a suitable protective mask / equipment and 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:

– the number of days before the start date or confirmation in the laboratory, after the date of admission to a health unit (hospital, dialysis center), extended residential center (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)

There may be the following situations:

Community case COVID-19

– symptoms present at the time of hospitalization or at onset in the first 48 hours after hospitalization;

– 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

– 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. The assignment of one transmission category or another should be made after careful evaluation of each case.

Death of patient 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 no complete recovery period between illness and time of death.

Death in a confirmed COVID-19 patient cannot be attributed to a pre-existing disease (eg, Cancer, hematologic 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.

COVID-19 must be listed on the death certificate as the cause of death for all deceased individuals whom COVID-19 caused or allegedly caused or contributed to death.

We also mention that, according to the Order of the Ministry of Health No. 961/2020 to amend and complement the Order of the Ministry of Health no. patients tested positive for the SARS-CoV-2 virus in Phase I and Phase II and the List of Support Hospitals for patients with tests positive or suspected of detecting the SARS-CoV-2 virus, confirmed cases of COVID that resulted in death in which the RT-PCR tests in sputum / bronchial aspirate dynamics are negative (2 tests), death from SARS-CoV-2 infection can be considered if the clinician shows highly suggestive signs and symptoms and the death is correlated with the clinical course determined by COVID. in which it is necessary to clarify the cause of death, RT-PCR examinations of lung tissue collected by the pathological / forensic anatomy specialist without necropsy required “, shows INSP.

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.

Recommendations for Prioritizing RT-PCR Testing for COVID-19

1. Symptomatic persons, including medical and auxiliary personnel, according to the case definition;

2. People with a positive result in the SARS-CoV-2 antigen test;

3. Direct symptomatic contacts of confirmed cases;

4. Patients up to 48 hours before the transplant procedure (asymptomatic) and donors of hematopoietic organs, tissues and 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;

5. Transplant organ transplant medical teams that move from the transplant center to the sampling centers – every 2 weeks;

6. Asymptomatic patients with immunosuppression in the context of disease or drug-induced, with a maximum of 48 hours before hospitalization; In this context, the term immunosuppression refers to: cytotoxic chemotherapy, long-acting biological agents, cellular immunotherapy and high doses of glucocorticoids, according to the guide of the American Society for Infectious Diseases (6.05.2020), which is accessed in https: //www.idsociety .org / practice-guideline / covid-19 guideline-diagnostics /

7. 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 at the hospital for follow-up;

– Patients with asymptomatic cancer undergoing radiotherapy – before the first session and then after 14 days, until the end of treatment;

8. Asymptomatic cancer patients before surgical interventions or invasive maneuvers, with a maximum of 48 hours before the intervention / operation; Note: With reference to points 6., 7. and 8., in the case of pediatric patients who are hospitalized with a companion, the companion test is also performed.

9. 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;

10. Symptomatic hemodialysis patients;

11. Asymptomatic institutionalized people: twice a month;

12. Care staff in residential centers: weekly;

13. 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;

14. Direct contact with asymptomatic medical-health and auxiliary personnel with a confirmed case, 6-7 days after the last possible infectious contact **; ** In the period immediately after the possible infectious contact and until the reception of the laboratory result, the medical-health and auxiliary personnel will carry out their activity in compliance with the standard protection measures.