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People with symptoms such as a cough, fever, or shortness of breath and who have had direct contact with a confirmed case of COVID-19 within the 14 days prior to the onset date are considered suspected of COVID-19 and undergo mandatory testing , and those with radiological evidence of lesions compatible with COVID-19 or nucleic acid or SARS-CoV-2 antigen is detected in a biological sample are considered confirmed cases. The case definitions were updated today by the National Institute of Public Health.
Clinical criteria:
Anyone with at least one of the following signs and symptoms:
- Cough
- Fever
- Difficulty breathing
- Sudden onset of anosmia, ageuzia, or dysgeusia
- Less specific symptoms and additional signs may include headache, chills, myalgia, asthenia, vomiting, and / or diarrhea.
Diagnostic imaging criteria:
- Radiological evidence of lesions consistent with COVID-19
Laboratory criteria:
- Detection of SARS-CoV-2 nucleic acid or antigen in a biological sample. Rapid antigen testing must be performed no later than 5 days after the start date or no later than 7 days after the exposure date. If the date of exposure is unknown, the rapid antigen test should be performed as soon as possible.
Epidemiological criteria:
- direct contact with a confirmed COVID-19 case within 14 days prior to the start date;
- resident or staff of an institution for the care of vulnerable people during the period of 14 days before the start date, institution in which the transmission of SARS-CoV-2 has been confirmed.
Classification of cases:
- A. Possible case – Anyone who meets the clinical criteria
- B. Probable case – Anyone who meets the clinical criteria and is epidemiologically related to a confirmed case OR anyone who meets the diagnostic imaging criteria.
- C. Confirmed case – Anyone who meets the laboratory’s criteria.
The SARS-CoV-2 test is mandatory for all possible cases.
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);
- Person who has had direct unprotected contact with infectious secretions from a COVID-19 case (for example, 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 a duration of at least 15 minutes;
- Person who was in the same room (e.g. 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;
- A medical staff member or other person providing direct care to a COVID-19 patient or a laboratory staff member handling samples taken from a COVID-19 patient 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 a suitable protective mask / gear and observed physical distance IS NOT CONSIDERED DIRECT CONTACT.
SARS-CoV-2 Source: Healthcare Associated Versus Community-transmitted
Classification of COVID-19 cases as healthcare-associated infections must take into account the currently known incubation periods (Lauer SA et al. Ann Intern Med. 2020; 172: 577-582. Two: 10.7326 / M20- 0504), respectively the number of days until the onset of symptoms, or until the positive laboratory test (regardless of which is the first), after admission to a health unit (day 1), source evaluation, prevalence of COVID-19 in the institution / department, contact with known cases in the community or medical unit, as well as any other data that plausibly indicates the origin of the infection.
In this sense, we can have the following situations:
Hospitalized COVID-19 case, with community source:
- Symptoms present at admission or beginning on day 1 or 2 after admission;
- The appearance of symptoms in days 3-7 and a strong suspicion of transmission in the community.
Hospitalized COVID-19 case, of undetermined origin:
- Onset of symptoms on day 3-7 after admission, without sufficient information about the origin of the virus to assign it to another category
Hospitalized case of COVID-19, with probable origin in the hospital:
- Onset of symptoms between day 8 and 14 after admission
- Onset of symptoms on day 3-7 and a strong suspicion of virus transmission through medical care
COVID-19 hospitalized case, with hospital source:
- Onset of symptoms on day ≥14 after admission
There is also the situation in which characteristic symptoms of COVID-19 appear that begin within 14 days of discharge from a health facility (for example, readmission), in which case the source of the virus may be community or undetermined. In this situation, the final evaluation must take into account the particularities of the case.
Note:
These definitions cannot be applied in the case of COVID-19 to medical personnel.
The classification of the source of the virus among health professionals recognizes the same categories, but should be based on an individual assessment of each case on the probability of exposure to COVID-19 cases in the medical care provided in the health unit or in the community, respectively.
Death of patient confirmed with COVID-19
Death from COVID-19 is defined as the death of a confirmed COVID-19 patient, unless there is another clear cause of death that cannot be related to COVID-19 (eg, Trauma, Acute Major Bleeding, Heart attack acute myocardial stroke, acute stroke, sepsis, etc.) and in which there was no complete recovery period between the disease and the time of death.
Death in a confirmed COVID-19 patient cannot be attributed to a pre-existing disease (eg, cancer, hematological conditions, etc.) and COVID-19 must be reported as the cause of death, regardless of pre-existing medical conditions. suspected that they 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.
In addition, in accordance with the Order of the Ministry of Health No. 961/2020 for the modification and completion of the Order of the Ministry of Health No.. 555/2020 on the approval of the Plan of measures for the preparation of hospitals in the context of the coronavirus epidemic COVID-19, from the List of hospitals that provide medical care to patients who tested positive for the SARS-CoV-2 virus in phase I and phase II and the List with support hospitals for patients who have tested positive or are suspected of having the SARS-CoV-2 virus, confirmed cases of COVID that resulted in death in which RT-PCR tests in Sputum / bronchial aspirate dynamics are negative (2 tests) may be considered death from infection with SARS-CoV-2 if the doctor shows highly suggestive signs and symptoms and death is correlated with the clinical course of COVID-19.
If the cause of death needs to be clarified, RT-PCR examinations of lung tissue collected by the pathology / forensic specialist without necropsy are indicated.
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, and the collection of relevant epidemiological and clinical information.
- 1.Symptomatic people, including medical and auxiliary personnel., depending on the case definition – RT-PCR or rapid antigenic test.
- 2. Symptomatic individuals with a negative SARS-CoV-2 antigen test result, carried out in healthcare units – RT-PCR test
- 3. Direct contacts of confirmed cases – RT-PCR test for symptomatic contacts and rapid antigenic test in community outbreaks (residential centers, chronic psychiatric wards, prisons) confirmed by RT-PCR, to facilitate the early detection of other cases, as part of surveillance and investigation of contacts outbreak.
- 4. Patients no later than 48 hours before the transplant procedure (asymptomatic) and hematopoietic organ, tissue and stem cell donors before donation; patients with hematopoietic organ, tissue and stem cell transplantation under immunosuppressive treatment, before each hospitalization during the post-transplant follow-up period – RT-PCR test – 2 tests at 24 hour intervals.
- 5. Medical organs for organ harvesting transfer from transplant center to sampling centers – RT-PCR test – every 2 weeks.
- 6. Asymptomatic patients with immunosuppression in the context of disease or drug-induced, with a maximum of 48 hours before hospitalization – RT-PCR test.
- 7. Asymptomatic cancer patients undergoing chemotherapy and / or radiotherapy: Asymptomatic cancer patients undergoing chemotherapy: up to 48 hours before each treatment, respectively each hospital presentation for follow-up; Asymptomatic cancer patients undergoing radiotherapy – before the first session and then at 14 days until the end of treatment – RT-PCR test.
- 8. Patients with asymptomatic cancer before surgery or invasive maneuvers, with a maximum of 48 hours before the intervention / operation – RT-PCR test.
- 9. Companions of pediatric patients in points 6, 7 and 8 – Rapid antigenic sau RT-PCR test.
- 10. 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 – RT-PCR test.
- 11. Asymptomatic institutionalized people, including chronic psychiatric patients with a duration of hospitalization greater than one month, at the time of hospitalization, people in prisons, upon admission to the unit and subsequently with the aforementioned frequency – RT-PCR test 2 times a month or antigenic test fast 4 times a month.
- 12. Residential care staff, chronic psychiatric wards and prison staff – RT-PCR or rapid antigenic test.
- 13. Asymptomatic pregnant women in home quarantine / isolation or were in direct contact with a confirmed case – on day 14, if no symptoms – RT-PCR or rapid antigenic test.
- 14. Direct contact of asymptomatic medical-health auxiliary personnel with confirmed case, from the fifth to the seventh day after the last possible infectious contact: RT-PCR or rapid antigenic test.
