Embedded Files
Page 17
the strategy for testing should be in accordance with the ECDC case identification [85]. In addition, all patients with SARI requiring hospitalisation should be considered as suspected cases on admission and tested. As long as influenza is still circulating in the population, hospitalised patients with SARI should also be tested for influenza to initiate early antiviral treatment and separate them from other patients. Once local transmission has been reported in the country or area (scenarios 2-4), as is the situation for most EU/EEA countries already or very soon, all patients presenting with symptoms of acute respiratory infection in primary care or the accident and emergency department of a hospital (first contact with the healthcare system) should be considered as suspected cases (considering also local influenza epidemiology). This may imply that a very large number of tests would need to be performed overwhelming testing capacity and priority groups will need to be established. As a rational approach, the following should be considered for priority testing (in decreasing order of importance): 1. Testing of hospitalised patients with SARI in order to inform appropriate clinical management, including isolation and PPE measures; 2. Testing any cases of acute respiratory infection in hospitals or long-term care facilities (LTCF) in order to guide infection control and PPE use to protect both vulnerable persons and healthcare staff; testing of symptomatic healthcare staff to guide decisions on exclusion from and return to work; the aim is to protect health and social care services; 3. Testing of patients with ARI/ILI in sentinel outpatient clinics and among patients admitted to hospitals with SARI in order to assess virus circulation in the population. 4. Elderly people with underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, and immunocompromising conditions exhibiting signs of acute respiratory illness should be prioritised for testing, given that they may more rapidly need respiratory support. Healthcare workers should apply strict IPC measures when dealing with suspected cases (see below). During triage, suspected cases should be given a surgical mask and be directed to a separate area. Organising separate triaging areas or facilities in order to minimise contact between suspect cases and other patient groups should be considered. Such cohorting will also decrease the needs for PPE for staff. In South Korea and some EU/EEA countries, drive-in facilities for testing have been established. Surveillance Surveillance for COVID-19 is currently based on the EU case definition for probable and confirmed cases, which was updated on 02 March 2020 [86] and is in line with the updated case definition of the World Health Organization from 27 February 2020 for the global surveillance for human infection with COVID-19 [85]. The definition for a suspected case includes: people with ARI coming from an area with local transmission or contact with a confirmed case, as well as all SARI cases with no other aetiology irrespective of travel history or contact with a confirmed case. The inclusion of hospitalised (including specifically ICU-admitted) patients with SARI irrespective of travel history or residence in areas with localised (or more widespread) transmission in the EU/EEA in the case definition is essential at this stage of the epidemic and fully supported by ECDC. Cases that fit the probable or confirmed criteria of the case definition should be reported through TESSy. Variables collected are based on the WHO case reporting form [87,88]. Data have been collected since January 2020. ECDC also intends to start collecting data on the total number of tests performed for COVID-19 overall and the number of positive tests, in sentinel outpatient settings and among hospitalised patients with SARI. Considering that countries are rapidly progressing in their epidemics to scenarios 2-4, the current surveillance objectives include: · monitor the intensity and geographical spread of COVID-19 in the population; · detect nosocomial outbreaks; · identify and monitor changes in risk groups; · measure the impact on population and the healthcare system and to measure the impact of any mitigation measures. These objectives can be addressed through different surveillance methods depending on the stage of the epidemic, existence of surveillance systems which can be repurposed for COVID-19 surveillance, and the availability of resources. Surveillance of confirmed cases: although case finding based on the surveillance case definition might still be of benefit in areas with ongoing community transmission, limited resources for testing might mean that this cannot be comprehensive. Such surveillance is therefore unlikely to give a full picture of the epidemiology of COVID-19. Despite this, the data can be useful to assess risk groups and inform control measures. Surveillance systems should be able to capture information on affected healthcare workers. Surveillance of confirmed cases and national and international reporting of these data should therefore continue as long as possible. At this stage, it is likely that detailed reporting is not feasible and a reduced dataset should be used for case-based reporting at national level and in TESSy. Countries might also decide to
Report abuse