INSP updated today the case definitions regarding infection with the new Coronavirus, establishing a series of new rules regarding how people who are considered to be possibly infected are analyzed and treated.
"Suspicious case
- anyone with sudden onset of fever and cough or anyone with sudden onset of any 3 or more of the following signs and symptoms: fever, cough, asthenia, headache, myalgia, sore throat, coryza, dyspnoea, anorexia/nausea/vomiting , diarrhea, altered mental status;
- any person with pneumonia, bronchopneumonia +/- pleurisy;
- anyone with severe acute respiratory infection (SARS) – fever or history of fever and cough and difficulty in breathing (shortness of breath) and requiring overnight hospitalization.
- for children up to the age of 16 who present gastrointestinal manifestations (vomiting, diarrhea) not associated with food, infection with SARS-CoV-2 can be suspected, says INSP.
The 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, according to the INSP.
Probable case
- a patient who meets the clinical criteria stated for the suspected case and is a contact of a confirmed case or has an epidemiological link with an outbreak with at least one confirmed case;
- a suspicious case with lung image suggestive of COVID-19: Lung X-ray: unclear, frequently round opacities, with lower peripheral distribution; Pulmonary CT: multiple bilateral opacities with a ground-glass appearance, frequently round, with lower peripheral distribution; lung ultrasound: thickened pleural lines, B lines (multifocal, discrete or confluent), consolidation patterns with or without bronchograms;
- a person with recent onset of anosmia (loss of smell) or ageusia (loss of taste) in the absence of an identified cause;
- an adult who died without an explainable cause, with respiratory failure that preceded death and who was in contact with a confirmed case or who was epidemiologically related 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
- the person who lives in the same household as a patient with COVID-19;
- the person who had direct physical contact with a case of COVID-19 (e.g. shaking hands without subsequent hand hygiene);
- the person who had unprotected direct contact with infectious secretions of a case of COVID-19 (e.g. during coughing, touching handkerchiefs with the hand not protected by a glove);
- the person who had face-to-face contact with a case of COVID-19 at a distance of less than 2 m and with a duration of at least 15 minutes;
- the person who was in the same room (e.g. classroom, meeting room, hospital waiting room) with a case of COVID-19, for at least 15 minutes and at a distance of less than 2 m;
- a health care worker or other person who provides direct care to a patient with COVID-19 or a laboratory worker who handles samples collected from a patient with COVID-19 without wearing the correct protective equipment.
Any person who wore the appropriate mask/protective equipment and respected physical distancing is not considered direct contact.
Types of COVID-19 cases
A case of COVID-19 can be of community origin or healthcare associated (IAAM), depending on:
- the number of days prior to the date of onset or confirmation in the laboratory, after the date of hospitalization in a health facility (hospital, dialysis center), long-stay residential center (day 1);
- the arguments from the epidemiological investigation regarding the community origin or IAAM (belonging of the case to outbreaks of infections with one or another of the origins).
Community COVID-19 case
- symptoms present at admission or onset within the first 48 hours after admission;
- onset on days 3-7 after hospitalization and a strong suspicion of community transmission (belonging to an outbreak of community cases);
Case of COVID-19 associated with medical assistance
- onset after 48 hours of admission and a strong suspicion of transmission associated with medical assistance;
- the cases of medical and sanitary personnel and auxiliary, if there are no strong arguments in favor of a community transmission;
Death of a confirmed patient with COVID-19
- Death with COVID-19 is defined as death occurring in a confirmed patient with COVID-19, unless there is another clear cause of death that cannot be related to COVID-19 (e.g. trauma, major acute hemorrhage , etc) and in which there was no complete recovery period between the illness and the moment of death.
- Death in a patient with confirmed novel coronavirus cannot be attributed to a pre-existing disease (e.g. cancer, hematological disorders, etc.) and COVID-19 must be reported as the cause of death, independent of pre-existing medical conditions suspected to have contributed to the development severe SARS-CoV-2 infection.
- COVID-19 must be listed on the death certificate as the cause of death for all deceased persons in whom COVID-19 caused or is suspected to have caused or contributed to death.
- Also, confirmed cases of COVID resulting in death, in which dynamic RT-PCR tests from sputum/bronchial aspirate are negative (2 tests), can be considered death due to SARS-CoV-2 infection if the clinician shows highly suggestive signs and symptoms and death is correlated with the clinical evolution determined by COVID.
- In the situation where there is a need to clarify the cause of death, RT-PCR examinations from lung tissue collected by the pathological anatomy/legal medicine specialist are indicated without the need for necropsy."
