Case Definition issues - Revision history

79.129.118.174: /* National COVID-19 Case Definitions and/or Criteria for Testing */

2020-03-26T15:03:14Z

‎National COVID-19 Case Definitions and/or Criteria for Testing

79.129.118.174: /* Observations */

2020-03-25T19:30:42Z

‎Observations

Charlie: /* Analysis and interpretation */

2020-03-18T08:44:37Z

‎Analysis and interpretation

Charlie: /* Observations */

2020-03-18T08:43:33Z

‎Observations

Charlie: /* Analysis and interpretation */

2020-03-18T08:42:19Z

‎Analysis and interpretation

Charlie: /* Consequences for and considerations about action */

2020-03-18T08:37:47Z

‎Consequences for and considerations about action

Charlie: /* Implementing case definition changes (2 March) */

2020-03-17T08:12:09Z

‎Implementing case definition changes (2 March)

Charlie: /* Implementing case definition changes */

2020-03-17T08:11:47Z

‎Implementing case definition changes

Charlie: /* National COVID-19 Case Definitions */

2020-03-17T08:10:07Z

‎National COVID-19 Case Definitions

Charlie: /* National COVID-19 Case Definitions */

2020-03-17T08:04:04Z

‎National COVID-19 Case Definitions

← Older revision		Revision as of 15:03, 26 March 2020
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	[https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/information-till-varden/ Sweden] See "Falldefinitioner vid anmälan enligt smittskyddslagen av infektion med covid-19"		[https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/information-till-varden/ Sweden] See "Falldefinitioner vid anmälan enligt smittskyddslagen av infektion med covid-19"

		+	[https://eody.gov.gr/neos-koronoios-covid-19-kritiria-gia-ergastiriako-elegcho/ Greece] See "Λοίμωξη από νέος κορωνοϊό Covid-19 – Κριτήρια για εργαστηριακό έλεγχο"
	==Observations==		==Observations==

@@ Line 54: / Line 54: @@
 * The new approach created anxiety. Experts were surprised that WHO did not distinguish between countries with "local transmission". De facto, the majority of returning travelers now came from Corona-Risk areas, regardless of the extent of transmission.
 * The new approach had a significant impact on testing demand, generating discussions on how to deal with that. In addition, it impacted on case identification among the hospitalized SARI cases, which might have received less attention due to focus on the widely extended travel criteria. Much time was spent (and lost?) on discussing priorities for testing.
 ==Analysis and interpretation==

@@ Line 58: / Line 58: @@
 * This led to some countries still having no updated policy several days or even two weeks after the new case definitions were published, and as a consequence, most of the medical staff was still focussing on suspected cases coming from high-risk areas with obvious, widespread community transmission of SARS-CoV-2 (such as Italy, China, Iran, South-Korea) or on suspected cases having had contact with a confirmed case only. As a consequence, many new COVID-19 cases could have remained undetected and unreported.
 * Some experts strongly disagree with WHO/ECDC about the need to exclude other etiology first. The recommendation is probably aimed to decrease the need for COVID-19 testing, but the fact that this leads to a significant delay in the COVID-19 diagnosis (and thus increased exposure of healthcare workers to undetected COVID-19) some experts find hard to accept.
-* The above analysis reflects the situation that has arisen shortly after 2 March. Circumstances and case numbers have rapidly changed since then in many countries, furthermore extremely strict travel restrictions have been implemented by many governments rendering the travel criteria less and less relevant.
+* The above analysis reflects the situation that had arisen shortly after 2 March. Circumstances and case numbers have rapidly changed since then in many countries, furthermore extremely strict travel restrictions have been implemented by many governments rendering the travel criteria less and less relevant.
 ==Consequences for and considerations about action==

@@ Line 53: / Line 53: @@
 * Countries were not aware that this new WHO/ECDC  approach was coming out on March 2.
 * The new approach created anxiety. Experts were surprised that WHO did not distinguish between countries with "local transmission". De facto, the majority of returning travelers now came from Corona-Risk areas, regardless of the extent of transmission.
-* The new approach had a significant impact on testing demand, generating discussions on how to deal with that. In addition, it impacted on case identification among the hospitalized SARI cases. Much time was spent (and lost?) on discussing priorities for testing.
+* The new approach had a significant impact on testing demand, generating discussions on how to deal with that. In addition, it impacted on case identification among the hospitalized SARI cases, which might have received less attention due to focus on the widely extended travel criteria. Much time was spent (and lost?) on discussing priorities for testing.
 ==Analysis and interpretation==

@@ Line 56: / Line 56: @@
 ==Analysis and interpretation==
-* This led to some countries still having no updated policy several days or even two weeks after the new case definitions were published, and as a consequence, most of the medical staff was still focussing on suspected cases coming from high-risk areas with obvious, widespread community transmission of SARS-CoV-2 (such as Italy, China, Iran, South-Korea) or on suspected cases having had contact with a confirmed case only; as a consequence, many new COVID-19 cases could have remained undetected and unreported.
+* This led to some countries still having no updated policy several days or even two weeks after the new case definitions were published, and as a consequence, most of the medical staff was still focussing on suspected cases coming from high-risk areas with obvious, widespread community transmission of SARS-CoV-2 (such as Italy, China, Iran, South-Korea) or on suspected cases having had contact with a confirmed case only. As a consequence, many new COVID-19 cases could have remained undetected and unreported.
 * Some experts strongly disagree with WHO/ECDC about the need to exclude other etiology first. The recommendation is probably aimed to decrease the need for COVID-19 testing, but the fact that this leads to a significant delay in the COVID-19 diagnosis (and thus increased exposure of healthcare workers to undetected COVID-19) some experts find hard to accept.
 * The above analysis reflects the situation that has arisen shortly after 2 March. Circumstances and case numbers have rapidly changed since then in many countries, furthermore extremely strict travel restrictions have been implemented by many governments rendering the travel criteria less and less relevant.

@@ Line 61: / Line 61: @@
 ==Consequences for and considerations about action==
-* Countries should be prepared to rapidly shift gear when international case guidelines change. During pandemics, it is unrealistic to expect that coordinating organizations such as WHO and ECDC can predict when they will change guidelines, so one cannot expect timetables for this. However, since both WHO and ECDC have formally nominated contact points in national public health bodies, it is still sensible and possible to inform countries at least one or two days in advance about major changes planned. Note that the WHO case defition was created on 27 February and published on 2 March only.
+* Countries should be prepared to rapidly shift gear when international case guidelines change. During pandemics, it is unrealistic to expect that coordinating organizations such as WHO and ECDC can predict when they will change guidelines, so one cannot expect timetables for this. However, since both WHO and ECDC have formally nominated contact points in national public health bodies, it is still sensible and possible to inform countries at least one or two days in advance about major changes planned. Note that the WHO case definition was created on 27 February and published on 2 March only.
 * Communication channels from national public health bodies to health care professionals should ideally allow for such rapid changes, and a platform of rapid exchange of information and advice would be beneficial. However, it is unrealistic to expect that national laboratory capacity, health care staff (primary, secondary, tertiary) and public health authorities have the chance to follow and implement changes immediately.
 * Health care providers on their term should be prepared to receive rapidly changing guidelines during international infectious disease crises. What is considered a constant among all large pandemics, is that gaps in knowledge are rapidly filled; therefore new insights have to be translated to an improvement of prevention and control in a timely and efficient way. However, when health care providers are increasingly overwhelmed with the management of new suspected and confirmed COVID-19 cases, the focus may inevitably shift to imminent treatment efforts.

@@ Line 47: / Line 47: @@
 (2) Given that the spread of SARS-CoV-2 has resulted in a massive public health emergency worldwide, it is not self-explanatory why physicians are recommended to exclude other causes/pathogens first, according to WHO and ECDC (see "with no other aetiology that fully explains the clinical presentation" clause in the case definitions).
-=Implementing case definition changes (2 March)=
+=Implementing case definition changes (2 March 2020)=
 ==Observations==
 WHO (and ECDC) published their new recommendation on COVID case definition on March 2: this contained a significant shift from the previous approach.

@@ Line 66: / Line 66: @@
 * One of the possible ways for countries to prepare for this is to have regular simulation exercises that take these issues into account. It is particularly important for countries to design their own national simulation exercises as health care systems (including infrastructure, staffing, organisation of laboratory services and other relevant factors), health care seeking behaviour, and cultural determinants differ significantly.
-=National COVID-19 Case Definitions=
+=National COVID-19 Case Definitions and/or Criteria for Testing=
 [https://www.health.nsw.gov.au/Infectious/diseases/Pages/2019-ncov-case-definition.aspx Australia]
@@ Line 81: / Line 81: @@
 [https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection United Kingdom]
 [https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/information-till-varden/ Sweden] See "Falldefinitioner vid anmälan enligt smittskyddslagen av infektion med covid-19"

← Older revision		Revision as of 08:04, 17 March 2020
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	[https://www.health.nsw.gov.au/Infectious/diseases/Pages/2019-ncov-case-definition.aspx Australia]		[https://www.health.nsw.gov.au/Infectious/diseases/Pages/2019-ncov-case-definition.aspx Australia]
		+
		+	[https://thl.fi/fi/web/infektiotaudit-ja-rokotukset/taudit-ja-torjunta/taudit-ja-taudinaiheuttajat-a-o/koronavirus-covid-19/toimenpideohje-epailtaessa-koronaviruksen-covid-19-aiheuttamaa-infektiota Finland]

	[https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/articles/infection-au-nouveau-coronavirus-sars-cov-2-covid-19-france-et-monde France]		[https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/articles/infection-au-nouveau-coronavirus-sars-cov-2-covid-19-france-et-monde France]