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Chief Medical Officer on New Coronavirus Protocol: Not Only the Hospitalized Tested, Doctors Can Decide on Necessity

Fanni Kaszás 2020.04.06.

Since the epidemic has progressed, it was inevitable to change the medical protocol used to decide, for example, who should be tested for coronavirus. The latest protocol was released on April 1st, and Independent MP Ákos Hadházy, immediately called out authorities on Facebook, saying that according to the new procedure, only the most serious coronavirus patients treated in hospitals are tested. Chief Medical Officer Cecília Müller answered the claims that they “abundantly comply” with the World Health Organization’s (WHO) procedures, as well as their own.

What exactly is the procedure?

Most people (about 80%) recover from the disease without needing special treatment, but older people and those with underlying medical problems like high blood pressure, heart problems, or diabetes are more likely to develop serious illness. When people start noticing symptoms of the coronavirus (milder symptoms like high fever, fatigue, dry cough ,and severe symptoms such as hard of breathing and pneumonia), they should not go to medical facilities, but call their treating physician, who may be a general practitioner, a specialist, or an emergency doctor. The doctor will classify the case as suspicious or probable. 

Do I Have Coronavirus? What Should I Do if I Think I Have It?

According to the newest protocol, patients suspected of having the virus and those under medical inspection are reported to the relevant public health department by telephone immediately after the case has been classified as a suspicious coronavirus case by the treating physician. If the patient is treated in a hospital or any other care facility, the public health department of the county government office must also be notified. All suspected cases are entered into the system by the treating physician on an infectious disease report form. After this, a case of illness is created within 24 hours in the system. Hospital-associated infections, i.e. infections that develop as a result of hospitalization, should also be reported. The epidemic statistics should be updated daily, including the number of suspected and confirmed, symptomatic and asymptomatic healthcare workers and patients, the onset and outcome of the disease, the number of healthcare workers in quarantine, and the beginning and end of quarantine.

Who counts as a suspicious case?

The cases classified by the physicians are divided into three groups. Suspicious cases are those patients who:

  • Suffer from an acute respiratory infection, have had at least one of the symptoms of coronavirus (fever of at least 38 degrees, cough, shortness of breath) AND has been abroad in the last 14 days prior to the onset of symptoms.
  • A patient with an acute respiratory infection AND was in close contact with a confirmed or suspected coronavirus patient in the last 14 days prior to the onset of symptoms (same household, stayed within 2 meters for more than 15 minutes, stayed together in enclosed spaces, in direct physical contact – e.g. handshake, contact without protective equipment, etc.)
  • A patient with a severe acute respiratory infection who has at least one symptom of respiratory disease in addition to fever (cough, shortness of breath, pneumonia) AND the condition justifies hospitalization.

The doctor can decide who is considered a suspicious case based on clinical and epidemiological data, but in special cases, they can declare someone a suspicious case even if it does not meet the above descriptions.

A probable case is one in which the patient shows symptoms or is asymptomatic, but the laboratory test results are doubtful, or on whom the test could not be performed for any reason, or only a rapid test was performed on them. Only those cases count as confirmed, in which the laboratory test showed the coronavirus infection.

All cases that belong in one of the aforementioned groups must be isolated. If, based on a risk analysis performed by the GP over the phone, the suspected patient has only mild symptoms and is not at risk (by age or chronic disease), they can be isolated in their home if possible. If the patient’s condition requires hospital care, belongs to a risk group, or isolation at home cannot be resolved (e.g. the presence of an elderly family member), the National Ambulance Service will transport the patient to a hospital.

Who is tested for coronavirus and how many times?

Under current procedures, laboratory testing must be performed on all suspected cases who are treated in inpatient facilities. If patients are in home quarantine, the test is only performed if there is capacity, so it is not necessarily done. The laboratory tests are prioritized, with patients with severe symptoms in need of hospital care being pushed forward, as are patients in hospital or in other care institutions with acute complaints. This is followed by medical staff with respiratory symptoms, those at risk with mild symptoms, and lastly, other patients with mild symptoms. If the patient tests negative but is still classified as suspicious by the treating physician, another sample may be sent in for examination after 48 hours. Medical staff with suspected coronavirus infection are tested three times: at the start of isolation and on days 7 and 14.

What is the contacts research look like?

If someone is diagnosed with coronavirus or belongs to the probable group, their contacts  – those who have been in contact with the patient during the onset of symptoms (the time of the sampling) and two days before it, are traced. Anyone who has been in close contact with a confirmed coronavirus patient should be placed under a 14-day epidemiological observation (i.e. compulsory home quarantine) to detect any symptoms as soon as possible. If symptoms occur, they are treated as a suspicious case. If the observation ends and the patient is asymptomatic, no laboratory examination is required. However, healthcare workers who have been placed under quarantine but are asymptomatic are also examined three times, just as those with symptoms: at the start of isolation and on days 7 and 14.

Hadházy: They gave up extensive testing

“According to the new procedure signed by Minister Kásler on April 1st, only the most serious coronavirus patients who are treated in hospital will be tested from now on,” said Ákos Hadházy, an independent MP and veterinarian, in a video posted on Facebook.

He wrote that the previous instructions also allowed for the testing of suspected cases with milder symptoms, but the new instructions include only the recommendation issued by the European Center for Disease Prevention. According to this,  those countries where adequate testing is not available, only those must be tested who require hospital treatment. Hadházy added that on the other hand, WHO recommends that countries should test as many patients with mild or asymptomatic symptoms as well, if possible.

According to the MP, the lack of tests and the concealment of detailed data is a dangerous combination, because “we can rock ourselves into the belief that everything is going very well with us, but although the government can draw as flat a curve due to the lack of tests and detailed spatial data as they want, it doesn’t mean that is the reality.”

In the last 24 hours, only 11 new patients were tested positive for coronavirus, which made many people raise eyebrows. In most of the other countries – although some could successfully slow down the spread of the disease with the measures they introduced – the statistics never showed the same results as in Hungary. What is more, Chief Medical Officer Cecília Müller has been warning the public for days that the country is on the brink of mass infection and the epidemic may even “explode” in Budapest and Pest country, where most of the confirmed cases are situated.

Chief Medical Officer: Sampling requirements are met

At today’s daily press briefing of the Operative Board, Chief Medical Officer Cecília Müller answered a question from the press concerning Hadházy’s claim that the new procedure, which was released on April 1st, only specifies the minimum necessary. It only states that the laboratory test is mandatory in cases in which the patient is treated in hospital and is in the most serious state, but tests can be carried out at other times as well. She added that if someone tests positive, their environment is also tested. According to Müller, they “abundantly comply” with the sampling requirements, following WHO protocol and their own specifications.

Featured photo illustration by Zsolt Czeglédi/MTI

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