Decision 3468/QD-BYT “Interim Guidance on Surveillance and Prevention of COVID-19”

Interim Guidance on Surveillance and Prevention of COVID-19
(Attached to the Ministry of Health’s Decision No. 3468/QD-BYT dated August 07, 2020)

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I. GENERAL FEATURES

COVID-19 is a group-A contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).  This disease can be transmitted from person to person, with an incubation period of about 14 days. Infected persons may have variable clinical symptoms such as fever, cough, sore throat, body aches, fatigue, reduction or loss of smell and taste, shortness of breath, possible severe pneumonia, acute respiratory failure, and mortality, especially in people with underlying heath conditions, chronic disease, and the elderly. There is a high percentage of people infected with the SARS-CoV-2 virus, who show no clinical symptoms (about 40%) and the source of transmission may have appeared in the community, making it difficult for monitoring and preventing the pandemic. This disease so far has not had specific drug or vaccine.

The first case was confirmed in Wuhan City, Hubei Province, China on December 03, 2019.  The World Health Organization (WHO) on March 11, 2020, has declared the COVID-19 outbreak a global pandemic. As of August 07, 2020, 19,266,075 cases have been recorded in 215 countries and territories, and 717,787 of which died. Vietnam has recorded 750 confirmed cases in 40 provinces and cities in all 4 regions (the North, Central, South and Central Highlands) with 346 imported cases from many countries and 404 cases of secondary transmission in the country.

This Interim Guidance containing surveillance contents and prevention and control activities according to the pandemic development, which is used as a basis for the provinces, cities, health units and related units to apply, organize the implementation according to the actual situation.

II. GUIDANCE ON SURVEILLANCE

1. Definition of cases and close contacts

1.1. Suspected case (surveillance case)

Means a person who show at least one of the following symptoms: fever; cough; sore throat; shortness of breath; fatigue, body aches, chills; reduction or loss of taste and smell; or pneumonia and have one of the following epidemiological factors:

- He/she has traveled to/been through/stayed in/returned from a country or territory with a confirmed case according to the information of the World Health Organization within 14 days from the date of entry.

- He/she has traveled to/stayed in/returned from an active outbreak in Vietnam within 14 days prior to the onset of illness. The Institute of Hygiene and Epidemiology and Pasteur Institute shall, on a daily basis, synthesize a list of active outbreaks in their respective areas and send it to the General Department of Preventive Medicine to notify localities to exploit epidemiological information.

- He/she has been in close contact with a confirmed case or a suspected case within a period of 14 days prior to the onset.

1.2. Confirmed case

Means the suspected case or any person having a positive test with SARS-CoV-2 virus (detecting genetic material or antigens) that are carried out by testing establishments permitted by the Ministry of Health.

1.3. Close contact

A close contact is a person who has been in contact within 02 meters with a confirmed case or suspected case within a period of 03 days prior to the onset of the confirmed case or suspected case until he/she is quarantined. If he/she is a healthy carrier, the date of onset shall be the date when the specimen is collected and tested positive for SARS-CoV-2. The onset of a case shall be counted as the day when such person's first unusual health symptom appears, which can be one of the following: Fatigue; body aches, chills; reduction or loss of taste or smell; fever; cough; sore throat, etc.

Close contact includes:

a) Person who lives in the same household, house or room.

b) Person who directly cares for, visits a confirmed case, or patient in the same room as a confirmed case.

c) Person who is in the same teamwork or office.

d) Person in the same group who has been in contact with the confirmed case, including group of travel, business, entertainment, party, meeting, the same group of religious activities, the same group of clubs. ..

dd) Person who sits in the same row, in front or behind 02 rows of seats of the same vehicle (train, car, airplane, ship, etc.) In a number of specific case, depending on the epidemiological investigation result, health agencies shall decide to expand the list of close contacts to passengers traveling in the same vehicle.

e) Anyone who has been in close contact with the confirmed case or suspected case in other situations within a period of 03 days prior to the onset of the confirmed case or suspected case until he/she is quarantined.

2. Definition of outbreak

2.1. Outbreak: a place (village, hamlet, neighborhood/residential group/sub-village/unit, etc.) where one or more confirmed cases are recorded.

2.2. Inactive outbreak: when no new confirmed case is recorded within 28 days from the date the last confirmed case was quarantined.

3. Monitoring contents

The pandemic development can be very different in provinces and cities across the country. Some provinces and cities have recorded cases; while some others have not yet recorded any new cases. Depending on the pandemic development in each province or city, the following monitoring contents shall be implemented:

3.1. In case no confirmed case is recorded in the province or city

It is requested to early detect the first suspected case for quarantine, sampling, avoiding the pandemic from spreading in the community. Monitoring contents include the following activities:

- Strictly monitoring at the border gates combined with supervising at medical establishments and the community, with focus on surveillance at the border gate for all passengers entering from countries and territories that have already recorded confirmed cases through body temperature measurement, physical observation and other measures under the guidance of the Ministry of Health.

- Monitoring, organizing epidemiological investigation, taking samples for testing, making lists of suspected cases, confirmed cases and close contacts of confirmed cases according to the Forms No. 1, 2, 3, 4 and 6 provided in Appendix 3.

- Carrying out quarantine, closely monitoring close contacts within 14 days from the last day of contact.

- Implementing surveillance of severe viral pneumonia, severe acute respiratory infection, influenza syndrome, event-based surveillance for early detection of suspected cases in treatment establishments and the community. Such persons’ samples should be taken for testing for SARS-CoV-2.

- Reporting according to Section 3.5 of this Interim Guidance.

3.2. In case a confirmed case is recorded without spreading in the community in the province or city

Immediately detecting suspected cases, newly confirmed cases, close contacts; organizing the quarantine; thoroughly handling an outbreak to minimize the spreading in the community. Monitoring contents include the following activities:

- Continuing to supervise and detect suspected cases at border gates, treatment establishments and in the community according to the guidance of the Ministry of Health.

- Monitoring, organizing epidemiological investigation, taking samples for testing, making lists of suspected cases, confirmed cases and close contacts of confirmed cases and suspected cases according to the Forms No. 1, 2, 3, 4 and 6 provided in Appendix 3.

- Continuing to strengthen the surveillance of severe viral pneumonia, severe acute respiratory infection, influenza syndrome, event-based surveillance for early detection of suspected cases in treatment establishments and the community. Such persons’ samples should be taken for testing for SARS-CoV-2.

- Reporting according to Section 3.5 of this Interim Guidance.

3.3. In case the pandemic spreading in the community

A pandemic is considered community-wide pandemic if a total of more than 50 confirmed cases of secondary transmission are recorded in 02 districts/cities/towns or more in a province/city within 14 days.

It is required to maintain the early detection of new outbreaks in the community, thoroughly handling of new outbreaks, continue controlling the current active outbreaks, prevent the pandemic from developing and spreading in the community. Monitoring contents include the following activities:

- Continuing to supervise and detect suspected cases at border gates, treatment establishments and in the community according to the guidance of the Ministry of Health.

- For districts/cities/towns without confirmed cases: Monitoring, carrying out epidemiological investigation, taking samples for testing, isolating all suspected cases and close contacts of confirmed cases.

- For districts/cities/towns with confirmed cases:

+ Monitoring, carrying out epidemiological investigation, taking samples for testing to confirm at least 5 confirmed cases first detected in the new outbreak. The following cases shall have their samples taken depending on the pandemic development.

+ At identified and active outbreaks, all suspected cases in the outbreaks shall be considered clinical cases and must fully implement quarantine and pandemic prevention and control measures and reporting regimes.

- Carrying out quarantine, closely monitoring and supervising close contacts within 14 days from the last day of contact.

- Continuing to strengthen the surveillance of severe viral pneumonia, severe acute respiratory infection, influenza syndrome, event-based surveillance for early detection of suspected cases in treatment establishments and the community. Such persons’ samples should be taken for testing for SARS-CoV-2.

- Reporting according to Section 3.5 of this Interim Guidance.

3.4. Collection, storage and transport of specimens: Details in Appendix 1.

3.6. Information and report

Synthesizing the reporting data on a daily basis at all level: Information data recorded from 12:00 of the previous day to 12:00 of the following day.

- Centers for Disease Control of provinces and cities shall manage lists of confirmed cases, suspected cases, close contacts, people in contact with close contacts, the number of quarantined people in their respective provinces and cities (including all treatment establishments in areas) and monitor their health status; report aggregate data according to the Form 7 provided in Appendix 3 and report the list of confirmed and suspected cases according to the Form 4 provided in Appendix 3 to the Institute of Hygiene and Epidemiology, Pasteur Institute before 14:00 every day.

- The Institute of Hygiene and Epidemiology and Pasteur Institute shall manage lists of confirmed cases, suspected cases, the number of close contacts and quarantined people in their respective areas and monitor their health status; report aggregate data according to the Form 7 provided in Appendix 3 and report the list of confirmed and suspected cases according to the Form 4 provided in Appendix 3 to the General Department of Preventive Medicine before 15:00 every day. The General Department of Preventive Medicine shall report leaders of the Ministry and the National Steering Committee before 17:00 every day.

- Testing establishments including private and public hospitals, medical examination and treatment establishments must report the testing data and results, the number of samples taken in a day, the number of tests, etc. to Centers for Disease Control of provinces/cities before 13:00 every day. Centers for Disease Control of provinces and cities shall report to the local Institute of Hygiene and Epidemiology and Pasteur Institute before 14:00 every day. Institute of Hygiene and Epidemiology and Pasteur Institute shall synthesize reports on testing results, the number of samples taken a day and the number of tests, etc. according to the Form 8 provided in Appendix 3 and send them to the General Department of Preventive Medicine before 15:00 every day. The General Department of Preventive Medicine shall report leaders of the Ministry and the National Steering Committee before 17:00 every day.

- For samples tested positive for SARS-CoV-2 virus made by testing establishments permitted by the Ministry of Health, the testing unit shall immediately update the case information and test results on the Ministry of Health's automated patient code dispensing system and notify the results to the unit sending the test samples, and at the same time report to the provincial Department of Health, General Department of Preventive Medicine, Institute of Hygiene and Epidemiology, Pasteur Institute under the management.

- For samples tested negative for SARS-CoV-2 virus, the testing unit shall notify results to the unit sending test samples.

- Implementing the regime of information and reporting applicable to group-A contagious disease under the Ministry of Health's Circular No. 54/2015/TT-BYT dated December 28, 2015, guiding the regime of declaration, information and reporting of contagious diseases.

III. PREVENTIVE MEASSURES

1. Non-specific preventive measures

To proactively implement the following preventive measures:

- Avoiding traveling to pandemic areas. Avoiding visit crowded places. In case of visiting crowded places, it is necessary to take personal protective measures such as wearing masks, performing hand hygiene, keeping safe distance, etc.

- Limiting to be in direct contact with people with acute respiratory disease (fever, cough, shortness of breath); in case of contacting, it is required to wear medical masks properly and keep a safe distance of at least 02 meters.

- People with suspected signs must stay at home, wear masks, and immediately notify the nearest medical establishments for timely advice, examination and treatment. Making a phone call to medical establishments prior to arrival to provide information about symptoms and recent travel schedule for the right support; Avoiding going to crowded places. Pupils, students and employees who show any suspected signs must stay at home and immediately notify health agencies.

- Performing personal hygiene, washing hands regularly under running water with soap or common antiseptic solution for at least 20 seconds; rinsing the mouth and throat with mouthwash, avoiding touching eyes, nose and mouth to prevent infection.

- Covering mouth and nose when coughing or sneezing, preferably with a cloth or handkerchief or disposable tissue or sleeve to reduce the spread of respiratory secretions; washing hands with soap and water or an antiseptic solution immediately after coughing or sneezing. Not spitting indiscriminately in public areas.

- Ensuring food safety, only using cooked food.

- Not purchasing or touching wild animal.

- Keeping the body warm, promoting health by eating, resting, reasonable living, practicing sports.

- Improving air ventilation by opening doors and windows, avoiding using air conditioners.

- Regularly cleaning houses, offices, schools, factories, etc. by wiping floors, doorknobs and surfaces of objects in the house with soap and common detergents; other disinfectant chemicals according to the instructions of the health sector.

- Regularly cleaning and disinfecting vehicles, including airplanes, trains, ships and cars, etc.

2. Specific preventive measures

Until now, there is no specific vaccine for this disease.

3. Border health quarantine

- Monitoring people on entry and applying regulations on health declaration according to the Government’s Decree No. 89/ND-CP dated June 25, 2018, detailing the implementation of a number of articles of the Law on Prevention and Control of Infectious Diseases, regarding border health quarantine, directions of the National Steering Committee and the Ministry of Health's instructions.

- The quarantine and medical treatment at border gates shall comply with the Government’s Decree No. 101/2010/ND-CP dated September 30, 2010, detailing the implementation of a number of articles of the Law on Prevention and Control of Infectious Diseases regarding the application of measures for quarantine, involuntary quarantine, typical epidemic prevention, directions of the National Steering Committee and the Ministry of Health's instructions.

4. Medicines, supplies, chemicals and equipment for pandemic prevention and control

Provinces and cities shall actively prepare adequate medicines, supplies, chemicals and equipment for surveillance, testing and pandemic prevention and control works of localities.

IV. ANTI-PANDEMIC MEASSURES

1. Implementing preventive measures as specified in Part III

2. The following addition measures should be taken:

2.1. Quarantine and medical handling

2.1.1. For confirmed cases

- To strictly quarantine them and provide them with the treatment at health establishments, minimizing complications and death.

- To limit the transfer of treatment line for the patients to avoid the transmission except for cases going beyond the treatment capacity.

- To organize the treatment and quarantine according to the guidance of the Ministry of Health.

2.1.2. For people in close contact with confirmed cases (first-round contacts):

- To organize investigations and quick tracing close contacts as soon as information about confirmed cases is received. To make the list of people in close contact with confirmed cases with information about their addresses, places of residence, phone numbers; names and phone numbers of their family members when needed to contact.

- To organize the quarantine of people in close contact with confirmed cases in concentrated quarantine establishments for 14 days from the date of last contact with confirmed cases.  It is best to set up separate concentrated quarantine establishments for people in close contact because such people are at higher risk of contracting the disease than other people in concentrated quarantine. In case there is no separate concentrated quarantine establishment, to arrange separate quarantine subdivisions for people in close contact in the concentrated quarantine establishments. People living in the same household, same house, same room, same office as the confirmed cases should be quarantined separately from other because they are at the highest risk of infection.

- To take specimens for PCR test for SARS-CoV-2 virus at least 2 times during the quarantine.

- To take specimens for the first time right upon the quarantine:

+ If the SARS-CoV-2 PCR test result is positive, to handle as for confirmed cases.

+ If the SARS-CoV-2 PCR test result is negative, to quarantine them and monitor their health (measuring their body temperature, detecting symptoms) on a daily basis in concentrated quarantine establishments for 14 days from the date of last contact with confirmed cases.  During the monitoring process, if they have symptoms of the disease, to continue taking samples for testing for SARS-CoV-2.

- To take specimens for the second time right in the last day of the quarantine duration:

+ If their SARS-CoV-2 PCR test results are positive, to handle as for confirmed cases.

+ If their SARS-CoV-2 PCR test results are negative, to end the quarantine.

2.1.3. For people in contact with close contacts of confirmed cases (second-round contacts)

- To request them to implement the at-home quarantine and give them instructions on self-prevention of the disease and self-monitoring during the waiting time for PCR test results of first-round contacts:

+ If the SARS-CoV-2 PCR test results of the first-round contacts are positive, the level of quarantine applied to the second-round contacts shall be changed to the one applied to first-round contacts.

+ If the SARS-CoV-2 PCR test results of the first-round contacts are negative, the quarantine applied to the second-round contacts shall be terminated.

2.1.4. For suspected cases

To require the patients to wear masks and apply the quarantine and medical treatment measures to them at health establishments in areas separate from the one used for treatment of confirmed patients.

- To take specimens for the first time for SARS-CoV-2 PCR test right when they are hospitalized:

+ If their SARS-CoV-2 PCR test results are positive, to handle as for confirmed cases.

+ If their SARS-CoV-2 PCR test results are negative, to transfer them to quarantine areas, separately providing medical treatment for them, and continue the quarantine of 14 days from the date of last contact with the infection sources.

- To take specimens for the last SARS-CoV-2 PCR test right in the last day of the quarantine duration

+ If their SARS-CoV-2 PCR test results are positive, to handle as for confirmed cases.

+ If their SARS-CoV-2 PCR test results are negative, to end the quarantine.

2.1.5. For people in close contact with suspected cases

- To request them to implement the at-home quarantine and give them instructions on self-prevention of the disease and self-monitoring during the waiting time for test results of suspected cases:

- If the SARS-CoV-2 PCR test results of suspected cases are positive, the level of quarantine applied to them shall be changed to the one applied to first-round contacts.

- If the SARS-CoV-2 PCR test results of suspected cases are negative, the quarantine applied to them shall be terminated.

2.1.6. For persons epidemiologically related to confirmed cases in other situations

For those who do not have close contact with the confirmed cases but are only in the same crowded events or on the same vehicles as confirmed cases, the health agencies shall notify them via telephone, text message, social network or other mass media so that relevant people may know and proactively contact the local health agencies for instructions on health declaration, health monitoring and promptly contact the health agencies in cases of arising suspected COVID-19 symptoms.

2.2. Inspection and propaganda of proactive pandemic prevention and control activities in the community

- To immediately set up groups of "Inspection and propaganda of COVID-19 prevention and control in the community", or "community-based COVID working groups" for short in all residential areas in the pandemic zones and neighboring communes. If there are resources, it is advisable to set up groups in all other locations.

- Each group consists of 2-3 people that should be officials of the residential group, village, street group, unions, and volunteers in the residential area. Each group shall be in charge of between 30 and 50 households with a specific assignment.

- Tasks of groups: “go to every alley, knock on every door, track every person” on a daily basis to:

+ Propagate pandemic prevention and control measures, mobilize and remind people of the implementation in each household: wear the mask; wash hands with soap; keep distance; limit contact, stay at home, do not go out unless absolutely necessary.

+ Ask, monitor, detect and immediately report to local authorities and health agencies suspected cases of COVID-19 in households with symptoms such as fever; cough; sore throat; sick; fatigue; flu symptoms or chest pain - shortness of breath to for quarantine and taking samples for testing in time.

2.3. Infection prevention for health staff

- To thoroughly perform personal protective measures such as wearing specialized medical masks; glasses; gloves, protective costumes, hats; shoe covers, etc. during the contact with patients.

- To immediately wash hands with soap and sanitizer before and after each contact with/examination of patients or when entering/leaving the patient room.

- To limit close contact and minimize the time of contact with patients.

- Making a list of health staff in close contact with patients and monitoring their health on a daily basis are required. For cases with suspected symptoms, to strictly quarantine them, management the treatment and taking specimens for testing according to regulations.

- Health staffs who are pregnant, nursing children aged under 36 months old, have chronic diseases (such as asthma, chronic cardiopulmonary disease, kidney failure, liver failure, heart failure, cancer, diabetes, immunodeficiency, etc.) shall not be arranged to participate in jobs requiring direct contact with confirmed cases, suspected cases of COVID-19.

2.4. For the patients’ households

- To implement disease prevention measures specified in Section 1, Part III.

- To clean, keep the houses well-ventilated, regularly wipe floors, doorknobs and surfaces of objects with common detergent such as soap and other sanitizer.

2.5. For the community, schools, factories, offices

- To implement the same pandemic prevention and control measures as households.

Depending on the specific pandemic situation of each locality, the Provincial Steering Committee for Pandemic Prevention and Control shall decide to implement infection prevention and control measures, including:

- Do not organize crowded events.

- To limit or temporarily suspend high-risk activities at establishments such as cinemas, bars, discos, gaming venues, massage establishments, stages, karaoke, music lounges, crowded gym or sports establishments, religious activities in enclosed spaces, etc.

- To implement other pandemic prevention and control measures.

2.6. Infection prevention in treatment establishments

To strictly implement the classification of patient examination, quarantine and treatment; measures to prevent and control the infection according to the Decision No. 468/QD-BYT dated February 19, 2020 of the Ministry of Health.

2.7. Disinfecting and treating the outbreak environment

- The patients’ houses and surrounding households must be disinfected by cleaning or spraying floors, doorknobs and surfaces of household objects with a disinfectant solution containing 0.05% active chlorine (the contact time on the surface is 10 minutes) or 0.1% active chlorine (the contact time on the surface is 1 minute). Other areas, such as kitchen, restroom, yard, surrounding areas, etc., must be disinfected with disinfectant solution containing 0.01% active chlorine. The surface to be treated must be sufficiently sprayed. The number of sprays shall be depended on the actual pollution status at the outbreak.

- The patients’ gates/doors should be closed to prevent others to come in or out when the patients and their family members are quarantined in medical establishments.

- Vehicles used to transport patients must be disinfected with disinfectant solution containing 0.01% active chlorine.

- The disinfection of related areas by spraying disinfectant solution containing 0.01% active chlorine on surfaces shall be decided by epidemiologists according to actual investigation on a principle that all contaminated, suspected contaminated areas with a risk of spreading to the community must be treated.

Depending on the COVID-19 development, and results of investigation, epidemiological, virological, clinical studies and recommendations of the World Health Organization, the Ministry of Health shall continue to update, adjust this guidance in an appropriate manner./.

* All Appendices are not translated herein.