Decision 3638/QD-BYT “Interim Guidance on Surveillance and Prevention of COVID-19”

DECISION

On promulgating the “Interim Guidance on Surveillance and Prevention of COVID-19”

___________

THE MINISTER OF HEALTH

Pursuant to the Government's Decree No. 75/2017/ND-CP dated June 20, 2017, defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the proposal of Director of the General Department of Preventive Medicine under the Ministry of Health,

DECIDES

Article 1. To issue together with this Decision the “Interim Guidance on Surveillance and Prevention of COVID-19”.

Article 2. The “Interim Guidance on Surveillance and Prevention of COVID-19” shall be used as the technical guidance document applicable to preventive medicine establishments and medical examination and treatment establishments nationwide.

Article 3. This Decision takes effect on the date of its signing; replaces the Ministry of Health's Decision No. 3468/QD-BYT dated August 07, 2020, on promulgating the Interim Guidance on Surveillance and Prevention of COVID-19.

Article 4. Mr./Ms.: The Chief of Ministry Office; the Chief Inspector of Ministry; Directors and Directors General of Departments and Agencies of the Ministry of Health; Directors of Institute of Hygiene and Epidemiology and Pasteur Institute; Directors of hospitals of the Ministry of Health; Directors of Health Departments of provinces and centrally-run cities; heads of medical units of ministries and branches; heads of relevant units shall be responsible for the implementation of this Decision./.

INTERIM GUIDANCE

ON SURVEILLANCE AND PREVENTION OF COVID-19
(Attached to the Ministry of Health’s Decision No. 3638/QD-BYT dated July 30, 2021)

I. GENERAL FEATURES

COVID-19 is a group-A contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This virus often mutates, creating variants with the ability to spread faster. As of July 2021, Vietnam has recorded 07 strains of SARS-CoV-2 virus, including common variants in Europe, Africa, UK and India; and since April 27, 2021, Vietnam has recorded 02 variants, including Delta variant (B.1.617.2, which was first discovered in India) and Alpha variant (B.1.1.7, which was first identified in the UK), in which the Delta variant was assessed as highly contagious and was classified by WHO as a “variant of concern” with a transmission rate of 50% higher than that of the Alpha variant.

This disease can be transmitted from person to person by inhalation, with an incubation period of about 14 days. There is a high percentage of people infected with the SARS-CoV-2 virus, who show no clinical symptoms (about 60%). 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. This disease so far has vaccines but no specific drugs for treatment.

This Interim Guidance is developed and updated through practical activities with monitoring 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 with at least two among the following symptoms: Fever, cough, sore throat, shortness of breath, body aches - fatigue - chills, reduction or loss of taste or smell; or a person who has a positive screening test result for the SARS-CoV-2 virus.

1.2. Confirmed case (F0 case)

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

1.3. Close contact (F1 case)

A close contact is a person who has been in close contact within 02 meters with a F0 case or in the same enclosed space at the place of residence, workplace, factory, study, activity, entertainment, etc. or in the same compartment on the transport vehicle with a F0 case during the transmission period of F0 case. To be specific:

- For F0 cases with symptoms: Within 03 days prior to the onset of a F0 case until the F0 case is quarantined. The time of onset of a case is the day when the patient has the first unusual health symptoms, which can be one of the following: Fatigue; anorexia; body aches, chills; reduction or loss of taste or smell; fever; cough; sore throat, etc.

- For asymptomatic F0 cases:

+ If the infection source of the F0 case has been identified: During the period from the F0 case first came into contact with the source of infection until he/she is quarantined.

+ If the infection source of the F0 case has not yet been identified: Within a period of 14 days before the F0 case was sampled and tested positive until he/she is quarantined.

* Some groups of common close contacts, including:

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

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

- Person who is in the same teamwork or office.

- 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, on the same transport vehicle, etc.

1.4. Person in contact with a close contact (F2 case)

Is a person who has been in close contact within 02 meters with the F1 case from the time the F1 case is likely to infect from the confirmed case (F0 case) to the time the F1 case is quarantined.

2. Definition of outbreak

2.1. Outbreak: is the place of residence (village, hamlet, neighborhood/residential group/sub-village/unit, etc.) of the confirmed case before the onset or before taking samples for confirmatory testing.

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

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

2.4. Information and report

Synthesizing the reporting data on a daily basis at all level:

- Centers for Disease Control of provinces and cities, medical centers of districts and towns, medical stations of communes and wards shall manage lists of confirmed cases, suspected cases, close contacts, people in contact with close contacts, the number of quarantined people in their respective areas (including all treatment establishments in areas); Centers for Disease Control of provinces and cities shall synthesize and report aggregate data according to the Form 7 provided in Appendix 5 and report the list of confirmed and suspected cases according to the Form 4 provided in Appendix 5 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 update information about their health status; report aggregate data according to the Form 7 provided in Appendix 5 and report the list of confirmed and suspected cases according to the Form 4 provided in Appendix 5 to the General Department of Preventive Medicine before 15:00 every day.

- Testing establishments including private and public hospitals, medical examination and treatment establishments must report the testing data (including test results, the number of samples taken in a day, the number of tests, etc.) to Centers for Disease Control of provinces and cities before 13:00 every day. Centers for Disease Control of provinces and cities shall report to the 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 test results, the number of samples taken a day and the number of tested people, etc. according to the Form 8 provided in Appendix 5 and send them to the General Department of Preventive Medicine before 15:00 every day.

- The Institute of Hygiene and Epidemiology and Pasteur Institute shall conduct assessment and analysis the COVID-19 pandemic situation and make comments, forecasts, and proposals on solutions to prevent and control pandemic in their respective localities and include them in reports sent to the General Department of Preventive Medicine before 14:00 every Monday. The General Department of Preventive Medicine shall synthesize and 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-CoV2 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. Complying with 5K message (Khẩu trang (face mask), Khai báo y tế (health declaration), Không tụ tập (no gathering), Khoảng cách (distance), Khử trùng (disinfection)). 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 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 for at least 40 seconds or with common antiseptic solution (containing at least 60% alcohol); 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 eating cooked food.

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

- Improving air ventilation for houses and workplaces 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

Vaccinating against COVID-19 according to the indications and instructions as prescribed.

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 medical treatment and quarantine 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, mandatory 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 according to the four on-spot motto.

IV. ANTI-PANDEMIC MEASSURES

A. General measures

1. Investigating and tracing F1 and F2 cases

- Quickly and thoroughly tracing contact cases without exception. The Steering Committees of provinces, districts and communes, relevant agencies and units must mobilize all sources to ensure fast and effective tracing.

- Tracing as soon as possible, immediately after receiving information about the confirmed case.

Tracing according to principles and methods provided in the “Handbook for tracing people in contact with persons positive with SARS-CoV-2 virus” promulgated by the Ministry of Health.

2. Taking samples to test for SARS-CoV-2

- Taking samples to test for SARS-CoV-2 for people in the community in the area with the outbreak to respond to the fight against the pandemic and assess and monitor the outbreak situation.

- Taking samples to test for SARS-CoV-2 for groups of high-risk people and groups of people in high-risk areas other than the outbreak to assess and evaluate the general pandemic development in the community.

- Based on the pandemic development and risk assessment, the National Steering Committee for COVID-19 Prevention and Control, the Ministry of Health or the Steering Committees for COVID-19 Prevention and Control of provinces or cities shall adjust the testing strategy, scale and sampling process accordingly.

3. Quarantine and medical treatment

3.1. Confirmed cases

- To receive, quarantine, manage and provide treatment for them according to the Ministry of Health’s instructions.

- To limit the patient referrals to avoid the transmission except for cases going beyond the treatment capacity.

3.2. Persons in close contact with confirmed cases (F1 cases)

- To organize the quarantine of people in close contact with confirmed cases in concentrated quarantine establishments for at least 14 days from the date of last contact with confirmed cases. It is highly recommended to set up separate concentrated quarantine establishments for people in close contact because such they are at higher risk of contracting the disease than others in concentrated quarantine. In case there is no separate concentrated quarantine establishment, to arrange a separate quarantine subdivision for people in close contact in the concentrated quarantine establishments. People living in the same households, same houses, same rooms, same offices as the confirmed cases should be quarantined separately from others because they are at the highest risk of infection. To arrange quarantine rooms for quarantined people on the principle of risk classification: people with the same epidemiological characteristics, the same risk at the same time, shall be quarantined in the same room/same quarantine area.

- To take patients’ specimens for Real time RT-PCR test for SARS-CoV-2 virus at least 2 times during their quarantine period.

- To take the first specimens on the first day of quarantine.

- To take the second specimens on the 14^th day of quarantine.

+ If their SARS-CoV-2 Real time RT-PCR test results are positive, they shall be handled like confirmed cases.

+ If their SARS-CoV-2 Real time RT-PCR test results at least 2 times are negative, they shall be no longer subject to concentrated quarantine and must self-monitor health status at their places of residence for another 14 days, strictly comply with 5K message, without mass gatherings.

People on entry who are subject to concentrated quarantine for at least 14 days as required, shall be quarantined, sampled and tested like F1 cases.

In case the high number of F1 cases is beyond the capacity of concentrated quarantine or other special cases (such as the elderly, people with limited mobility, children, sick or weak people need to be cared for, etc.), the 14-day home quarantine shall be considered for F1 cases according to specific instructions of the Ministry of Health and the Provincial Steering Committee for COVID-19 Prevention and Control. To take samples for testing on the first and last day of quarantine, if the SARS-CoV-2 Real time RT-PCR test results at least two times are negative, the home quarantine shall be terminated, F1 cases shall self-monitor their health status at their places of residence for another 14 days and strictly comply with 5K message; leaving home without notifying local authorities or mass gatherings are banned.

3.3. For people in contact with close contacts of confirmed cases (F2 cases)

- To make a list of F2 cases; and take specimens for widely testing F2 cases, depending on the assessment of risks and epidemiology.

- To organize the at-home quarantine for F2 cases in the waiting time of F1 cases’ RT-PCR test results:

+ If the first-time SARS-CoV-2 RT-PCR test result of an F1 case is positive, the quarantine level applied to his/her F2 cases shall be changed to the one applied to F1 cases.

+ If the first-time SARS-CoV-2 RT-PCR test results of an F1 case and his/her F2 cases (if any) are negative, based on the assessment of risks and epidemiology, the at-home quarantine applied to his/her F2 cases may be terminated and self-monitoring of their health within 14 days is required to be continued. In case there are suspected symptoms, to promptly notify the health agencies and community-based COVID groups.

3.4. For suspected cases

a. For suspected cases that are detected in the community

- Suspected cases are required to wear masks and comply the at-home quarantine immediately. They and their family shall strictly comply the 5K message. The suspected cases must not contact the people in their house and other people.

- The local health agencies shall immediately take specimens for SARS-CoV-2 RT-PCR tests:

+ If their SARS-CoV-2 test results are negative, they shall be considered not to be effected by COVID-19.

+ If their SARS-CoV-2 test results are positive, to handle as for F0 cases according to routine process.

b. For suspected cases that are detected in medical establishments

- To implement the classification of examination to screen suspected cases according to the regulations of the treatment system and temporarily quarantine suspected persons immediately in a separate room of an antechamber separate from the area with F0 cases and other treatment areas of the medical establishment.

- To immediately take specimens for SARS-CoV-2 RT-PCR test:

+ If their SARS-CoV-2 test results are negative, they shall be considered not to be effected by COVID-19.

+ If their SARS-CoV-2 test results are positive, to handle as for F0 cases according to routine process.

3.5. 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, quarantine and testing in accordance with epidemiological investigation results or at the request of the Provincial Steering Committee for COVID-19 Prevention and Control.

4. Organization of community-based pandemic prevention

To launch the movement “all people participate in pandemic prevention and control” and immediately establish "Community-based COVID groups" in all residential areas, ensuring their active and effective operation, to be specific:

- Each community-based COVID group consists of 2-3 people that should be officials of the residential group, village, quarter, unions, and volunteers in the residential area. Depending on the situation, each group shall be in charge of between 30 and 50 households with a specific assignment of list of households.

- Their tasks: “go to every alley, knock on every door” on a daily basis to:

+ Propagate pandemic prevention and control measures, mobilize and remind people of the implementation of pandemic prevention and control measures in each household. Request and guide the people to self-monitor their health, daily measure the body temperature (if the family has a thermometer). + Provide the people with their telephone numbers and request them to proactively make health declaration right when they or their family members have symptoms such as fever, cough, sick; or suspected symptoms.

+ Ask, monitor, detect and immediately report to local authorities and commune-level health agencies suspected cases of COVID-19 in households with symptoms such as fever; cough; sore throat; flu; sick and fatigue; respiratory tract infections... for promptly organizing the quarantine and taking specimens. Grasp the pandemic situation and risk factors in each household.

+ Detect and immediately report to competent authorities on cases not voluntarily making health declarations; failing to comply with pandemic prevention and control measures as prescribed; illegally entering in Vietnam; returning from pandemic areas, etc.

+ Assist authorities and health agencies in tracing F1, F2 cases when there are related confirmed cases in the area of which they are in charge.

+ Implement other suitable tasks assigned by the Steering Committees for COVID-19 prevention and control of communes and wards.

- Prevention of the infection for community-based COVID groups: Members of community-based COVID groups must wear masks, use the hand disinfectants, and face shields (if any). During their task performance, community-based COVID groups are not allowed to come in the people’s houses; they shall knock on doors, stand outside the house, ask the people to wear masks and keep a distance as far as possible upon communication to ensure the safety, prevent the infection (the minimum distance of more than 2 meters is required).

Community-based COVID groups should make Zalo groups with households which they are in charge of for daily report and contact.

5. Disinfecting and treating of outbreak environment

- Disinfecting and treating of outbreak environment shall be carried out according to the Appendix 4 to this Guidance.

- People disinfecting and treating outbreak environment must fully wear personal protective equipment during the task performance.

- People residing in an outbreak are required not to go around the common areas within at least 30 minutes after the disinfection of the outbreak to ensure the disinfection effect.

- Vehicles used to transport F0 cases must be disinfected with disinfectant solution containing 0.01% active chlorine.

- To prioritize surface disinfection by wiping objects that are frequently touched by people such as tables, chairs, side rails of beds, wardrobes, refrigerators, doorknobs, stair handrails, furniture, appliances, sinks, toilets, washbasin, faucets, shelves/cabinets in kitchens, walls, windows, doors, etc in houses, offices, factories, schools, etc. For cases in which the wiping measure cannot be carried out, to spray disinfectants with shoulder or hand-held sprayers, absolutely avoiding spraying directly on people.

- The disinfection of other related areas by spraying disinfectant on surfaces shall be decided by epidemiologists and environmental health officers according to actual investigation on a principle that all contaminated, suspected contaminated areas with a risk of spreading to the community must be treated. The number of disinfection times shall be depended on the actual pollution status at the outbreak.

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.

6. Communications for pandemic prevention and control

To effectively implement 5K message (in Vietnamese) Mask - Health declaration - Distance - No gathering - Disinfection and get vaccinated against COVID-19. To request the people to wear masks on public transport vehicles and public places and crowded places. To limit organizing crowded events, keep a distance in public places. To organize propaganda of pandemic prevention and control measures in many forms in the community, to each household. To propagate the role, civic responsibility and social responsibility of each person, each family in the implementation of pandemic prevention and control measures. To launch the movement “all people participate in pandemic prevention and control”.

B. Specific measures to handle outbreaks when there are confirmed cases in the community

1. Principles: Quick response to the pandemic plays a crucial role, including fast tracing, quarantine, zoning; rapid sampling and testing.

2. Specific measures for handling are specified in appendices (from the Appendix 1 to Appendix 5 issued together with this Decision).

APPENDIX 1

HANDLING OUTBREAKS IN CASE THERE IS A CONFIRMED CASE IN THE COMMUNITY
(Attached to the Ministry of Health's Decision No. 3638/QD-BYT dated July 30, 2021)

1. Principles:

Quick response to the pandemic plays a crucial role in handling an outbreak, including fast tracing, quarantine, zoning; rapid sampling and testing.

2. Specific activities:

- Immediately transferring F0 cases to quarantine establishments, managing and providing them with treatment as prescribed.

- Conducting epidemiological investigation for patients according to the routine process.

- Tracing F1 cases, organizing quarantine and taking F1 cases’ specimens for testing.

- Tracing F2 cases, organizing quarantine and taking F2 cases’ specimens for testing (if any).

- Temporarily zoning out epidemiological areas in residential areas with confirmed cases. The extent of the epidemiological area is based on an initial assessment of the outbreak and its risk. The temporarily zoning out epidemiological areas does not depend on the administrative division, and does not require any administrative decision.

- Depending on the outbreak size and epidemiological assessment, to conduct large-scale testing in the temporary epidemiological area:

To focus human resources, conduct large-scale testing in a quickly manner in the temporary epidemiological area. Samples should be pooled by households or groups of households that are close together.  To conduct a pooled sample test immediately to assess the risk and assess the pandemic situation in the community.

- To block the outbreak (quarantine in pandemic area):

+ The extent of the official blockade shall be decided depending on the results of testing F1 cases and testing of community samples in the outbreak.  Blockade principles: Any risk area shall be blocked (the risk is assessed according to the distribution of F0 cases; F1 cases; epidemiological milestones and epidemiological relationship in the community). In the blockade area, to comply with the “Handbook on guiding the implementation of quarantine in areas with COVID-19 pandemic” of the Ministry of Health.

+ Blocking the outbreak must achieve two goals as follows: Locking down the outbreak to prevent the infection source from transmitting to other areas and thoroughly stamping out the pandemic in the outbreak. In order to achieve these two goals, nobody is allowed in or out the blockaded area and every house shall be isolated with one another in the blockaded area with the following principles: Neither leaving home, meeting anyone outside, visiting anyone's house nor letting anyone into the house; all shops and stores must be closed. Setting up checkpoints to control the entry and exit of the blockade area.

+ To continue taking samples for testing every three days for all citizens in the blockade area by pooling samples of households or adjacent households to detect and quickly transfer F0 cases to quarantine establishments. The number of the next sampling shall be decided depending on the test results. In many outbreaks where there has been a complex infection in the community, it is necessary to take samples many times to filter out the pathogen to extinguish the outbreak.

+ To make statistics and publish lists of blockade areas and areas where COVID-19 cases are recorded in the community on the provinces’ or cities’ websites; such lists must be regularly updated (contact email: [email protected] for further instructions, and access permission and editing). In order to recommend travel, and quarantine of people returning from the blockade areas and the areas where COVID-19 cases are recorded in the community, the Ministry of Health publicly posted a list of the blockade areas and areas where COVID-19 cases are recorded in the community on the website https://moh.gov.vn/.

- To consider to impose social distancing measure under the Directive No. 15/CT-TTg dated March 27, 2020 and the Directive No. 16/CT-TTg dated March 31, 2020 of the Prime Minister, on urgent measures to prevent and control the COVID-19 pandemic or choose to apply a number of principal contents of these Directive for communes/wards where confirmed cases are recorded, some neighboring communes, wards or communes related to epidemiology or important epidemiological milestones and apply other directives of the Government, National Steering Committee for COVID-19 Prevention and Control, Provincial Steering Committee for COVID-19 Prevention and Control.

- To organize comprehensive, thorough surveillance, take samples for testing all cases of fever, cough, sore throat, flu syndrome, acute respiratory infection in the community, treatment establishments, pharmacies in the area. In the first days, it is necessary to conduct a general review and take samples of all people with symptoms of fever, cough, sore throat, fatigue, respiratory infection, loss of smell or taste in the area.

- To establish community-based COVID groups in all residential areas. Community-based COVID groups must operate actively and effectively, go to every alley, knock on every door every day to perform their tasks as prescribed. Representatives of households are required to actively make mandatory health declarations by phone on a daily basis about their family members’ health status to the community-based COVID groups or grassroots health agencies.

- To propagandize to each residential area and launch a movement of the whole population to participate in pandemic prevention. Especially, to implement 5K message and strictly implementing social distancing measure being applied in the area and the direction of the Government, the National Steering Committee for COVID-19 Prevention and Control, and the Provincial Steering Committee for COVID-19 Prevention and Control.

- Local authorities shall organize police and civil defense forces to strengthen inspection and supervision of the implementation of pandemic prevention and control of citizens in pandemic areas. To promulgate sanction policies to severely punish those who violate regulations to deter and ensure the pandemic prevention and control.

- To disinfect and treat the outbreak environment in the places of residence, workplaces of F0 cases according to Appendix 3 attached to this Guidance.

Attention:

- The temporary zoning and community sampling need to be carried out on a large scale, but the blockade must be compact enough, only block risk area.

- Symptomatic cases and F1 cases should be conducted one simple test in the first testing.

- Community samples should be tested for pooling to save biological products (following the Decision No. 1817/QD-BYT dated April 07, 2021, on promulgating the temporary guidance on pooling samples for SAR-CoV-2 testing).

APPENDIX 2

SAMPLE COLLECTION, STORAGE AND TRANSPORT OF SPECIMENS
(Attached to the Ministry of Health's Decision No. 3638/QD-BYT dated 7/30/2021)

_______________________

1. Specimens

Specimens suspected to be infected with COVID-19 must be collected by health staff well-equipped with knowledge on specimen collection. It is required to take at least one respiratory specimen:

1.1. Genetic material testing

a. Upper respiratory tract specimens:

+ Nasopharyngeal swab sample;

In case it is impossible to take Nasopharyngeal swab sample, one of the following samples may be taken:

+ Throat swab sample;

+ Nasal swab sample (both sides of the nose);

b. Lower respiratory tract specimens:

+ Sputum;

- Endotracheal, alveolar, pleural fluid, etc.

+ Tissues of lungs, bronchi, alveoli.

1.2. Antigen test

+ Nasopharyngeal fluid sample;

+ Throat swab sample;

+ Nasal swab sample (both sides of the nose);

1.3. Antibody test

- Blood specimen (Optional, depending on the serological testing of the local units that develop the specific plan)

- Blood specimen volume: 3ml - 5ml

2. Methods of collecting specimens

2.1. Preparing instruments

- Instrument used to collect nasopharyngeal, throat and nasal swab samples for SARS-CoV-2 testing whose handle is not made from calcium or wood, it should be a rod with a synthetic fiber tip.

- Tongue depressors;

- 15ml conical centrifuge tubes, containing 2-3ml of virus transport medium;

- Plastic vials (Falcon 50ml tubes) or nylon bags for packaging specimens.

- Antiseptic bandages and gauzes;

- Antiseptic alcohol, writing pen;

- Waterproof protective clothing (separate or integral) or long-sleeved waterproof medical gown that covers the whole body from neck to knees with fasteners fixed at the nape of the neck and around the waist;

- Eye protection goggles;

- Powder-free clean gloves;

- Medical masks with high filtration efficiency (N95 or equivalent);

- Sterile 10 ml syringe;

- Sterile anticoagulant-free tubes.

- Cold boxes.

2.2. Process

2.2.1. Use of personal protective equipment

Step 1: Perform hand hygiene.

Step 2: Wear shoes cover.

Step 3: Wear a gown or a suit (separate or integral).

Step 4: Wear mask.

Step 5: Wear goggles (for goggles with ear-hanging frame).

Step 6: Wear hood cap to cover hair, head, ears, and mask straps completely.

Step 7: Wear face shield or goggles (goggles with headband outside the hood cap).

Step 8: Wear powder-free clean gloves.

Note: It is not necessary to wear both glasses and a face shield.

2.2.2. Specimen collection techniques for genetic material testing

2.2.2.1. Techniques for collecting nasopharyngeal and throat swab samples.

a) Techniques for collecting nasopharyngeal swab samples

- The patient is required to sit still, gently blow the nasal secretions into a tissue, face slightly up, young children must be kept by an adult.

- The person taking specimen tilts the patient’s head back about 70 degrees, hands holding patient’s neck.

- Use the other hand to gently insert the swab into one nostril, push and turn to make the swab easier to go forward about ½ length from the nose edge to the earlobe of the same side.

Note: If you have not reached such a depth but feel a clear resistance, remove the swab and try to get specimen from the other nostril. When you feel the swab touch the back of the nose and throat, then stop, turn and slowly withdraw the swab.

- Hold the swab at the sampling site for 5 seconds to ensure maximum infiltration.

- Slowly turn and withdraw the swab.

- Place the tip of a swab in the medium canister and break the swab handle at the marking point to have a length consistent with the length of the medium canister. Note: Nasopharyngeal swabs shall be placed in the medium tube containing the throat swabs if both types are collected.

- Recap, tighten and wrap with paraffin paper (if any).

Note: For small children, let them sit on the parent's lap, the child's back is facing parent's chest. Parent needs to hold the child's body and arms tightly. Ask the parent to tilt the child's head back.

Figure 1: Taking nasopharyngeal swab sample

b) Techniques for collecting throat swab samples:

- Ask the patient to open his mouth wide.

- Use the instrument to gently press the patient tongue.

- Insert the swab into the oropharynx, rub and gently rotate from 3 to 4 times at the 2 sides of the tonsils and the back wall of the throat to get fluids and cells.

- After taking the specimen, the swab is put into a tube containing 3 ml of medium (VTM or UTM) for storage. Note, the swab tip must be completely submerged in the medium, and if the swab is longer than the medium canister, it is necessary to break/cut the swab handle to fit the length of the medium canister.

- Recap, tighten and wrap with paraffin paper (if any).

Figure 2: Taking throat fluid swab

2.2.2.2. Techniques for collecting nasal swab samples

- The patient is required to sit still, gently blow the nasal secretions into a tissue, young children must be kept by an adult.

- The person taking specimen slightly tilts the patient’s head back, hands holding patient’s neck.

- With the other hand, gently insert the swab into the nostril about 2cm deep, rotate the swab into the nasal wall for about 3 seconds. After taking one nostril, use the same swab to collect the sample with the other nostril.

- Place the tip of a swab in the medium canister and break the swab handle at the marking point to have a length consistent with the length of the medium canister.

- Recap, tighten and wrap with paraffin paper (if any).

Figure 3: Taking nasal swab sample

2.2.2.3. Endotracheal fluid sample

The patient shall be intubated and on mechanical ventilation. Place 1 suction catheter along the endotracheal line and use the syringe to aspirate the endotracheal fluid out through the catheter. Store the endotracheal fluid in a tube containing virus storage medium.

2.2.3. Collecting and storing samples for antigen test in accordance with the manufacturer's instructions.

2.2.2.4. Taking blood specimen for antibody test

Use a sterile needle and syringe to take 3ml-5ml of venous blood and transfer it into an anticoagulant-free tube and store it at 2° C - 8° C for 48 hours. For longer storage, specimens should be stored at minus 70°C (-70°C).

Note:

- Write the name, age, address of the patient, type of specimens, date of sampling on the specimen-containing tubes.

- Specimens collected in the lower respiratory tract (endotracheal, alveolar, pleural fluid) must be coordinated with clinicians during the collection of patient specimens.

2.2.3. Taking off personal protective equipment

2.2.3.1. Taking off gowns, hood caps and shoes cover

Step 1: Remove gloves. Roll the inside out when removing, then put them into waste container.

Step 2: Perform hand hygiene.

Step 3: Remove fasteners and gown, roll the inside out and put it into waste container.

Step 4: Perform hand hygiene.

Step 5: Remove shoes cover, turn the inside out and put them into waste container. Step 6: Perform hand hygiene.

Step 7: Remove face shield or goggles (for goggles with headband outside the hood cap).

Step 8: Perform hand hygiene.

Step 9: Remove cap by slipping hand into the cap. Step 10: Remove goggles (glasses with frames and straps inside the hat).

Step 11: Remove mask (by holding the strap behind the head or ears)

Step 12: Perform hand hygiene.

Note: The area to put on and take off personal protective equipment should be two separate areas.

2.3.2.2. Taking off detached pants, removing gown and cap

Step 1: Remove gloves. Roll the inside out when removing, then put them into waste container.

Step 2: Perform hand hygiene.

Step 3: Remove fasteners and gown, roll the inside out and put it into waste container.

Step 4: Perform hand hygiene.

Step 5: Remove pants and shoes cover simultaneously, turn the inside out and put them into waste container.

Step 6: Perform hand hygiene.

Step 7: Remove face shield or goggles (for goggles with headband outside the hood cap).

Step 8: Perform hand hygiene.

Step 9: Remove cap by slipping hand into the cap.

Step 10: Remove goggles (glasses with frames and straps inside the cap).

Step 11: Remove mask (by holding the strap behind the head or ears)

Step 12: Perform hand hygiene.

Note: The area to put on and take off personal protective equipment should be two separate areas.

2.2.3.2. Removing coveralls and cap

Step 1: Remove gloves. Roll the inside out when removing, then put them into waste container.

Step 2: Perform hand hygiene.

Step 3: Remove face shield or goggles with headband outside the hood cap. In case of using glasses with frames in a cap, remove the hood cap first, then remove the glasses.

Step 4: Perform hand hygiene.

Step 5: Remove cap, coveralls. When removing, roll the inside out and put them in the waste container.

Step 6: Perform hand hygiene.

Step 7: Remove shoes cover, turn the inside out and put them into waste container.

Step 8: Perform hand hygiene.

Step 9: Remove mask (by holding the strap behind the head or ears)

Step 10: Perform hand hygiene.

Note: The area to put on and take off personal protective equipment should be two separate areas.

2.2.3.3. Sterilizing the instrument and disinfecting the sampling areas

- All personal protective equipment, along with other dirty instrument, shall be put into a specialized plastic bag designed for containing infectious waste which is capable of withstanding high temperatures (On-duty health staff must use new gloves and face masks).

- Fasten and dry such wet bag at 120°C in 30 minutes before collecting it with other infectious waste for further treatment according to regulations.

- Wash hands with soap, clean and disinfect all sampling instrument and areas, and the cold boxes used to transport specimens to the laboratory with chloramine 0.1%.

3. Preserving, packaging and transporting specimens to the laboratory

3.1. Preservation

After being collected, specimens shall be sent to the laboratory in the shortest time:

- Specimens shall be stored at 2-8°C, and transferred to the laboratory as soon as possible, within less than 48 hours after being collected. If is not possible to transfer the sample within 48 hours after collecting, the specimens should be stored at minus 70°C.

- Specimens shall not be stored in the freezer compartment of the refrigerator or at minus 20°C.

3.2. Packaging the specimens

- Specimens shall be packed according to the 3-layer principle prescribed by the standards of the Ministry of Health in the Circular 40/2018/TT-BYT dated December 07, 2018 on management of infectious disease specimens.

- Check the consistency between the information on the specimen collection tube and the information on the questionnaire.

- Check to make sure that the specimen collection tube is tightly closed, covered with paraffin paper (if available) or blotter.

- Place the specimen collection tube in a waterproof/plastic bag or container with a lid and seal.

- Place the bag/box containing the specimen in the cold box or hard container.

- Add enough cooler bags/containers to the cold box/sample containers so that the samples are stored at between +2°C and +8°C, during the sample transport.

- For frozen samples, add enough cooler bags/containers that have been placed in a 70°C negative cabinet so that the samples do not thaw during transport.

- The test request forms shall be placed in a waterproof bag/other plastic bag (the form must not be put together with the specimen) and placed in a cold box/sample container, labeled on the outside as prescribed in the Circular 40/2018/TT-BYT upon transporting.

3.3. Transportation of specimens to the laboratory

- Specimens must be preserved in +2^oC to +8^oC (or minus 70^oC, for frozen specimens) during the transportation.

- Test request forms and questionnaires must be attached to the specimens.

- Establishments that send specimens must immediately notify the laboratory of the expected time to receive the specimens so that the laboratory staff can prepare for the specimen receipt.

- Select means and forms of transportation for the shortest transportation time, while ensuring specimen preservation conditions during the transportation.

APPENDIX 3

INSTRUCTIONS FOR USE OF CHEMICAL DISINFECTANTS CONTAINING CHLORINE IN THE PANDEMIC PREVENTION AND CONTROL
(Issued together with the Decision No. 3638/QD-BYT dated July 30, 2021 of the Ministry of Health)

1. Introduction

Chlorine (Cl) is a halogen that is widely used for disinfection due to its high bactericidal activity with oxidation-reduction reaction. The chlorine-containing chemicals dissolve in water to create a solution with active chlorine for disinfection. Commonly used chlorine-containing chemicals include:

- Chloramine-B with 25% - 27% active chlorine.

- Chloramine-T

- Calcium hypochlorite (Chlorinated lime).

- Sodium dichloroisocyanurate.

- Javel water (Sodium hypochlorite or Potassium hypochlorite solution).

2. Use of chlorine-containing chemicals in the pandemic prevention and control

- In the pandemic prevention and control, solutions made from chlorine-containing chemicals with active chlorine concentrations of 0.05 and 0.1% are commonly used, depending on the purpose and method of disinfection. The solution concentration must be calculated based on active chlorine concentration.

- Because chemicals have different concentrations of active chlorine, it is necessary to calculate the volume of chemicals for a solution with the expected concentration of active chlorine.

- The amount of chlorine-containing chemicals required to make the number of liters of solution with the required active chlorine concentration shall be calculated according to the following formula:

* The active chlorine content of a chemical to be used is always stated on the label, packaging or use instruction sheet by the manufacturer.

* For example:

- To make 10 liters of solution with active chlorine concentration of 0.05%, the necessary amount of Chloramine-B powder with 25% active chlorine is : (0.05 x 10 / 25) x 1,000 = 20 gram.

- To make 10 liters of solution with active chlorine concentration of 0.05%, the necessary amount of Calcium hypochlorite powder with 70% active chlorine is: (0.05 x 10 / 70) x 1,000 = 7.2 gram.

- To make 10 liters of solution with active chlorine concentration of 0.05%, the necessary amount of Sodium dichloroisocyanurate powder with 60% active chlorine is : (0.05 x 10 / 60) x 1,000 = 8.4 gram.

Table 1: Amount of chlorine-containing chemicals for 10 liters of solution with active chlorine concentrations commonly used in pandemic prevention and control

3. Mixing method

- To completely dissolve the required amount of chemicals in 10 liters of clean water.

- The effectiveness of chlorine-containing solutions will rapidly reduce over time, so only mix the required amount and use it as soon as possible after mixing. It is best to mix and use within the day, not prepare solutions for storage. These prepared solutions with chlorine should be stored in a cool, dry place, tightly closed, protected from light.

Attention:

- Chlorine-containing compounds only have an antimicrobial effect when they are dissolved in water for a solution (these compounds shall release active chlorine with antimicrobial effect), so the use of chlorine-containing compounds in the form of pure powder for disinfection is banned.

- The effectiveness of chlorine-containing solutions will reduce over time, so only mix the required amount and use it as soon as possible after mixing. It is best to mix and use within the day, not prepare solutions for storage. If not using the solutions up within the day, the solutions must be covered, protected from light and be used as soon as possible.