Policy responses for Belgium - HSRM


Policy responses for Belgium

1.3 Isolation and quarantine

Since the beginning of May, all people with symptoms and high-risk contacts of COVID-positive people are tested. The following isolation and quarantine rules apply:
• For symptomatic people: If results are positive, people have to isolate at home for at least 7 additional days after receiving their test results. If they have no symptoms at day 7, isolation can be stopped.
• For asymptomatic high-risk contacts: Up to October 1st, if the test result was negative, high-risk contacts must remain in quarantine for 14 days after the last risk contact. Going out was only authorised for small essential purchases (food, pharmacy, etc.), with the use of a cloth facemask and in strict compliance with hygiene measures. In agreement with the patient, the physician could perform a second PCR test if the first test was performed within 7 days after exposure (with a 5-day interval between the two tests and with the second test carried out at least 9 days after the last risk contact). If this second PCR test was negative, then quarantine could be stopped (therefore no sooner than 10 days after the last exposure).
• From October 1st, to increase the adherence of people, the same rules remain but quarantine is reduced to 7 days (and only one test is required at day 5 after the last contact). From October 21th, if no test is performed for asymptomatic high-risk contacts (see the section 1.5 on testing),  a 10 day quarantine must automatically be respected.
• Concerning negative high-risk contacts working in an essential profession, such as carers, work is exceptionally allowed if this is necessary to ensure continuity of services but only if strict hand hygiene is observed, they continue active monitoring of body temperature and for possible symptoms, and a social distance of 1.5m from colleagues is maintained.

The first quarantine in Belgium was imposed on nine people who came back from Wuhan (China) on February 2nd. They were isolated in the Central Military Hospital in Neder-over-Hembeek (Brussels). Tests were performed at the national reference lab in the KU Leuven. One of the nine people tested positive and was admitted to the reference-hospital (Hôpital St Pierre Brussels) although he was asymptomatic. He was allowed to return home after 14 days. The other people had to stay in the military hospital for 14 days. None of them tested positive.

Between February 18th and 21st, ten Belgian passengers from the cruise-ship Westerdam (where one US-passenger tested positive) were repatriated from Cambodia. They tested negative, but were asked to self-isolate and most of them were followed by the federated entities.

On March 1st, people started coming back from winter holidays in France and in the north of Italy. This was the real beginning of the outbreak of COVID-19 in Belgium. These people were advised to self-isolate, but there was no obligation to do so, nor real controls. The suspected cases (with symptoms) were tested and their contacts were traced.

One week later, 200 cases were confirmed and testing began to be prioritised for people whose symptoms could lead them to hospital admissions or to health care professionals. Other reference labs received agreement to perform COVID-19 tests. Since then, this list has grown longer (see further).

People with fever and/or respiratory problems (such as coughing and breathing difficulties) were advised not to go to the waiting room of general practitioners (GPs) nor to the emergency department in hospitals. GPs had to determine by telephone whether they could stay ill at home or should go to hospital.

People with symptoms that don’t require hospitalisation must stay at home (i.e. they are not allowed to leave their house) and avoid contact with other people (even with housemates: they should stay in a different room, eat separately, sleep separately, and use different bathrooms if possible).

Housemates or other contacts (such as colleagues) do not have to go into isolation. They have to comply with the general obligation to go outside as little as possible (unless for work, shopping, exercise) and to strictly follow hygiene regulations. Family members or contacts working in the care sector do not have to self-isolate at home either. As long as they do not have any health symptoms (i.e. coughing or fever), they are allowed to continue working and they do not have to wear protective equipment, except in situations in which they already wear such equipment.

Regularly updated guidelines for health care professionals and for residential care can be found on the websites of Sciensano and on the websites of the Federated entities:
• Sciensano (2020). Coronavirus. Brussels: Sciensano (https://epidemio.wiv-isp.be/ID/Pages/default.aspx, Accessed April 2020)
• Flemish Agency for Care and Health (2020). Uitbraak coronavirus COVID-19. Brussels: Flemish Agency for Care and Health – Agentschap Zorg en Gezondheid (https://www.zorg-en-gezondheid.be/covid-19, Accessed April 2020);
• AVIQ (2020). Coronavirus 2019. Charleroi : Agency for a Quality Life-Agence pour une vie de Qualité (https://www.aviq.be/coronavirus.html, Accessed April 2020) ;
• Iriscare (2020). COVID-19. Brussels: Iriscare (http://www.iriscare.brussels/fr/professionnels/, Accessed April 2020);
• Ostbelgienlive (2020). Coronavirus: Fragen und Antworten. Eupen: Ostbelgienlive (http://www.ostbelgienlive.be/desktopdefault.aspx/tabid-6711/, Accessed April 2020)