Policy responses for Belgium - HSRM

Belgium


Policy responses for Belgium

1.5 Testing

PCR testing

From May 4th the definition of ‘possible cases’ was enlarged (see section 1.4) and GPs were asked to start prescribing a test to any person presenting with these enlarged symptoms and to notify all these ‘possible cases’ via an electronic form which has been integrated into their electronic software packages. However, individual contact tracing occurs only after confirmation of the case with a positive laboratory result (unless the GP explicitly mentions that there is a highly suggestive clinical and epidemiological link to a confirmed case). All people living with the patient have to isolate at home for 14 days. From May 7th, the call centres for tracing could also request the testing of people identified as contacts of a COVID-positive person.

From May 8th, the priority for testing was changed. People who should be PCR-tested are, in order of priority:
• Any ‘possible case’, with special attention to caregivers (people who provide care and/or assistance) and people in residential facilities;
• People who have had a high-risk contact with a case of COVID-19 and who are themselves in professional contact with people at risk of developing a severe form of the disease (according to the modalities issued in the contact procedure, i.e. a test on day 12 of the isolation period).
Then if the testing capacity is sufficient:
• Any person requiring hospitalisation;
• Any person entering a residential facility for the first time.

Updates to definitions include: A high-risk contact (or close contact) is defined as follows: a person who has cumulative contact of at least 15 minutes within a distance of less than 1.5 m ("face to face"); a person who was in the same room/closed environment for more than 15 minutes with a COVID-19 patient, where a distance of 1.5 m was not always respected (except when plexiglass divisions were used) and/or where objects were shared. This includes all classmates for children under 6 years and neighbours in a classroom with children under 7 years old; a person who has had direct physical contact with a COVID-19 patient; a person who has been in direct physical contact with excretions or body fluids of a COVID-19 patient, such as during kissing and mouth-to-mouth ventilation, or contact with vomit, bowel movements, mucus, etc.; a caregiver in contact with a COVID-19 patient during care or medical treatment or examination within a distance of 1.5 m, without the use of personal protective equipment (according to protocol/activity); a person who has travelled with a COVID-19 patient for more than 15 minutes, in any means of transport, seated within two seats (in any direction) from the patient.

The samples can be taken by the GP himself (if he is equipped to do so) or in the former ‘triage centres’ (i.e. specific sites organised by GPs, hospitals, municipalities, etc.). These ‘triage centres’ are from then on called ‘sampling centres’; they are coordinated by the GPs circles (local associations). On May 7th, the Interministerial Conference decided that 120 sampling centres should remain operational (i.e. one sorting centre per 100,000 inhabitants) with each federated entity being responsible for ensuring an adequate distribution of centres on its territory. Sampling centres can organise their collection in several places and in different forms (drive-in, mobile teams, etc.) to increase accessibility.

The GP can consult the results of tests performed on a results server, even if the sample was taken by someone else, and he receives an automatic notification for all the patients whose medical records he holds. He can also deliver ‘quarantine attests’ to the members of the family and close contacts of a positive patient (even if asymptomatic).These attests are to be given to the patient either in person or by post or e-mail, depending on the nature of the consultation (physical or telephone contact). They do not have to be signed by the doctor if they are sent by e-mail, but must then contain an identification of the physician. The patient is responsible for forwarding it either to the employer or to the sickness fund. Asymptomatic patients in quarantine are allowed to telework.

Algorithms summarizing the possibilities are available on the Sciensano website: https://covid-19.sciensano.be/sites/default/files/Covid19/d%C3%A9claration%20obligatoire%20et%20suivi%20des%20contacts.pdf (French); https://covid-19.sciensano.be/sites/default/files/Covid19/verplichte%20melding%20en%20contact%20opvolging.pdf (Dutch).

Every patient being tested is invited to record his or her contacts over the past few days using a form available on the eHealth platform: https://www.ehealth.fgov.be/file/view/AXICTBY_l9vUUfvGGeqj?filename=Invulblad%20contacten%20FR.pdf (French); https://www.ehealth.fgov.be/file/view/AXICTJIQl9vUUfvGGeqk?filename=Invulblad%20contacten%20NL.pdf (Dutch). This form facilitates the tracing if the patient turns out to be COVID-positive.

Serological testing

On May 20th, Sciensano published instructions for serological testing. People allowed to be serologically tested are the following:

1. In inpatients who meet the ‘possible case’ definition AND have a chest CT suggestive of COVID-19 but a negative PCR. Serology will be performed a minimum of 7 days after symptom onset.

2. In outpatients or inpatients with a suggestive and prolonged clinical picture for COVID-19 but a negative PCR test or who could not be tested within 7 days of symptom onset. Serology will be performed a minimum of 14 days after the onset of symptoms.

3. In a context of differential diagnosis, in the case of atypical clinical presentation. Serology will be performed a minimum of 14 days after the onset of symptoms.

4. To review serological status among health care staff and staff working in hospitals/services or communities at high risk of exposure to COVID-19 (COVID service or nursing homes) as part of local risk management.

Along with these instructions, it was stressed that the effective antibody levels needed to provide protection against the virus were not known, nor the duration of the protection. Nor is it known whether people with antibodies were still contagious. Therefore, the presence of antibodies should not be seen as a guarantee of protection and the preventive measures remained valid regardless of the test result.

Warning was also given about the risk of fraud with regard to the CE marking. Only the tests recommended by the FAMHP or Sciensano were recommended (ELISA method or equivalent - immuno-chromatographic tests are not indicated).

Sources:
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) ;
https://www.inami.fgov.be/fr/covid19/Pages/retribution-soutenir-postes-triage.aspx (French) / https://www.inami.fgov.be/nl/covid19/Paginas/vergoedingen-triagecentra.aspx (Dutch)
• 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).
https://organesdeconcertation.sante.belgique.be/fr/documents/covid-19-communiques-de-la-cim (French) / https://overlegorganen.gezondheid.belgie.be/nl/documenten/covid-19-persberichten-van-de-imc (Dutch)

PCR testing

From May 4th the definition of ‘possible cases’ was enlarged (see section 1.4) and GPs were asked to start prescribing a test to any person presenting with these enlarged symptoms and to notify all these ‘possible cases’ via an electronic form which has been integrated into their electronic software packages. However, individual contact tracing occurs only after confirmation of the case with a positive laboratory result (unless the GP explicitly mentions that there is a highly suggestive clinical and epidemiological link to a confirmed case). All people living with the patient have to isolate at home for 14 days. From May 7th, the call centres for tracing could also request the testing of people identified as contacts of a COVID-positive person.

From May 8th, the priority for testing was changed. People who should be tested are, in order of priority:
• Any ‘possible case’, with special attention to caregivers (people who provide care and/or assistance) and people in residential facilities;
• People who have had a high-risk contact with a case of COVID-19 and who are themselves in professional contact with people at risk of developing a severe form of the disease (according to the modalities issued in the contact procedure, i.e. a test on day 12 of the isolation period).
Then if the testing capacity is sufficient:
• Any person requiring hospitalisation;
• Any person entering a residential facility for the first time.

The samples can be taken by the GP himself (if he is equipped to do so) or in the former ‘triage centres’ (i.e. specific sites organised by GPs, hospitals, municipalities, etc.). These ‘triage centres’ are from then on called ‘sampling centres’; they are coordinated by the GPs circles (local associations). On May 7th, the Interministerial Conference decided that 120 sampling centres should remain operational (i.e. one sorting centre per 100,000 inhabitants) with each federated entity being responsible for ensuring an adequate distribution of centres on its territory. Sampling centres can organise their collection in several places and in different forms (drive-in, mobile teams, etc.) to increase accessibility.

The GP can consult the results of tests performed on a results server, even if the sample was taken by someone else, and he receives an automatic notification for all the patients whose medical records he holds. He can also deliver ‘quarantine attests’ to the members of the family and close contacts of a positive patient (even if asymptomatic).These attests are to be given to the patient either in person or by post or e-mail, depending on the nature of the consultation (physical or telephone contact). They do not have to be signed by the doctor if they are sent by e-mail, but must then contain an identification of the physician. The patient is responsible for forwarding it either to the employer or to the sickness fund. Asymptomatic patients in quarantine are allowed to telework.

Algorithms summarizing the possibilities are available on the Sciensano website: https://covid-19.sciensano.be/sites/default/files/Covid19/d%C3%A9claration%20obligatoire%20et%20suivi%20des%20contacts.pdf (French); https://covid-19.sciensano.be/sites/default/files/Covid19/verplichte%20melding%20en%20contact%20opvolging.pdf (Dutch).

Every patient being tested is invited to record his or her contacts over the past few days using a form available on the eHealth platform: https://www.ehealth.fgov.be/file/view/AXICTBY_l9vUUfvGGeqj?filename=Invulblad%20contacten%20FR.pdf (French); https://www.ehealth.fgov.be/file/view/AXICTJIQl9vUUfvGGeqk?filename=Invulblad%20contacten%20NL.pdf (Dutch). This form facilitates the tracing if the patient turns out to be COVID-positive.

Serological testing

On May 20th, Sciensano published instructions for serological testing. People allowed to be serologically tested are the following:

1. In inpatients who meet the ‘possible case’ definition AND have a chest CT suggestive of COVID-19 but a negative PCR. Serology will be performed a minimum of 7 days after symptom onset.

2. In outpatients or inpatients with a suggestive and prolonged clinical picture for COVID-19 but a negative PCR test or who could not be tested within 7 days of symptom onset. Serology will be performed a minimum of 14 days after the onset of symptoms.

3. In a context of differential diagnosis, in the case of atypical clinical presentation. Serology will be performed a minimum of 14 days after the onset of symptoms.

4. To review serological status among health care staff and staff working in hospitals/services or communities at high risk of exposure to COVID-19 (COVID service or nursing homes) as part of local risk management.

Along with these instructions, it was stressed that the effective antibody levels needed to provide protection against the virus were not known, nor the duration of the protection. Nor is it known whether people with antibodies were still contagious. Therefore, the presence of antibodies should not be seen as a guarantee of protection and the preventive measures remained valid regardless of the test result.

Warning was also given about the risk of fraud with regard to the CE marking. Only the tests recommended by the FAMHP or Sciensano were recommended (ELISA method or equivalent - immuno-chromatographic tests are not indicated).