Policy responses for Croatia - HSRM


Policy responses for Croatia

1.4 Monitoring and surveillance

As of 29 May, the definition of COVID-19 has been revised and it now includes the following:

Clinical criteria
A person who has at least one of the following symptoms:
• cough
• fever
• dyspnea (shortness of breath)
• sudden loss of smell, taste or change in taste

Radiological diagnostic criteria
Radiological evidence of lesions compatible with COVID-19.

Laboratory criteria
Detection of SARS-CoV-2 RNA in a clinical specimen.

Epidemiological criteria
At least one of the following:
• close contact with a COVID-19 patient within 14 days before the onset of symptoms
• within 14 days before the onset of symptoms, the patient was a user or employee of a facility for the accommodation of vulnerable groups in which transmission of COVID-19 was confirmed.

Case classification
1. Possible case
A person who meets the clinical criteria
2. Probable case
A person who meets the clinical criteria and one of the epidemiological criteria
A person who meets radiological diagnostic criteria
3. Confirmed case
A person who meets the laboratory criteria

On July 2, the Croatian Institute of Public Health revised their COVID-19 recommendations. New criteria for terminating the isolation of patients with COVID-19 have been published and include the following:

A symptomatic patient with COVID-19 completes isolation if the following criteria are met:
• At least 14 days have passed since the first day of illness,
• At least 3 consecutive days the patient was afebrile without the use of antipyretics
• Significant improvement in respiratory functions and other symptoms of COVID-19.

For asymptomatic cases of COVID-19, completion of isolation is recommended for 14 days after the first positive SARS-CoV-2 test for asymptomatic patients. If symptoms develop during this period, criteria for symptomatic patients are used, with the reference point being the date of onset of symptoms.

In addition to these clinical criteria, control laboratory testing before returning to work is indicated for employees in health care institutions, nursing homes as well as other institutions with an increased risk of COVID-19. In this instance, the following laboratory criteria must be met:

• 2 negative RT-PCR of the nasopharyngeal swab at an interval of at least 24 hours

Definition of COVID-19
The national definition is as follows:
"The new coronavirus, which appeared in 2019 is called SARS - CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2). It was discovered in China at the end of 2019. This is a new coronavirus strain that hasn't been previously detected in humans. The disease caused by this virus is called COVID-2019.“ (source: Croatian Institute of Public Health)

Definition of probable cases and contacts
The European Centre for Disease Prevention and Control (ECDC) defines probable and confirmed cases as follows:
Probable case
A suspected case for whom testing for the virus causing COVID-19 is inconclusive (according to the test results reported by the laboratory) or for whom testing was positive on a pan-coronavirus assay.
Confirmed case
A person with laboratory confirmation of the virus causing COVID-19 infection, irrespective of clinical signs and symptoms

Monitoring of self-isolation
Monitoring is conducted on several levels:
o On 3 February, border health monitoring was introduced. Several protocol changes have been made so far in line with the development of the epidemiological situation (version 17 is currently in use). The changes have included the addition of countries where COVID-19 local transmission has been recorded, as well as certain modifications of control measures.
The health monitoring protocol is specifically implemented in the following situations:
• Health monitoring of people who cross the border checkpoints of the Republic of Croatia
• Health monitoring of people who have been in an area affected by the COVID-19 outbreak within the last 14 days or who have been in close contact with COVID-19 patients
• On 3 February, specific health monitoring was introduced and is being conducted on people who do not have symptoms/signs of the disease as well as on people who have symptoms/signs of the disease (including their close contacts) – it includes health monitoring and self-isolation measures for people who have travelled or lived in high-risk areas during the last 14 days
o At the beginning of the monitoring process, people in self-isolation had to report daily to an epidemiologist. Later, some changes were introduced. They did not have to contact an epidemiologist daily: only at the beginning, in case of symptoms and at the end. However, people who had been in contact with infected people were still required to communicate daily with an epidemiologist. The following procedure is currently in progress: Passengers receive self-isolation instructions at the border, noting that, if symptoms occur, they must report to their family doctor at the beginning and end of the monitoring period (14 days). People who do not have a doctor in the Republic of Croatia must report their health status to an epidemiologist.
o Pharmacists have been given the opportunity to check the epidemiological status of people in the Central Health Information System (CEZIH). Before entering the pharmacy, all citizens must submit their health ID to a pharmacist, who will not only check their status but also check if self-isolation measures were issued to the patient 

Systems used for surveillance of COVID-19
Surveillance is being conducted on several levels:
o Epidemiological surveillance: this is conducted via reporting all COVID-19 patients – including those who have died of COVID-19 – in the National Public Health Information System (Croatian acronym: NAJS). This system is used to monitor and store all medical data, in this case, data on the number of patients and deaths from COVID-19.

Since this is a new disease, it was necessary to adapt the online interface for the entry of new disease: COVID-19 and its virus SARS-CoV-2. They are now included in the list of infectious diseases  monitored under the Law on the Protection of the Population from Infectious Diseases.
o Surveillance at primary care level: If the primary care physician suspects a COVID-19 infection, they can refer the patient to one of the designated ambulances specifically set up for taking samples or for drive-in diagnostics (if established in the county).
o Surveillance at the secondary health care level: If the clinician suspects a COVID-19 infection at the hospital (in the case of patient hospitalisation), they will take samples and send them to the nearest diagnostic center. Until the arrival of results, the patient is treated as positive (meaning isolation and other measures to prevent the spread of infection).