3.2 Managing cases
Update 18th May 2021
In mid-April 2021 the MoH released a revised protocol for the discharge of coronavirus cases and close contacts from mandatory confinement (https://www.pio.gov.cy/coronavirus/uploads/14042021_instructionsforpersonsquarantinedEN.pdf) and a revised protocol for the management of health services personnel, following a new assessment of the risk of exposure to a confirmed case of Covid-19 infection in areas providing health services (https://www.pio.gov.cy/coronavirus/uploads/12052021_diaxeirisiprosopikouygeias.pdf).
Update 8th April 2021
By the middle of March, despite the measures taken, data showed that there was a continuous increase in cases, as well as in hospitalisations. On average, 7-10 people were admitted for treatment, a number greater than the number of people receiving discharge, with an increase of 100% in positive cases when compared to the end of February
The contact tracing team of the MoH, following recent incidents of self-isolation violations by persons tested positive proceeded in reviewing and updating the relevant protocol. The updated protocol now provides a detailed description of what the obligations are and what procedures need to be followed by the personal doctors and providers for persons in mandatory self-isolation who are either tested positive or are close contacts of persons tested positive.
https://www.pio.gov.cy/coronavirus/uploads/31032021_PIO%20DECREE%20No%2012%20EN.pdf, pages 17-18.
In order to reduce the probability of virus spreading in schools and the community, on April 8th the MοΗ in consultation with the Ministry of Education and the Scientific Advisory Committee, changed the protocol for tracing positive cases in schools.
Update 11th March 2021
The rapid spread of the virus has resulted in more people in need of hospitalisation and of specialised care in an Intensive Care Unit. These were the crucial indicators which determined the decision of the Cyprus government to take new stricter measures with the aim to reduce cases to safety levels and be able to provide quality health services to those who need them (https://www.pio.gov.cy/coronavirus/uploads/8012021_diloseisYPygeiasEN.pdf). See 1.2 Physical distancing, for the new measures.
There were serious concerns about the resilience of hospitals as the number of patients treated for coronavirus increased. At the beginning of January 2021, the reference hospital for COVID-19 patients, reached to 100% of its capacity (https://gr.euronews.com/2021/01/04/kipros-anisixi-i-afxisi-krousmaton). In this context of epidemiological deterioration, the State Health Services Organization assured that the mechanism for securing more beds was activated. New clinics for coronavirus patients were set up at the Larnaca General Hospital and contacts with other hospitals were made to coordinate actions in case of increased need for beds arose. Adequate numbers in medical and nursing staff, as well as the appropriate equipment, were secured (https://ygeia-news.com/kratika-nosileytiria/28-klines-gia-nosileia-asthenon-me-koronoio-sti-nea-kliniki-covid-19-toy-g-n-larnakas/). At present (March 6th, 2021) Limassol is the district with the highest epidemiological burden and with increasing hospitalization needs, and as a result patient requiring hospitalisations from this particular district are directed to the reference hospitals in Ammochostos district and the Nicosia General Hospital (https://www.kathimerini.com.cy/gr/kypros/kypros-ygeia/apo-tin-lemeso-i-pleiopsifia-ton-eisagogwn-sta-nosokomeia).
Due to the increasing needs in intensive care nurses, the education department of the directorate of nursing services of the MoH has carried out an fast-paced online training program titled "Basic Principles of Intensive Care - COVID-19" (https://ygeia-news.com/nosileytikes-ypiresies/taxyrrythmo-ekpaideytiko-programma-tomea-ekpaideysis-%C2%ABbasikes-arxes-entatikis-nosileytikis-covid-19%C2%BB/).
On January 22nd, the MoH announced the revised guidelines for the management of close contacts of COVID-19 (https://www.pio.gov.cy/coronavirus/uploads/%CE%9F%C%CE%B1%20COVID19.pdf).
Τhe role of primary care and personal doctors (GPs) in managing cases remains the same as in the onset of the pandemic. During the pandemic there were efforts to support personal doctors with PPE. The plan of the Health Insurance Organization is to change the way of operation of GPs’ (by including actions to prevent and treat chronic diseases and vaccinations) and also the way of their compensation in NHS on the basis of quality and performance indicators.
Update 31st December 2020
During December 2020, the MoH announced a series of revised Guidelines for managing the confirmed cases for COVID-19, in line with the new data and the scientific developments (https://www.pio.gov.cy/coronavirus/uploads/Isolation%20Guidelines%20for%20Suspected%20Cases%20of%20COVID-19.pdf)
On December 28th, a written statement by the Minister of Health, stated that in the recent days the Health System has been under intense pressure due to the growing number of patients and especially the admissions to the ICU (https://www.pio.gov.cy/coronavirus/uploads/28122020--%CE%93%CF%81%CE%B1%CF%80%CF%84%CE%AE%20%CE%B4%CE%AE%CE%BB%CF%89% D%CE%BF%CF%85%20%CE%99%CF%89%CE%AC%CE%BD%CE%BD%CE%BF%CF%85.pdf).
Update 7th December 2020
At the end of November 2020 the MoH announced the Revised Guidance for the discharge and ending of isolation for people tested positive to SARS-CoV-2 (https://www.pio.gov.cy/coronavirus/uploads/Revised%20Guidance%20for%20persons%20in%20quarantine_%2023nov.docx.pdf), he new Guidelines for suspected COVID-19 cases, (https://www.pio.gov.cy/coronavirus/uploads/guidelines%20for%20suspected%20covid-19%20cases_November%202020.pdf), as well as new Guidelines for confirmed COVID-19 cases (https://www.pio.gov.cy/coronavirus/uploads/guidelines%20for%20confirm%20covid-19%20cases_November%202020.pdf). All of the guidelines have been drawn up in cooperation with the Advisory Scientific Committee.
Moreover, the MoH informed the public that as of November 20th and on the basis of the new revised protocol for the discharge of patients, the Personal Doctors for adults and paediatricians for children are the designated professionals responsible for the management of patients tested positive (https://www.pio.gov.cy/coronavirus/uploads/23112020_revisedprotocolfordischarge_ENGL.pdf).
Update 7th NOvember 2020
On November 6th the Scientific Advisory Committee reported that in the last few days the daily numbers of positive tests continued to be in three digits, therefore a higher percentage of patients developing severe symptoms was very likely in the following weeks requiring to be admitted to hospital. The second wave of the pandemic is with greater numbers in hospitalisations and increasing demand for ICU care (https://www.pio.gov.cy/coronavirus/uploads/06112020_sinentefxitypouepistimonikiomada.pdf).
Update 2nd November 2020
Due to the increasing number of phone calls received by the Ambulance Service call centre, regarding questions of general nature, on October 19th the MoH reminded that the 1420 line operates strictly for Covid-19 emergency reporting, and 1412 for any other general information about Covid-19. Citizens may also use the email address [email protected], for questions related to protocols and guidelines in force. It was also reminded that relevant information is available on the official website of the Public Information Office (PIO) https://www.pio.gov.cy/coronavirus/ (https://www.pio.gov.cy/coronavirus/uploads/19102020_1420number.pdf).
In the light of the increased Covid-19 positive tests being recorded daily and, in an effort, to improve the procedures of informing persons tested positive and their close contacts, on October 23rd and 30th, the Tracing Team of the Epidemiological Monitoring Unit proceeded in implementing some changes in its procedures in order to minimize the time required to inform both the confirmed positive tests and their close contacts.
At the same time the MoH circulated revised guidelines and a risk assessment procedure for the management of healthcare personnel exposed and /or tested positive to the virus while working at the healthcare facilities.
On October 21st the MoH announced that the personal doctors should assess the influenza cases according to the revised algorithms for the management of suspected and confirmed COVID-19 cases. (https://www.pio.gov.cy/coronavirus/uploads/21102020_enimerosiprosgiatrous.pdf).
It is important to note that MoH have updated all the algorithms / Specific clinical protocols used for patient pathway based on risk of infection and outlining the provision of treatments for Covid-19 in various settings (Public Health Clinics, Primary Healthcare Centres and Hospitals).
For further details see: https://cyma.eu/2017/index.php/2016-06-11-08-13-31/item/508-anatheorimenoi-algorithmoi-enilikon-kai-paidion-vasei-epikindynotitas-me-pithani-loimoksi-Covid-19 and https://www.pio.gov.cy/coronavirus/pdf/alg4.pdf
Update 18th October 2020
Following the recent deterioration of the pandemic situation and the increasing incidence of non-compliance with protocols and decrees by the public, on October 16th the MoH issued new instructions to persons testing positive to the virus, making compulsory self-isolation, avoiding close contacts with family members and next of kin, (https://www.pio.gov.cy/coronavirus/uploads/16102020_3EN.pdf). It is also emphasised that under no circumstance must a positively-tested person come out of self-isolation and that the relevant protocols should be always followed (https://www.pio.gov.cy/coronavirus/pdf/o1.pdf).
On October 17th, following the increased number of Covid-19 cases, the MoH announced that individuals who are informed that are positive to the virus, should contact their close contacts and inform them that they also must remain in self-isolation until the Epidemiological Unit contacts them. In the event that any of these persons, develops symptoms prior to being contacted by the Epidemiological Unit, they should inform their personal doctor stating the they were a close contact of a confirmed Covid-19 case (https://www.pio.gov.cy/%CE%B1%CE%BD%CE%B1%CE%BA%CE%BF%CE%B9%CE%BD%CF%89%CE%B8%CE%AD%CE%BD%CF%84%CE%B1-%CE%AC%CF%81%CE%B8%CF%81%CE%BF.html?id=16318#flat).
According to the scientific director of the reference hospital for Covid-19, the average age of people treated, has dropped, as now 50% are under 45 (https://ygeia-news.com/kratika-nosileytiria/to-50-ton-asthenon-sto-nosokomeio-einai-kato-ton-45-eton-tonizei-i-amalia-xatzigianni/).
Update 28th September 2020
On September 18th the MoH announced that the European Medicines Agency (EMA) has adopted the use of dexamethasone in patients with COVID-19 with oxygen or mechanical ventilation (https://www.pio.gov.cy/coronavirus/press/18092020_3.pdf). On the same day, the MoH announced that the European Medicines Agency (EMA) has confirmed its recommendation to suspend all ranitidine medicines in the EU due to the presence of an impurity called N-nitrosodimethylamine (NDMA) found in low levels which is classified as a probable human carcinogen based on animal studies. This follows a re-examination of CHMP’s April 2020 opinion, which was requested by one of the companies marketing ranitidine medicines (https://www.pio.gov.cy/coronavirus/en/press/18092020_2.pdf).
Update 10th September 2020
In response to a COVID-19 positive citizen who had symptoms for several days before being subjected to laboratory examination, on September 4th the MoH reiterated its call to all citizens to contact their Personal doctor as soon as they develop coronavirus symptoms. In addition, it was emphasised that any citizen who presents COVID-19 symptoms must at the same time terminate all social contacts and activities and remain in self-isolation, strictly following the instructions of his/her Personal doctor (https://www.pio.gov.cy/coronavirus/press/4092020_8.pdf).
On September 4th the MoH announced that the European Medicines Agency (EMA) has begun evaluating an application for approval of Dexamethasone Taw for the treatment of adult patients infected with COVID-19 (https://www.pio.gov.cy/coronavirus/press/4092020_1.pdf).
Update 29th August 2020
On August 18th the MoH announced that Cyprus has submitted a request through the European Commission, to secure a sufficient quantity for vaccination coverage of the population against COVID-19 (first agreement with AstraZeneca Pharmaceutical Company (https://www.pio.gov.cy/coronavirus/press/18082020_1.pdf).
Updated guidelines for laboratories and health professionals involved in laboratory testing of SARS-CoV2 patients, were announced (https://www.pio.gov.cy/coronavirus/pdf/7_4_odhgies_ergasthriakhs_diereunhshs.pdf).
Update 5th July 2020
On June 30th the MoH announced that all persons entering the Republic from the countries of category C (higher risk) or from countries other than categories A (low risk) or B (moderate risk), have to remain in quarantine for 14 as per MoH guidelines (https://www.pio.gov.cy/coronavirus/press/30062020_2.pdf).
On June 26th the MoH announced that the European Medicines Agency (EMA) has now recommended conditional authorisation of the use of the antiviral medicine Remdesivir for the treatment of SARS-CοV-2 in adults and adolescents of age 12 and above presenting with pneumonia who require supplemental oxygen. (https://www.pio.gov.cy/coronavirus/press/26062020_1.pdf).
Update 9th June 2020
On June 9th the MoH announced that the European Medicines Agency (EMA) has now received an application for conditional authorisation of the use of the antiviral medicine Remdesivir for the treatment of COVID-19 and has formally started its evaluation. The medicine is available to patients through clinical trials and palliative-care programmes (https://www.pio.gov.cy/coronavirus/en/press/9062020_2.pdf).
For the better management of new cases of SARS-CoV-2, the MoH is purchasing services from nurses and health professionals for the operation of thermal cameras and the platform that will be used for travellers and for assisting the Surveillance and Control of Communicable Diseases Unit at the MoH (https://www.moh.gov.cy/moh/moh.nsf/All/70AE07E00EE522F9C22585840048F668?OpenDocument).
From the beginning, telephone helplines for COVID-19 have been set up, as well as national guidance protocols (see for example https://www.pio.gov.cy/coronavirus/pdf/7_1_odhgies_pros_epaggelmaties.pdf or https://www.pio.gov.cy/coronavirus/pdf/alg1.pdf) for personal doctors in order to triage and direct people for further investigation to the Unit of Epidemiological Surveillance and Control of Infectious Diseases at the MoH and arrange an appointment for testing. Personal doctors can also direct people for further triage through Public Health Clinics in primary care, where doctors and nurses with the appropriate Personal Protection Equipment (PPE) examine patients on an appointment basis. In emergency situations patients can be hospitalised according to the national guidance protocols for admission and the protocols of the Ambulance Service. Lastly personal doctors received guidelines for the management of patients with suspected or confirmed COVID-19 that present with mild symptoms and are not hospitalised but remain on quarantine. A protocol for the discharge of patients with confirmed COVID-19 infection treated with 14 days of quarantine in outpatient settings is being used. Protocols and guidelines can be found on the Cyprus Government website: https://www.pio.gov.cy/coronavirus/.
Specific clinical protocols are in use for all in-patient pathways based on risk of infection, which outline the provision of treatments for COVID-19 in various settings, including critical care. Moreover, guidance outlines measures to control and prevent the transmission during care provision to in-patients with possible or confirmed COVID-19. The infection prevention and control guidance for COVID-19 recommends strict hand hygiene, physical contact and human droplet precautions, clinical waste management as well as appropriate PPE to prevent droplet transmission of the virus. In most cases, including emergency departments and isolation wards, this includes a fluid resistant mask, a plastic apron, gloves and goggles or face shield, in line with ECDC and WHO guidance, (https://www.pio.gov.cy/coronavirus/pdf/1042020_i3.pdf). According to WHO guidance, airborne precautions should only be implemented when undertaking an aerosol generating procedure and in clinical areas such as ICUs that are treating COVID-19 patients. Until a patient is confirmed positive for the virus, and if hospitalisation is needed, the patient is referred to a Short-stay Nursing Clinic.
All clinical protocols or guidance are based on WHO, ECDC, and other international expert advice and are being updated when necessary by the Scientific Advisory Committee on the Treatment of COVID-19. The Committee is also monitoring the treatments given in other counties and the bibliography and decides about the final treatment protocols to be used.
For the better management of COVID-19, public hospitals will adjust their operations in order to increase their capacity to serve incidents (https://www.pio.gov.cy/coronavirus/press/30042020_4.pdf).
Update 18th April 2020
For the better management of patients and the protection of families from possible infection with the virus, the MoH proceeded on 2nd April with purchasing hospitality and surveillance services from health professionals in a rehabilitation, wellness and assisted living centre which will host patients testing positive for COVID-19, who are discharged with mild or no symptoms, for further treatment and monitoring until they become negative (https://www.pio.gov.cy/coronavirus/press/2042020_14.pdf).
On 3rd April 2020 the Scientific Advisory Committee of the MoH announced guidelines for pharmaceutical treatment of patients (children and adults) infected by the new coronavirus for, based on scientifically available data (https://www.pio.gov.cy/coronavirus/press/3042020_3.pdf).
Further, on 7th April, the MoH announced that the Medicines Council, after actions taken in consultation with the Embassy of Cyprus in Japan and the authorities of Japan, approved the introduction of the pharmaceutical product Avigan 200 mg for 20 patients with COVID-19 disease, who will join the relevant clinical study carried out in Japan (https://www.pio.gov.cy/coronavirus/press/7042020_4.pdf).
On 11th April the MoH clarified that following the confirmation of a case, the Epidemiological Surveillance and Control of Infectious Diseases Unit at the MoH investigates and tracks the contacts of positive cases. It then registers the names / contacts on the online platform for arranging appointments. In the case of tracking of a confirmed case at the hospital, the contact list is prepared by the local hospital infection committee (https://www.pio.gov.cy/coronavirus/press/11042020_3.pdf).
Update 26th April 2020
For the better management of cases, there is a cooperation between reference hospitals managing COVID-19 in Cyprus and Israel to exchange expertise on coronavirus cases treated and the therapeutic methods applied. At the same time, there is a cooperation between the Intensive Care Unit of the Nicosia General Hospital with the corresponding one of the Sheba Medical Centre in Israel, for the exchange of treatment protocols and experiences (https://www.pio.gov.cy/coronavirus/press/28032020_1.pdf).
As of April 25th, 9,070 persons were served by the six public health clinics for COVID-19 cases that operate in all five districts of the island. These clinics operate on an appointment-basis, providing clinical examination and taking of nasopharyngeal swab for Covid-19 testing to all NHS beneficiaries, following referral by their personal doctors.
Update 31st May 2020
On May 28th, the MoH announced that the use of Chloroquine and hydroxychloroquine for the treatment of patients with confirmed COVID-19 has been suspended by the WHO after a clinical study showing an increased risk of adverse reaction from its use in COVID-19 patients. The Scientific Advisory Committee had included the medication in the guidelines (March 2020) based on the existing literature and in the absence of specific or other treatment, but is expected to review the guidelines soon (https://www.pio.gov.cy/coronavirus/press/28052020_2.pdf).
Update 6th June 2020
On June 5th the National Medicines Agency announced that the concern that ACE-inhibitors or ARBs treatment may deteriorate the course of the infection, is not supported by clinical evidence. It is important that patients do not interrupt their treatment with ACE-inhibitors or ARBs (https://www.pio.gov.cy/coronavirus/press/5062020_2.pdf and https://www.pio.gov.cy/coronavirus/en/press/5062020_3.pdf).