Policy responses for Czech Republic - HSRM

Czech Republic


Policy responses for Czech Republic

1.3 Isolation and quarantine

Effective since March 1st, 2021, the minimum quarantine and isolation period was prolonged to 14 days (1). Starting March 9, a negative PCR test is required to terminate isolation for people infected with the South African variant and to terminate quarantine for their risky contacts and the PCR test has to be performed at least 14 days after the risky contact (2).

The main algorithm principles remain the same from September, with the addition of an algorithm for risky contacts in shared households and quarantine and isolation exceptions introduced for those who have either recovered from COVID-19 or who have been vaccinated (1):
- A patient who has tested positive with a PCR test without clinical symptoms is released from isolation 14 days after the positive result. In the case of clinical symptoms, the isolation shall be terminated no sooner than 14 days after the positive test and only if there are at least three days without clinical symptoms. No further PCR test is necessary to end the isolation, but a negative test result is necessary for cases of infection with the South African variant.
- For risky contacts: the 14-day quarantine applies, and a PCR test is ordered to be taken between days 5 and 7 after the risky contact, and no later than day 10.  In the case of a positive test, the above-mentioned isolation applies. If no test is taken and there are no symptoms, the quarantine is terminated on day 14. For contacts of confirmed cases with the South African variant, a negative PCR test is necessary, but no earlier than on day 14.
- Isolation is not required for asymptomatic PCR or POC antigen positive cases who have recovered from a COVID-19 infection within the last 90 days.
- Quarantine is not required for asymptomatic people who have had their COVID-19 vaccinations more than 14 days prior to the risky contact; symptomatic vaccinated people are however required to take a PCR test. Quarantine is not mandatory for contacts who have previously tested positive and recovered within the last 90 days.
- For patients who tested positive with a POC antigen test and with clinical symptoms, the algorithm for isolation is the same as for the PCR-positively tested patient. In the case of a positive antigen test and no clinical symptoms, or negative antigen test and demonstrated clinical symptoms, the result must be further confirmed using a PCR test and isolation that follows the plan above.

Sources:
1 MZDR 40555/2020-4/MIN/KAN, MZDR 40555/2020-3/MIN/KAN
2 MZDR 40555/2020-5/MIN/KAN

At the end of February, with the surge of COVID-19 cases in Europe, the government advised that Czech citizens arriving in the country from northern Italy and other high risk areas should quarantine themselves at home and contact their primary care physician or public health authority. After this consultation, the health professionals determined whether a 14-day quarantine for medical reasons was necessary [1].

On March 6, the Ministry of Health (MoH) ordered all Czech citizens coming back from Italy to stay 14 days in home quarantine, starting on March 7. Incoming citizens were obliged to contact their primary care physician who made the official quarantine decision. A day later, the MoH Extraordinary Measure was extended to permanent residents, temporary residents with 90+ days permits and workers in the Czech Republic [2]. Noncompliance with quarantining could result in a fine of up to 3 million CZK [3]. On March 13, the mandatory 14-day quarantine was extended to people returning from other high-risk countries [4]. On March 16, 3 villages in the Olomouc region were put under quarantine for two weeks because of the high occurrence of COVID-19 cases [5]. Because some residents of the quarantined district did not conform to quarantine orders, police forces were assigned to monitor the quarantined region. Starting on March 23, the 14 days quarantine also applies to cross-border movement, for details see section 6.

People who test positive for COVID-19, are suspected to be infected, or were in contact with a positively tested person are ordered to self-isolate in home quarantine, unless their health condition requires medical treatment [6]. Municipalities are required to provide for the isolation of homeless people, if required. For such reasons, tent camps were being built in bigger cities. During the first few months of the pandemic, social facilities for long-term care were required to reserve 10% of their capacity to accommodate suspected or infected cases among their residents in isolation. Where capacities were not sufficient, municipalities or regional authorities took actions to reserve extra capacities, for example at spas and rehabilitative facilities that were not in operation at the time. Starting on April 27, spas could reopen their rehabilitative programs under strict conditions (accommodation in 1-person rooms only, etc) and regions were allowed to decrease their reserved extra capacity for infected seniors with mild symptoms who were not able to stay at their home facility from 60 to 10 beds per 100 000 inhabitants (7).

Since June 1 (in effect till July 7), a new (updated) directive describing how to proceed with quarantining suspected and confirmed cases is in force. People with clinical symptoms are ordered to self-isolate or are hospitalized, depending on the seriousness of their symptoms. People coming in close contact with confirmed cases are ordered into home quarantine. This does not apply to people who already had the virus and had two negative PCR tests. These are considered immune to the disease and are at no risk of spreading it.

Furthermore, after the first positive test, a person is ordered into home isolation. If the test is negative, a person who came into contact with a confirmed case (a person who tested positive), is ordered into home quarantine for 14 days, even if they exhibit no symptoms (counted from the day of meeting the contact). If a person with clinical symptoms is not known to come into a contact with another infected person, neither quarantine nor home isolation are necessary, but the person will be monitored by his/her general practitioner.

To be cleared from quarantine, a person has to stay 14 days in quarantine with not having any symptoms and has to undergo one PCR test. This applies for people who came into contact with an infected person, with whom they do not live in one household. A person has to undergo blood test in addition to the PCR test, if they share a household with a positive COVID-19 patient, whereas this test has to be performed on the same day as the infected person’s second test. To be released from home isolation, a person has to undergo 14 days in isolation, must not have any symptoms of the disease whatsoever and they have to have two negative PCR tests within 24 to 48 hours of each other.

Sources:
https://koronavirus.mzcr.cz/wp-content/uploads/2020/06/Jednotny-postup-testovani-a-izolace-COVID-19_11062020.pdf
1 https://www.vlada.cz/cz/media-centrum/tiskove-konference/tiskova-konference-k-aktualni-situaci-v-souvislosti-s-vyskytem-koronaviru-v-evrope--28--unora-2020-179940/
2 https://www.mzcr.cz/dokumenty/ministerstvo-zdravotnictvi-vydalo-nove-mimoradne-opatreni-tykajici-se-karanteny-_18668_1.html
3 https://www.vlada.cz/cz/media-centrum/tiskove-konference/tiskova-konference-po-jednani-s-hejtmany-a-primatorem-hlavniho-mesta-prahy-ke-koronaviru--6--brezna-2020-180125/
4 https://koronavirus.mzcr.cz/pokyny-pro-osoby-vracejici-se-z-rizikovych-oblasti-ke-krizovemu-opatreni-vlady-ve-veci-karanteny-pro-tyto-osoby/
5 http://www.socr.cz/file/5952/Olomoucko%20-%20karant%C3%A9na%2020200316.pdf
6 https://koronavirus.mzcr.cz/mam-zdravotni-potize-co-mam-delat/
7 https://koronavirus.mzcr.cz/ministerstvo-upravilo-opatreni-tykajici-se-lazni-a-rezervnich-luzek-pro-seniory/

On September 11, the Chief Public Health Officer issued instructions to Regional Public Health Authorities concerning the classification of risky contacts. If people are in close contact covering mouth and nose during the whole contact time, or if not covering mouth and nose for less than 15 minutes of the whole contact time (for example eating), or if not covering the mouth and nose while at the same time being more than 1.5 meter apart, these contacts are not considered risky and no quarantine will be imposed. Any kind of face protection is acceptable, except for improvised scarfs (1).  

Effective since September 25, there has been adjustments to the isolation and quarantine algorithm. The second test requirement has been removed for all cases, including the health and social care workers who previously had to be tested again. Other principles remain (2):
- A PCR-positive patient without clinical symptoms is released from isolation after 10 days after the positive PCR test. In case of clinical symptoms, the isolation shall be terminated no sooner than 10 days after the positive test and only if there are at least 3 days without clinical symptoms; generally, GPs terminate isolation 10 days after symptoms began. No further PCR test is necessary to end the isolation.
- For risky contacts, the 10-day quarantine applies, and a PCR test is ordered to be taken between day 5 and 7 from the risky contact, no later than day 10.  In case of a positive test, the above-mentioned isolation algorithm applies. If no test taken and no symptoms, the quarantine is terminated on day 14.
For a patient tested positively with a POC antigen test with clinical symptoms, the algorithm for isolation is the same as for the PCR-positively tested patient. In case of positive antigen test and no clinical symptoms, or negative antigen test and demonstrated clinical symptoms, the result must be confirmed using a PCR test and isolation than follows the algorithm above.
 
Sources:
1 koronavirus.mzcr.cz/wp-content/uploads/2020/09/Metodický-pokyn-roušky.pdf
2 MZDR 40555/2020-1/MIN/KAN

On July 8, the MoH updated principles for PCR testing and ending the quarantine. The so-called time factor was added when assessing infection transmission potential. A PCR-positively tested person without clinical symptoms was released from isolation after 14 days (counting from the day of the first positive PCR test); and no PCR test is necessary to end quarantine. In case of mild clinical symptoms, the quarantine ended after the 14 days as well if there were at least 4 days without clinical symptoms; no further PCR test necessary. In the event of epidemiologically significant risky contact, 14-day quarantine applied, and a PCR test was recommended within the first 5 days. In case of a positive test, the above-mentioned algorithms applied. In case of a negative test, persons have to retake a PCR test  after 14 days from the risky contact; if this is also negative, the quarantine ended; if positive, the above-mentioned isolation algorithms applied (1).   

Effective from September 1, isolation and quarantine are shortened to 10 days. Basic quarantine and isolation principles remain the same: A PCR-positive patient without clinical symptoms is released from isolation after 10 days from the first positive PCR test. In case of clinical symptoms, the isolation is terminated after 10 days if there are at least 3 days without clinical symptoms. No further PCR test is necessary to end isolation, except for health and social care workers who are tested on the 10th day of isolation. In case of a positive test result, test must be retaken 5 days later. For close contacts, the 10-day quarantine applies, and a PCR test is recommended within the first 5 days after the risky contact. In case the test is positive, the above-mentioned isolation algorithms applied. In case the test is negative, another PCR test is done 10 days from the risky contact; if negative, the quarantine is ended; if positive, the above-mentioned isolation algorithms apply (2).

The MoH published a methodology unifying regional Public Health Authorities’ approaches to schools’ closure in case of confirmed cases among students or teachers (September 7). At the same time, the government considers not imposing quarantine on people wearing FFP2 respirators.

Sources: 
1 https://www.mzcr.cz/tiskove-centrum-mz/ministerstvo-zdravotnictvi-aktualizovalo-algoritmus-k-ukonceni-karanteny/
2 https://www.mzcr.cz/tiskove-centrum-mz/mimoradne-opatreni-zkracuje-karantenni-opatreni-na-deset-dni/