Policy responses for Czech Republic - HSRM

Czech Republic

Policy responses for Czech Republic

1.4 Monitoring and surveillance

Spring and summer:

The Czech Republic uses the ECDC definition of COVID-19 case and follows the same definition of probable cases and contacts (see http://www.szu.cz/tema/prevence/definice-pripadu-case-definition-evropska-surveillance). COVID-19 shall be reported in the Deceased Examination Report in all mortality cases where the illness has caused, is expected to cause, or has contributed to the death. The COVID-19 coronavirus shall be explicitly marked [1].

Monitoring of the epidemiology of COVID-19 cases and their contacts is undertaken by the Public Health Authorities. A designated webpage from the Ministry of Health (koronavirus.mzcr.cz ) provides up-to-date information on the number of diagnosed cases, performed tests, hospitalized COVID-19 patients, deaths, recoveries, etc., also the regional distribution of cases. 

Contract tracing is implemented in several ways. First, the Regional Public Health Authorities contact confirmed cases to develop a list of their contacts in an interview.

Second, a tracking system called “smart quarantine” was developed by an initiative Covid19CZ and then adopted by the Czech authorities. The main idea of smart quarantine was based on tracing confirmed cases by using a history of location data from mobile phone operators and banks (via card payments). With the explicit consent of the confirmed infected person, the so-called memory map would be created over the history of the last 5 days (places where the person could have come in contact with other people) and a Public Health officer then interviews him or her to identify all potential cases. The smart quarantine project was originally designed so that after the initial interviews, all identified suspected cases could be immediately contacted (via specially designed call center), put into quarantine, and subsequently visited by a designated team to collect sample for the testing. If positive, the process was about to be repeated with the newly confirmed case [2]. At first, the system was tested in 3 regions, but on April 20, it was introduced in a trial mode throughout the entire Czech Republic and since May 1, it has been fully operational [5]. Since June 1, modified measures on quarantining and isolating suspected cases apply (see Transition Measures to section 1.3), which also altered plans for immediately testing of all suspected cases by the designated mobile teams.

Third, there is a mobile phone application called eRouška (which translates to eMask), available for both Android and iOS. Using Bluetooth, it connects with other users nearby and exchanges designed identifiers. In the case that a person tests positive, Public Health officers are provided his or her close contacts by decoding application users’ phone numbers from the confirmed case’s own phone [3].

A study on collective immunity to COVID-19 took place between April 23 and May 1. A population-wide sample of 19 500 people was tested in 6 designated areas of the Czech Republic (including Prague). Only people with no respiratory or other symptoms were tested using the rapid blood tests for antibodies. Those with positive tests were also tested for virus presence using a nasopharyngeal sample [4]. The preliminary results showed that level of immunization is very low in the Czech Republic, with values ranging between almost 0% to at most 5% in the hardest hit areas. On average, for every diagnosed case of coronavirus, there were 2 that went undiagnosed. From these undiagnosed cases, a slight majority showed no symptoms of the disease and according to the authors of the study, it can be assumed, that between 27% and 38% of the cases experienced no symptoms [6].  

Regional Public Health Authorities are monitoring and surveying the situation in senior homes and long-term care facilities separately and provide summary statistics on their webpages. The Ministry of Health recommends testing all new clients prior to their arrival / transfer to these facilities; this recommendation was withdrawn by the end of June. 

Autumn development:

By September 1 and in light of the new surge in infection incidence, it become clear the monitoring and surveillance did not function desirably. The original concept of the memory map creation using digital maps was abandoned. Instead, the term “smart quarantine” is used by the government for all monitoring and tracking activities done by the Regional Public Health Authorities. The original eRouška- application was used by only 2% of the population (by the end of August).

Risky contacts continue to be tracked using controlled interviews with confirmed cases, but capacity of Regional Public Health Authorities  reached its limits already on September 4: The Chief Public Health Officer admitted the capacity limit was 400 confirmed cases to track per day at that time. Public Health Authorities did not manage to recruit enough new employees and staff shortcomings persist. Early-September plans were to increase capacity to track up to 750 cases per day with the help of joining medical students. Already on September 8, the number of new cases exceeded 1000. The Prime Minister and the Chief Public Health Officer stated in interviews (on September 4) that only contacts of the seriously ill infected people would be tracked. After public opposition, the Prime Minister denied this statement. The government then introduced the idea of “self-tracking”, but the new tool had to be developed. In early October, an electronic form was introduced that confirmed cases would be able to fill in prior to the expected call from a Regional Public Health Authority. The filled form is supposed to save time during the epidemiologic interview. On October 14, the tool was released for a wider use, but the access codes are not yet sent to all detected cases.

The epidemiological situation is quickly deteriorating  in September and October and partly this is assigned to low tracking capacities that have not been developed over the summer . Despite promises, call centres were not set up and no new staff was trained. In the beginning of September, the share of positive tests increased, but the exact number was not made public. In mid-October, the 7-day test positivity average is 27%.

With the new Minister of Health in office, more data were made open. Among others, the “smart quarantine dashboard” shows number of tracked detected and suspected cases, their % of the same-day detected cases, and number of tracking people, among others (koronavirus.mzcr.cz/chytra-karantena).

Tracking capacities were increased dramatically on a “help-ourselves” principle when business companies’ call centres joined the effort of Regional Public Health Authorities. Nowadays, private banks’, insurers’, energy providers’, mobile network operators’, transport companies’, and others call centres are connected within the system. These call centres operators handle calls to suspected cases and are mandated to order quarantine. They also inform a person to contact his/her general practitioner who then fills in the PCR test eRequirement (some call centres operators can do that directly, too). At first, Public Health Authorities insisted the first call with a detected case has to be led by an epidemiologists; with increasing number of cases, these calls are led also by trained non-epidemiologists (nurse and medical students for the most part).

In the beginning of September, there were around 200 tracking people a day; in mid-October this number increased to 1400. Still, a high share of both detected and suspected cases is not contacted within 48 hours (koronavirus.mzcr.cz/chytra-karantena).   

This problem shall be partly offset by the new version of eRouška-application (finalized in the second half of September) in which risky contact warning is provided anonymously. The MoH hopes this adjustment makes the app attractive to more people; 1.1 mil people has downloaded the app by Oct 16.  The smart-quarantine system sends mobile phone message to a newly detected case with a unique identifier code. If that person is an eRouška-app user, s/he can enter the code into the app and the app sends warnings to all risky contacts based on the length and proximity of mobile phones’ contacts in previous days. Receivers of such messages are advised to contact their general practitioner for further measures.

[1] https://www.uzis.cz/index.php?pg=aktuality&aid=8393 
[2] https://koronavirus.mzcr.cz/chytra-karantena/
[3] https://koronavirus.mzcr.cz/aplikace-erouska/
[4] https://covid-imunita.uzis.cz/
[6] https://covid-imunita.uzis.cz/res/file/prezentace/20200506-dusek.pdf