Policy responses for Czech Republic - HSRM

Czech Republic


Policy responses for Czech Republic

3.2 Managing cases

Primary care providers and/or Regional Public Health Authorities are the first point of contact. There are designated telephone helplines to provide information to people, including a chatbot to answer FAQ.

On April 9, GPs were ordered by the MoH to perform tests at the end of patients’ quarantine; later, GPs are still responsible for terminating a quarantine or isolation, but tests are not required anymore; since March 2021, an additional test is required for the South African variant (see section 1.3 for details). Primary care providers or Regional Public Health Authorities are the first point of (telephone) contact for suspected cases, mandated to require testing and to order the quarantine or isolation. Starting November, GPs can use the point-of-care (POC) antigen tests to confirm COVID-19 positivity for patients with symptoms. In such case, RT-PCR test is not necessary, and the GP puts a patient into isolation (see section 1.4). In case of negative POC antigen tests, a confirmation RT-PCR test must be ordered for a symptomatic patient. In other cases (asymptomatic patients), POC antigen tests are not recommended for use by GPs (3).

There is no hospitalization for mild cases required, unless special conditions apply (need to isolate cases from LTC facilities, for example).

The triage of COVID-19 patients takes place, at first, at home via phone. By the beginning of April, “first-line” physicians (describing those triaging patients in hospitals) acknowledged people were frequently using the recommended procedure to contact their GP or their local Regional Public Health Authority first.
  
In spring, triage stances at hospitals were set up in front of the buildings where nurses and other paramedical staff (including medical schools volunteers) were doing the triage. A separate waiting room and a consultation room were designated for triage positive patients in each hospital, which was ordered by an MoH extraordinary measure (1,2). At the beginning of May, hospitals started closing their outside triage premises and moved them indoors under strict hygienic regimes.

The MoH purchased about 500 thermocameras to measure the temperature of people entering hospitals. There has not been a general MoH order to test all patients accepted for hospitalization, but in mid-May it was realized by most hospitals. Waiting wards were designated for planned-care patients to wait approx. 6 hours for test results before being moved to their ward. Most hospitals abandoned this process in June. In defined (required) cases, hospitals get reimbursed for the tests by the health insurers above their usual monthly instalments. In most hospitals only patients with symptoms are tested for COVID-19 when hospitalized, others are generally not.

COVID-19 treatments are approved, if required, by the State Institute of Drug Control in a fast-track procedure (see section 2.1). There was not any rationing of care for COVID-19 patients during spring infection surge. In addition to Remdesivir, HIV drugs, antimalarials or flu pharmaceuticals are used in treatment, including the Japanese drug Favipiravir and blood plasma from those who have recovered from COVID-19.

Autumn and winter development:

The requirement to impose triage on incoming patients was in September associated with the official traffic light map in the country. Only when reaching a certain infection transmission level in a given district, providers had to re-install COVID-19 patient triage. In October, triage of incoming patient for COVID-19 was done by all inpatient facilities. Prague imposed requirement of a negative PCR test for all new admissions to LTC facilities; other regions followed soon after.

Since mid-October, non-urgent care was delayed to free-up capacities for COVID-19 cases. Deployment from all different hospital wards took place, together with wards repurposing (see section 3.1). Medical students and army were employed in hospitals and LTC facilities to support the stressed health workforce, also affected by the illness in many facilities. Regions were required to provide defined capacity for recovering COVID-19 patients not requiring the urgent care anymore. For details, see section 2.2.

COVID-19 positive patients’ treatment follows international recommendations. In November, convalescent plasma is being used and the MoH made a public call for recovered people to donate it.      

In mid-January 2021, a specialized Post-Covid Care Centre was set up in Hradec Králové teaching hospital. The centre takes care of complicated long-Covid patients who are more than three months from recovery. The care is provided by a multidisciplinary team of physicians, including pneumologists, cardiologists, neurologists, psychiatrists, nephrologists, dermatologists, gastroenterologists, rheumatologists and rehabilitation physicians. The Post-Covid Care Centre in Hradec Králové serves patients from the Královehradecký and Pardubický regions. It is expected that similar centres will open in other Czech regions.

Definition, diagnosis and classification of long-Covid and post-Covid syndrome, as well as outpatient care guidelines were published by the Czech Pneumological and Phthiseological Society of the J.E Purkyně Czech Medical Society in early January 2021. Due to ongoing international research on this topic, the guidelines will be subject to regular updates.

Patients experiencing persistent health issues following COVID-19 recovery are observed by their GP and in case of respiratory issues also by an outpatient pneumologist (more than 400 in Czechia, or 3.7 per 100 000 population). Regular check-ups with a pneumologist shall take place until the full patient’s recovery from post-Covid syndrome, including normalization of pulmonary findings.

Sources:
(1) https://video.aktualne.cz/zivot-v-pandemii/pravidla-spinave-cekarny-i-bleskove-zhorseni-stavu-rutina-to/r~aaf818d078f511eab1110cc47ab5f122/?utm_source=centrumHP&utm_medium=newsbox&utm_content=default&utm_term=position-1&utm_campaign=Aktualne 
(2) Ministry of Health Extraordinary Measure on COVID-19 patient triage, issued on March 25, 2020 (MZDR 13311/2020-1/MIN/KAN)
(3) https://koronavirus.mzcr.cz/wp-content/uploads/2020/11/Algoritmus-a-interpretace-antigenn%C3%ADho-testu-v-detekci-nemoci-covid-pro-l%C3%A9ka%C5%99e-od-2.11.2020.pdf