Policy responses for Estonia - HSRM


Policy responses for Estonia

1.4 Monitoring and surveillance

Since August 20, the mobile app HOIA is available for download via www.hoia.me, helping to curb the spread of the coronavirus with the help of app users. The application notifies the user if they have been in close contact with an infected person. The phones of the users of the application exchange anonymous codes, which means that the government, the manufacturer of the application, and the manufacturer of the phone will not know who was in close contact with whom. If any user of the application becomes ill, he or she will mark himself / herself (i.e. his / her anonymous code) as ill in the application and other users will be notified of a possible close contact with the infected person. The application notifies the person if he or she has been closer than 2 metres to an infected person for at least 15 minutes. The application also provides initial guidance on how to proceed. This way, the application can also inform people whom the infected person does not know or remember, allowing them to take steps to protect their own health and the health of others.

Special attention has been paid to privacy and security when developing the application. Phones communicate with each other using Bluetooth radio signals, exchanging codes that say nothing about the users of the application. Through the application, the state does not receive any information about the identity of those infected or their close contacts.

The application was created in cooperation with the Ministry of Social Affairs, The Health Board, the Health and Welfare Information Systems Center and 12 Estonian companies - Cybernetica, Fujitsu Estonia, Guardtime, Icefire, Iglu, Mobi Lab, Mooncascade, Velvet, FOB Solutions, Heisi IT OÜ, Bytelogics and ASA Quality Services OÜ. In addition, the Swiss DP-3T project team contributed to the development of the application, and the Estonian application is based on their solution.

For now the HOIA application can be used in Estonia and it has been downloaded 65,000 times (information based on 27th of August). The next step is to start exchanging anonymous codes for close contacts also across borders, so that the application can also be used when traveling abroad. For more information and frequently asked questions: https://hoia.me/en

Source: https://www.sm.ee/en/news/estonian-coronavirus-mobile-application-hoia-now-available-download

Instead of healthcare inspectors,  who work in the Health Board, Estonia has started using an automated computer robocall system  to call contacts of COVID-19 positive cases. The system was developed in order to reduce the burden on contact tracers and let the contacts know their exposure as soon as possible. The system provides voice support in 3 languages (EST, RUS, ENG) and became operational on the 17th of September. A contact of a positive case will first receive a text message, followed in 15 minutes by the robocall to let them know the situation and give first instructions. COVID-19 positive cases will still be initially contacted by real humans.

Probable cases are determined by clinicians based on existing symptoms. Contacts of probable cases include household members, persons in direct contact (e.g. hand shaking), persons spending more than 15 minutes less than 2 metres from a person who is a probable case, and health professionals or carers that provide care to the probable case without using proper personal protective equipment (PPE). The case definition has been updated regularly based on WHO or ECDC definitions.

Clinicians define cases by using WHO ICD-10 codes. Diagnosis code U071 (COVID-19, virus identified) is used when COVID-19 has been confirmed by laboratory testing. Diagnosis code U072 is used when COVID-19 is diagnosed clinically or epidemiologically but laboratory testing is inconclusive or not available. In addition, coding standards were developed for coding other manifestations caused by COVID-19 to assure unified coding by all health care providers dealing with COVID-19 or probable cases.

Contact tracing was used in the early stages until community transmission started.

Sources: https://www.terviseamet.ee/et/koroonaviirus/, https://www.kriis.ee/et,

On 4 April, the Health Board confirmed that in the regions where the infection is not yet widespread, the Health Board’s regional departments are focusing on case tracing in order to prevent COVID-19. In these regions, each confirmed case of COVID-19 is handled individually, including figuring out the potential contacts of the infected person and implementing additional isolation guidelines.

Source: https://news.err.ee/1072991/health-board-combating-coronavirus-according-to-regional-spread-patterns

As of May 8th, family doctors have diagnosed COVID-19 in 500 patients without testing. At the beginning of the coronavirus pandemic, Estonia lacked the capacity to test everyone who fell ill. As a result, family doctors were granted the right to diagnose patients with COVID-19 without testing based on the clinical picture as well as other diagnostic criteria — whether they had been in close contact with a known COVID-19 patient, whether they had travelled from abroad or a risk area, as well as in cases where the patients were employees who had come in contact with COVID-19 patients at work. Of the 500 patients who have been diagnosed with COVID-19 by their family doctors, only seven have not yet been determined to have recovered.

Source: https://news.err.ee/1087458/family-doctor-covid-diagnoses-significantly-increase-total-infection-stats