Policy responses for Greece - HSRM


Policy responses for Greece

1.4 Monitoring and surveillance

Despite the longstanding inefficiencies of its health system, Greece swiftly adopted a range of preventive health measures. In the first instance, measures to combat COVID-19 outbreak included identification of cases, contact tracing and imposition of quarantine to those individuals in order to prevent further transmission of the disease. Only patients with moderate to severe symptoms were hospitalized, while those with mild symptoms were encouraged to home isolate. From March 10, measures were reinforced, (while incidence of new cases was still low – 89, with 0 deaths) by physical distancing measures including closure of schools, restaurants, etc. (see section 1.2) and gradually evolved into a lockdown emergency protocol and a stay-at-home order.

The National Public Health Organisation (EODY) is drawing up the relevant definitions concerning the detection of cases with suspected infection of SARS-CoV-2, on the basis of epidemiological data at the time. Therefore, as the epidemic progresses, the case definition has been modified.

The definitions adopted on February 25 were as follows:
Suspected case: Patient with acute respiratory infection (sudden onset of disease, with at least one of the following symptoms: cough, fever, shortness of breath AND without any other reason that fully explains the clinical picture AND with a history of travel or residence in a country/region, according to the at-the-time- list of EODY, within the last 14 days prior to the onset of symptoms.
Patient with any acute respiratory disease AND a history of close contact with a confirmed or probable case of COVID-19 within the last 14 days prior to the onset of symptoms.
Patient with severe acute respiratory illness requiring hospitalization and for which no other cause has been established.
Each suspected case is to be subjected to laboratory testing for the SARS-CoV-2 virus.

Possible case:
Suspected case resulting in laboratory testing for the new SARS-CoV-2 coronavirus.
Positive, but by laboratory method that generally detects viruses belonging to the family of coronaviruses and not specifically the new SARS-CoV-2 coronavirus

Confirmed case: A person with laboratory confirmed infection with the new SARS-CoV-2 coronavirus, regardless of clinical symptoms and signs.

“Close contact” is defined as follows:
● Person staying in the same house as a COVID-19 patient.
● Person with direct physical contact with a COVID-19 patient (e.g. handshake).
● Person with unprotected contact with infectious secretions of a COVID-19 patient.
● Person with face-to-face contact with a COVID-19 patient at a distance of <2 meters and for 15 minutes.
● Presence in an indoor space with a COVID-19 patient (e.g. classroom or meeting room, hospital lounge, etc.) at a distance of <2 meters and for 15 minutes.
● A health professional or other person providing health care or an employee who handled a clinical sample of a COVID-19 patient without taking the appropriate personal protective measures.
● A fellow traveler on the same aircraft, who was sitting within a distance of two rows of seats (before each direction) from the COVID-19 patient, persons travelling together or caring for the patient, and crew members who served the specific part of the aircraft where the patient was sitting (in the presence of severe symptoms or movements of the patient on board, which may involve more extensive exposure, passengers sitting on the same part of the aircraft or even all passengers on the flight may be considered close contacts).

Contact tracing is performed on an ad hoc basis, whenever deemed necessary by the National Public Health Organisation such as in situations in which the patient’s source of infection is unclear or not previously recognized (e.g., an index case among a group of tourists),  aiming at rapid identification, evaluation, and monitoring of exposed asymptomatic contacts and prompt isolation of those who are found to be clinically ill.

Procedure for contact tracing:
● Contacts of known or possible cases of COVID-19 disease are identified. Information obtained from the case-patient, next of kin, workplace representative, or others with appropriate knowledge of the case-patient’s recent whereabouts and activities.
● Each contact is located and interviewed to: a) confirm exposure to the case, b) document the presence or absence of fever or lower respiratory symptoms, and c) identify additional contacts.
● For persons who are free of symptoms at the time of interview, ongoing symptom monitoring is initiated for 14 days after the last contact with the COVID-19 case.

Currently, any patient with acute respiratory infection, sudden onset of disease, with at least one of the following symptoms: cough, fever, shortness of breath, when admitted to a health service structure should be treated as a possible case of COVID-19, i.e. by taking the necessary isolation measures by other patients and visitors (e.g. a separate waiting area), as well as by receiving appropriate personal protective equipment by health service personnel.

Patients with mild symptoms should not visit hospitals or other health facilities and remain at home.

During the tourist season, in the event of a confirmed infection in a hotel, close contacts of the case will be transferred to a separate quarantine accommodation at the expense of the Greek state. Remaining guests will continue their holidays.