Policy responses for Greece - HSRM


Policy responses for Greece

3.2 Managing cases

The Emergency Response Committee for Public Health, comprised of 26 epidemiologists, infectious disease specialists and public health experts has been established to monitor international epidemiological data; study transmission trends, and based on epidemiological models, suggest measures to halt the spread of COVID-19; recommend treatment protocols, taking into consideration international clinical trials; determine the diagnostic strategy and triage protocol for COVID-19 testing procedures, which can be modified as the epidemic progresses; suggest specifications for PPE and medical devices.

Criteria for laboratory testing of suspected cases currently (4th April) is as follows:
● All Greek citizens returning from abroad.
● Patients with Severe Acute Respiratory Illness who are in need of hospitalization or are currently hospitalized.
● Patients in hospitals or elderly care or chronic care units who develop acute respiratory infection with fever, cough or dyspnea.
● Healthcare personnel who develop acute respiratory infection with fever.
● Older people (> 70 years old) or individuals with severe chronic underlying conditions (e.g. chronic pulmonary disease, chronic heart disease, diabetes mellitus, severe immunodeficiency) who develop acute respiratory infection with fever and cough or dyspnea.

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.

Migrant Communities in Greece

Operational guidance for the case management of COVID-19in reception centers for asylum seekers was issued by the National Public Health Organisation (NPHO) on February 29, which reads as follows and involves:

• The NPHO field coordinator appointing a COVID-19 infection supervisor who can be contacted and present at points of entrance of newly arrived individuals to do the triage based on the current COVID-19 case definition.
• If a suspected case is identified during the triage, the COVID-19 infection supervisor shall arrange transfer to the hospital for testing.
• If asymptomatic individuals are identified and have a travel history to areas of ongoing transmission within the past 14 days, the supervisor shall order the isolation of these individuals for at least 14 days since their reported exposure to infection.
• If isolation is not possible for asymptomatic individuals with a travel history to areas with ongoing transmission within the past 14 days, these individuals are strictly obliged to wear a surgical mask when moving and coming in contact with other persons, for at least 14 days since their reported exposure to infection. If they develop symptoms, they must immediately contact the Reception Centre’s health service and avoid visiting other health services without informing the Centre.
• The healthcare professional at the Reception Centre Health Service shall examine the suspected case of COVID-19 and shall inform the field coordinator and NPHO about the case transfer to the hospital for testing.
• Test results shall be communicated by NPHO to the field coordinator and the COVID-19 infection supervisor.
• The supervisor responsible for handling COVID-19 cases shall participate in the process of contact-tracing of the confirmed case and shall proceed with handling the contacts based on the guidelines and assistance provided by NPHO.

Use of PPE must be carried out in accordance with current NPHO guidance. NPHO’s field coordinator shall coordinate the centre’s preparation for potential cases. In particular, the coordinator must ensure there is PPE and train the healthcare personnel for handling a suspected case and for tracking and handling contacts in accordance with NPHO’s guidance.

On April 2, the Ritsona refugee camp with a population of 2,700, became the first in the country to have positive cases among residents, when a woman who had recently given birth in the local hospital tested positive. Ritsona was subsequently put under quarantine for two weeks with no residents permitted to leave. On April 5, the Malakasa camp, around 24 miles north of Athens, was also placed under quarantine measures after a 53-year-old Afghan resident tested positive. On April 21, 150 people tested positive for COVID-19 at a hotel thathas been converted into a migrant shelter in the town of Kranidi, in southern Greece, which was placed under strict quarantine on April 20, following apregnant 28-year-old woman from Somalia who lives at the hotel testing positive for the virus during a hospital visit. The confirmed cases include 148 asylum seekers, an aid worker and a hotel employee. The hotel hosts around 450 asylum seekers, most of whom are from Africaa.

On 14 August, two camps in Evros and Drama were put into quarantine until the end of August.

On September 2, Health authorities confirmed the first coronavirus case at the Moria refugee and migrant camp on the eastern Aegean island of Lesvos, where NPHO units descended within the same day to perform contact tracing of the identified case.35 confirmed cases were initially linked to the site. The camp was put into quarantine until 15/09/2020, however on 8th September the fire broke out, leaving an estimated 13,000 refugees and migrants homeless. As a response, a passenger ferry, two Navy landing ships and tents have been installed as temporary accommodation. 400 unaccompanied minors from the camp were transferred away from Lesvos island.

The NPHO has been responsible for providing coronavirus detection tests for refugees and local permanent residents, the strengthening of the Emergency Response Ambulance Service (EKAB), the operational readiness of the Mytilini General Hospital and, in cooperation with the WHO, the significant increase of the number of doctors and nurses in refugee accommodation structures.

Long-term care facilities

Following a deeply concerning picture of COVID-19 incidences in long-term care facilities in other countries, a circular was issued by the Ministry of Health on April 7 aiming to inform Geriatric Care Units personnel about the symptoms of SARS-CoV-2 infection, the necessary actions in case of an outbreak and preventive measures against the spread of the virus.

On April 12 and 13, a COVID-19 testing task force, formed by the NPHO in collaboration with the Ministry for Civil Protection, visited long-term care facilities for older people in Attica, following the investigation/contact-tracing of confirmed cases in the facilities or their contacts. Despite strict adherence to social distancing measures for many weeks in these institutions, transmission and spread of SARS CoV-2 was observed. Hence, all staff and guests were tested. Specimens for laboratory testing were collected from surfaces and air conditioning units, in order to ascertain the possible existence of the virus in communal areas.
Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in long-term care facilities was provided by the NPHO. Furthermore, supplies necessary to adhere to the recommended infection prevention and control practices were distributed.
Because of the ease of spread in a long-term care setting and the severity of illness that occurs in residents with COVID-19, facilities were instructed to immediately restrict all visitation except for certain compassionate care reasons, such as end-of-life situations. Signs at the entrances to the facility advising that no visitors may enter the facility were placed.

Decisions about visitation for compassionate care situations should be made on a case-by-case basis, which should include careful screening of the visitor for fever or symptoms consistent with COVID-19. Those with symptoms should not be permitted to enter the facility. Any visitors that are permitted must wear a cloth face covering while in the building and restrict their visit to the resident’s room, while frequently performing hand hygiene.

Care homes remained untouched during the first wave of the pandemic in Greece when a lockdown imposed early in the outbreak is credited with keeping the number of cases and deaths at low levels.
But an increase in the spread of the virus in August has resulted in outbreaks in at least two care homes, with several deaths reported.

As a result, on September 5, Greek authorities announced that coronavirus checks were to be carried out on all care homes throughout the country within the next 10 days. Moreover, measures for employees at these facilities, such as postponement of annual leaves, mandatory COVID-19 tests 48 hours before returning to work, and avoidance of non-essential travel abroad, were implemented.

Detention Facilities

On November 11, amid the sudden increase in the number of cases in detention facilities, a special plan was announced for the further shielding of prisons and youth detention centres from COVID-19, by upgrading their health protection system. The employees of detentions centres around the country will be tested for SARS-CoV-2 on a weekly basis. Moreover, the detainees will be tested based on a specific program/algorithm, giving high priority to facilities that exhibit a high epidemiological burden. In two hospitals in the Attica region special units are created, where inmates can be treated. Finally, Regional Health Authorities across the country will provide medical and nursing staff to local detention centres.