Policy responses for Lithuania - HSRM

Lithuania


Policy responses for Lithuania

1.4 Monitoring and surveillance

The definition of COVID-19 in Lithuania was changed several times (see also section 1.5). Since January 29, the MOH used the WHO definition.(1) First update of the definition was made on 4th of February (2019-nCoV) where ECDC definition (2) was used for case detection and epidemiological surveillance. Since February 24, the local definition was adapted based on decision of the Emergency Operation Centre of the MOH, and it is based on the guidelines of international organizations (see also section 1.5).(4) The newest definition (5) (in place since 28th March) includes: 1. Persons with respiratory infection symptoms (fever, cough, breathing difficulties), who returned from an area with the spread of COVID-19 in the past 14 days. 2. Person with respiratory infection symptoms who had close contact with confirmed or suspected COVID-19 case.  

From 7th April, MOH added a requirement to test anyone entering the country at the border or within 24 hours of entry.(6) Any suspected or confirmed case of COVID-19 shall be reported immediately to the National Center for Public Health (NCPH) under the Ministry of Health. In order to control the spread of communicable diseases, the NCPH conducts an epidemiological investigation of all COVID-19 cases (they use interviews, clarify circumstances of the infection, conduct contact tracing and collect other epidemiologically relevant information). Those who have been in contact are isolated, contacted daily and their health status is evaluated. The information on the results of the ongoing study, including the sites visited by COVID-19 infected persons, are published online on the NCPH website.

On 20th of March the Department of Statistics of Lithuania prepared a virtual map collection for analyzing a set of COVID-19 statistics (7) (e.g. registered cases, deaths, number of tests) at the national, county or municipality level. The map can be found here:
https://osp.maps.arcgis.com/apps/MapSeries/index.html?appid=79255eaa219140dfa65c01ae95ed143b

From 20th of May COVID-19 statistics are also reported in a virtual map, providing information on the situation of coronavirus infection in Lithuania according to various indicators by different municipalities, gender and age groups, trends and daily changes. https://registrucentras.maps.arcgis.com/apps/opsdashboard/index.html#/becd01f2fade4149ba7a9e5baaddcd8d

Monitoring and surveillance of cases (and deaths) include both long-term care facilities and home care. If an outbreak is detected in any care home, the monitoring is performed for all person who may have had a contact with a possible COVID-19 carrier (see section 3.2).
An app has also been created to monitor COVID-19 cases (see section 1.3)

Current situation as of 15th of May suggests that COVID-19 management is under control, with comparatively low disease incidence (54 cases per 100 thousand population). The distribution of cases varies regionally, with highest rates recorded in Klaipeda, followed by Vilnius and Marijampolė. Although new cases are still detected, they seem to be localized. The number of deaths currently stands at 60 in total.

Since November, when Lithuania started experiencing very rapid increase in COVID-19 cases, the highest incidence was registered in Vilnius county. This accounted for a about quarter of all infections until mid-December. The largest outbreaks are recorded in health care and social care institutions.(11)

In mid-December, Lithuania became a country with the highest weekly COVID-19 incidence per 100 thousand in the world (and 15th in terms of mortality). According to the publication, in Lithuania in seven days 100 thousand. 97.4 COVID-19 per day and the country is the first country among the world. An average of 2,718 new cases of coronavirus are detected daily in the country. 

On 29th December, the National Centre for Public Health (NTVC) announced that after audit of mortality figures another 324 deaths from COVID-19 and further 480 deaths of patients who died from other causes but were diagnosed with COVID-19 were discovered. This has increased the total COVID-19 mortality in 2020 almost 20%, to nearly 2,000 by the end of 2020.(12)

Genetic sequencing

In order to monitor the diversity, prevalence and evolution of various COVID-19 strains in Lithuania, a process of genome sequencing will be initiated at national level. On 4th February 2021, the Minister of Health issued an Order to organize, coordinate and carry out an in-depth SARS-CoV-2 testing process of identifying genetic variants of the virus. The order stipulates that the National Public Health Laboratory must organize and coordinate the SARS-CoV-2 genome sequencing process, ensuring once a week one percent or minimum of 200 (whichever is larger) of all SARS-CoV-2 RNA detected in the country in the last week by PCT test for genome sequencing. (18)

Two university hospitals and two universities are expected to start analysing around 500 genomes per week from early February/March.(14) By the end of February 2021, MOH reported that 11 new cases of the UK strain of coronavirus have been identified (out of 96 samples examined). (15)

From 13th of May, if the spread of a coronavirus varian of concern in a certain area is suspected, the NPHC together with the municipal administration have to organize mass testing using PCR  rather antigen tests in order to be able to perform genetic sequencing and effective detection of new variants.(21)


Tracing from October 2020

As of 26th of October catering establishments and leisure and entertainment service providers will be required to register the contact details of their customers. These data will have to be kept for 21 days and made available to the NCPH upon request.(8,9) Visitor registration is required for entry to leisure and entertainment venues such as cinemas, dance studios, sports clubs, etc., as well as catering establishments, such as restaurants, cafes, bars, nightclubs.(10)

Since the end of October, when there has been a significant increase in the incidence of COVID-19, the number of contacts who need to be traced has been increasing. To speed up the information flow, the NCPH sends text messages to the exposed persons from 29th of October. This means that from that date, people with high-risk contact will no longer receive a specialist call. Instead, they will receive a text message by phone, which will indicate that the person must be isolated and for how long. In addition, people with high-risk exposure will also find a link to a questionnaire, where they can provide relevant data to authorities, including whether they need sick leave during the isolation period, whether they agree to be tested for COVID-19 and whether they have suitable conditions for isolation.

In early February 2021, a questionnaire (optional) atvejis.nvsc.lt for persons with confirmed COVID-19 was released in order to collect epidemiological information, including how they were infected and high-risk contacts. (13)  On 23rd of February, more than 1,600 people  with COVID-19 have submitted information data on how and where they became infected and their high-risk contacts.(16) By April, 5,500 people filled in questionnaire, with 2,700 of those during April alone. (19)

On 23rd of February 2021  NVSC stated that over the past week its tracers on average reached 90% of people tested positive for COVID-19 within 24 hours to interview them about route of infection and contacts.(17)

From 29th of March 2021, the designated dashboard provides an interactive map of COVID-19 outbreaks (two or more related cases), based on tracing conducted by epidemiologists at the National Center for Public Health: https://nvsc.lrv.lt/lt/naujienos/sukurtas-interaktyvus-covid-19-protrukiu-zemelapis In mid-April, 87 active outbreaks of coronavirus infection (COVID-19 disease) were recorded in the country's educational institutions – substantially fewer that in the week before (49). Most outbreaks of COVID-19 have been reported in pre-schools settings (20).   according to data collected during epidemiological studies by the National Center for Public Health.