From the outset, reports of probable COVID-19 cases were set to be directed through the national helpline (1) (which later was replaced by COVID-19 specific helpline 1808) for testing. Organizational guidelines were created for mobile testing.(2) Description of the diagnostics and treatment of COVID-19 adults were created by an expert group that was assembled by the MOH.(3) After 19th of March, patients diagnosed with a mild form of coronavirus infection started to be treated at home if the isolation requirements were met.(4) People recovering from COVID-19 at home, in another place of residence or in a sanatoria can be re-examined at mobile points upon referral from a GP.(5)
ECDC’s “Infection prevention and control for COVID-19 in healthcare settings” guidelines in March 2020 were used to prepare Lithuanian prevention and control of Covid-19 in health care facilities.(6) Guidelines include preparedness, flow redistribution and administrative arrangements. The guidelines also outline measures to prevent contact transmission by decontamination of reusable equipment. An ECDC algorithm for wearing and removing protective devices was adopted.(7)(8) Airborne precautions should only be implemented when undertaking an aerosol generating procedure (AGP) and in clinical areas considered AGP ‘hot spots’ e.g. Intensive Care Units that are managing COVID-19 patients. This is also in line with WHO guidance. On 6th April, MOH provided recommendations for actions which COVID-19 has been diagnosed in a hospitalized patient or to a member of hospital staff. (9) On 8th April, MOH distinguished five levels of hazard that define in which cases and what PPE should be used by health care staff working in medical facilities. Hazard levels are determined by the nature of medical work, (i.e. types of patients, level of contact and type of service provided) (11).
On 16th of April procedures for diagnosis and treatment of pediatric coronavirus infection have been defined. (12,13)
The procedure for the handling of the remains of the COVID-19 deceased is in place from 1st April.(10)
From November 2020, municipalities are obliged to form mobile team(s) to provide personal health care to at-risk and vulnerable people sick with COVID-19 in their homes or social care homes. (103) The mobile team consists of a GP, a nurse, as well as another member of a primary care team trained in the safe use of PPE. By the beginning of December, such teams were operational in 9 municipalities. (19)
On 9th December MOH reminded that a person who has been infected with a coronavirus test must contact his/her GP immediately at a distance after a coronavirus test, when a positive response is obtained. The family doctor or nurse will discuss with the patient a monitoring and treatment plan, prescribe treatment if necessary, decide on the end of isolation and recovery for COVID-19 disease. It should be noted that the patient is considered to have recovered only by the decision of the doctor, but not before the isolation can be interrupted. After the patient recovers from coronavirus infection, the doctor enters the diagnosis with the code Z86.18 in the e-health form E025, which means "Other infectious and parasitic diseases in the former person". This code automatically travels to the National Public Health Centre under the Information System of the MOH and the person is no longer under the control due to mandatory isolation.
Outbreaks in LTC institutions
Sporadic outbreaks in long-term care institutions have highlighted the vulnerability of these to COVID-19 in Lithuania. Several actions have been taken: the priority is to detect and isolate cases, so as soon as first cases are known in either residents or staff, epidemiologists assess the situation in the care home and testing is performed on all staff and residents. Isolation may be applied to LTC wards where a case has been detected, even if other cases are negative and do not show any symptoms.(14) Cases in LTC are discussed widely both in the media, as well as by the authorities in official briefings.
An outbreak affecting most residents and staff (30 and 10 respectively) has been detected in a care home in Klaipeda. (15) On the week starting 20th April, epidemiologists are assessing the situation in a care home in Panevėžys where a worker has tested positive for coronavirus infection.(16)
From 12th May, the Ministry of Social Care and Labour has information on outbreaks in both public and private care homes on an interactive map. (17)
Role of GPs in COVID-19 during the second wave
According to MOH guidance, GPs are first point of contact for patients with fever and signs of respiratory infection. They are usually consulted remotely and advices to book a PCR test, as well as on treatment and monitoring of their condition. People with positive COVID-19 test are also consulted remotely, advised to monitor temperature and blood oxygen, and followed up if needed. Sometimes patients are invited for face-to-face consultations, referred to be seen in fever clinics, or to ambulance in case of severe breathing difficulties. Due to the need to devote efforts to COVID-19 patients, GPs report having less time for treating chronic patients and preventive work, potentially exacerbating delayed cancer diagnosis or neglected CVDs. The use of remote consultations for both COVID and non-COVID services has been expanding since the start of the pandemic.
From April 2021, patients with COVID-19 can receive inpatient or outpatient medical rehabilitation services. Rehabilitation can be provided no later than 3 months after active inpatient treatment. The service is available after referral from a physician, confirming the need for improved functioning, such as behavioural control, coordination, cognitive issues. Other services, such as massage, occupational therapy and physiotherapy are also available to COVID-19 patients with less severe complications. These services can be prescribed as soon as the patient's state of health so permits. (20)
The series of weekly show "Inspire for Life" has been launched in May 2021 for people who are looking for ways to restore their health faster after COVID-19 (or just want to learn breathing exercises). Health care workers, psychologists and opera singers collaborate on providing advice on breathing techniques for long- and post- COVID syndrome (21).