Policy responses for North Macedonia - HSRM

North Macedonia

Policy responses for North Macedonia

1.4 Monitoring and surveillance

The Institute of Public Health is responsible at the national level for epidemiological and laboratory surveillance and the response to all threats from communicable disease and to managing the implementation of the International Health Regulations (IHRs). All available surveillance systems for communicable disease are being used for detecting possible COVID-19 cases The Institute exercises its surveillance functions through: a) a syndromic surveillance and early warning system for outbreak identification or ALERT (EWARN) which it upgraded with WHO support to a real-time digitalized system (http://www.alert.mk); b) case-based surveillance of communicable disease as per the classic notification system of suspected and confirmed cases; c) Sentinel Surveillance of Influenza like illnesses (ILI), and Serious Acute Respiratory Infections (SARI). The Institute of Public Health prepares weekly and annual reports that are published on the Institute’s website (www.iph.mk). All confirmed COVID-19 cases and deaths are reported within 24 hours to WHO through IHR channels, according to the guidance provided by IHR procedures  
The regional surveillance network for communicable disease is composed of 10 Regional Centres for Public Health and 21 local Units of the Regional Public Health Centres, which are responsible for surveillance of communicable diseases, detection of clusters/outbreaks and response in their corresponding territory.
The country uses the WHO case definition of COVID-19.
Close contacts are defined as:
- Direct contact face-to-face, lasting more than 15 minutes in any environment with a confirmed case within a 24h period, or
- Sharing a confined space with a confirmed case over a prolonged period of time (e.g. longer than 2 hours), 24 hours prior to the onset of the symptoms in the confirmed case.
All contacts of confirmed COVID-19 cases are traced and interviewed by trained epidemiologists. 
WHO supported North Macedonia for Sero-epidemiological studies investigating the extent of infection in the general population, as determined by seropositivity. A standardized WHO master protocol was tailored to country needs in terms of public health, laboratory and clinical systems, capacity, availability of resources and cultural appropriateness. Using this standardized protocol allowed for comparability of data across different countries and helps to determine important epidemiological parameters (e.g. the proportion of the population that remains susceptible to infection, proportion of asymptomatic infections etc.) which inform public health action.
As laboratory capacity increased following the initial arrival of the pandemic, the Centre for Public Health and the Institute of Public Health developed a plan for screening people considered to be at high-risk (health professionals, employees in kindergartens and care homes, members of the police, public transport drivers, employees in public services and patients prior to hospitalization). The screening is to be done with PCR tests.

The Institute of Public Health and the Centre of Public Health in Skopje completed a plan for COVID-19 screening to start as of the week of 11 May for about 400-500 people of vulnerable groups, including health workers, kindergarten staff, and nursing/elderly homes in the first phase, and in a later phase members of the police, drivers, employees in public service, patients before hospitalization, and patients needing biological therapy. These are categories where it is essential to assess the risk and identify asymptomatic carriers.  Screening was to be done by PCR tests and with the help of primary care dentists and supported by the president of the Dental Association.  By 18 May 2020, 581 employees in kindergartens had been tested for SARS-CoV-2 over the previous three-days as part of the targeted screening following the registration of one COVID-19 case in Bitola. Between 14 and 19 May 2020, 908 screening tests were undertaken among employees in kindergartens in Bitola, Skopje and Veles and only one case has been detected.

Five coronavirus cases had been discovered in retirement homes in Skopje as of 3 June 2020. So far North Macedonia has been spared major outbreaks in these facilities which have claimed many lives in other countries. The cases were identified in privately owned homes managed by the same company in the north and the east of Skopje. In one case two female residents tested positive, and in the other, three employees.

As of 29 July, 62,979 citizens had downloaded the “StopKorona” app launched in April. The app notifies users if they have been in close proximity to potential coronavirus patients, thus help curb the spread of the infection. The aim of the app is to facilitate contact tracing by epidemiologists.

Representatives of the Football Federation of North Macedonia and members of the Commission for Infectious Diseases decided to test all athletes and all persons involved in training sessions ahead of the season restart. The Public Health Institute were to do the required testing.

As of 3 June 2020, 7 textile factories in Shtip were closed after employees tested COVID-19 positive. Three teams of epidemiologists carried out mass testing, a process which covered over 500 workers. 126 cases were confirmed, of which 24 people were hospitalized.

The Minister of Health urged infected citizens to cooperate fully with doctors when being asked about their contacts. It had been reported that many diagnosed patients refuse to cooperate with the mandatory surveys which prevents the full mapping of the new clusters. The Minister also noted that over 40 large clusters were registered in the past period on the entire territory of the country related to various family events where 50-150 people and in some cases 200 people were present.

WHO has worked closely with the Ministry of Health in refurbishing and equipping a dedicated space for real time epidemiological monitoring of outbreaks at the Institute of Public Health. This is part of the USAID emergency funds entrusted to WHO earlier in the outbreak for strengthening North Macedonia capacity in the COVID-19 response. This center is the first and so far only structure in a Ministry of Health among ministries in the Western Balkan countries.

As of 23 June 2020, over 60 000 citizens had downloaded the StopKorona app.

On 6 October 2020, based on a recommendation from the Commission for Infectious Diseases, the Government approved the algorithm for acting in schools in case of suspected or confirmed COVID-19 cases among students.

The first case of the British COVID-19 strain was reported on 27 January 2021.