Policy responses for Poland - HSRM


Policy responses for Poland

1.4 Monitoring and surveillance

Poland has adopted the COVID-19 case definition published by ECDC for the purposes of sanitary and epidemiological surveillance. This is defined as any confirmed SARS-CoV-2 infection, regardless of whether there were any symptoms. Under the case definition (from 22 March), the clinical criteria encompass:

Group A. Criteria that additionally require an epidemiological criterion.
A person experiencing at least one of the following symptoms of acute respiratory infection: fever, cough, shortness of breath.

Group B. Criteria that do not require an epidemiological criterion:
A person hospitalized with symptoms of a severe respiratory infection without finding another aetiology that fully explains the clinical picture OR a person in an emergency threatening life or health with symptoms of respiratory failure

The laboratory criteria for a confirmed case:
• Detection of SARS-CoV-2 nucleic acid from a clinical material confirmed by molecular testing directed to a different region of the virus genome

Criteria are also established for suspected cases. Meeting the criteria for a suspected case triggers testing through laboratory diagnostics. 

The laboratory criteria for a suspected case.
At least one of the following criteria is met:
• Positive molecular test for coronavirus (pan-coronavirus RT-PCR),
• Equivocal test result for COVID-19 nucleic acid.

Epidemiological criteria for a suspected case:
Any person who, within 14 days before the onset of symptoms, met at least one of the following criteria:
i) Has stayed or returned from an area where there is local or low-frequency COVID-19 transmission. Information on areas with local transmission is published by the WHO at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ 

ii) Has had contact with a person who was diagnosed with COVID-19 infection (contact with a confirmed or probable case). Close contact should be understood as:
• living with the COVID-19 case,
• direct physical contact with the COVID-19 case (e.g. handshake),
• direct unprotected contact with the secretions of a person with COVID-19 (e.g. touching a used tissue, exposure to coughing of a sick person),
• being in close proximity (face to face) to a sick person for any length of time,
• staying within a distance of 2 meters from the COVID-19 case for more than 15 minutes in a situation of exposure not mentioned above,
• medical staff or another person directly looking after patients with COVID-19 or a person working in the laboratory directly with samples of people with COVID-19 without adequate protection or in the event of damage to personal protective equipment or in the event of incorrect use,
• contact aboard an airplane and other collective means of transport, including people occupying two seats (in each direction) from a person with COVID-19, traveling companions or caring, crew members operating the section in which the patient is (in case of severe symptoms for persons with COVID-19 or their movement, all passengers in the section or on board of the means of transport should be considered as having been in close contact),
• obtaining information from relevant services that there has been contact with a confirmed case,
• professionally active medical personnel who may have had contact with an infected person during the performance of their duties who have symptoms of a respiratory infection without finding another etiology that fully explains the clinical picture.

Contact tracing using epidemiological interviews is carried out for people who may have had contact with an infected person and for everybody entering Poland (any person entering Poland has to fill in a card indicating the address of their stay so that they can be easily located). Data are gathered by the sanitary authorities.

Epidemiological surveillance is also undertaken for healthy people who have not been in confirmed contact with a person who may have been infected but may be at higher risk. Depending on an epidemiological interview - usually carried out by phone – such people are advised to practice social distancing and self-observation (e.g. temperature check every day).

Epidemiological situation is monitored by the National Sanitary Inspection, which comprises the Chief Sanitary Inspectorate (a ministerial agency), 16 provincial (voivodship) health departments, and 356 local sanitary stations (in the counties, at land borders and seaports).

On 20 April, the National Institute of Public Health published a manual for medical doctors on how to report COVID-19 in death certificates. According to the manual this should be done as follows:
• If death due to COVID-19 has been confirmed through testing, COVID-19 should be recorded in the death certificate as the underlying cause of death;
• In death due to COVID-19 is suspected, the underlying cause of death should be recorded as ‘suspected COVID-19’ in the death certificate and the physician can also add one of the following descriptions: ‘equivocal test result’ or ‘failed test’ or ‘death before obtaining test result’;
• If the test result is negative, COVID-19 cannot be recorded as the cause of death;
• Physicians should record causes of deaths in death certificates without using ICD-10 codes. Their descriptions are later translated into ICD-10 codes by specially trained so-called ‘physician- coders’ at the National Statistical Office.

All physicians are obligated by law to report all newly diagnosed COVID-19 cases, deaths as well as recoveries. Local sanitary and epidemiological stations collect this information and also perform epidemiological investigations to trace cases and their contacts. According to the ordinance of the Minister of Health from 10 December 2019 physicians should also report new cases and deaths due to severe acute respiratory distress syndrome (SARI) or due to organ failure caused by infectious or with undetermined aetiology. The reports of the National Sanitary Inspection units are sent to the National Institute of Public Health, where they are analysed. The Minister of Health publishes aggregated information about new cases, deaths and recoveries twice a day. Data is not disaggregated into age groups or by geographic location. 

The Minister of Health has established National Registry of COVID-19 Patients through an official decision from 9 April. The registry collects data about COVID-19 patients, their pathways of treatment and data on SARS-CoV-2 transmission for each case. The registry is situated within the National Institute of Cardiology in Warsaw.