Policy responses for Poland - HSRM

Poland


Policy responses for Poland

1.4 Monitoring and surveillance

MEASURES INTRODUCED IN 2020

JANUARY-APRIL:

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.
 
OCTOBER:

On October 31, the Minister of Health introduced a new definition of COVID-19 case for the purposes of monitoring and surveillance:

Clinical criteria
Anyone with at least one of the following symptoms:
• cough
• fever
• shortness of breath
• sudden onset loss of smell
• sudden onset of taste loss or disturbance
Criteria of medical imaging:
• changes in the radiographic image of the lungs indicating COVID-19
• Laboratory criteria
• detection of SARS-CoV-2 nucleic acid from clinical material
• detection of SARS-CoV-2 virus antigen(s) from clinical specimens

Epidemiological criteria
Any person who met with at least one other person during 14 days prior to the onset of symptoms
according to the following criteria:
• had close contact with a person diagnosed with SARS-CoV-2 infection (contact with a confirmed or probable case), with close contact understood as:
- Being in close proximity (face to face, less than 2m away) for more than 15 minutes with an infected person,
- Having direct physical contact with a person infected with SARS-CoV-2 virus,
- Having direct contact without protective measures with the secretions of a person with COVID-19 (e.g. touching a used tissue, exposure to a cough of a sick person),
- Being in contact on board a plane or other means of public transport including: (a) people occupying two seats (in each direction) from the person with COVID-19; (b) persons accompanying a person with COVID-19 on a journey or caring something for them; (c) crew members serving the section in which the sick person was occupying. Note: In case of severe symptoms in the person with confirmed COVID-19, all passengers in the section occupied by the  person with COVID-19 should be considered as close contacts, and, if the infected person was moving on board, all passengers should be considered as close contacts.
• medical staff or other person directly caring for patients with COVID-19 or a person working in the laboratory directly with samples of people with COVID-19 without adequate protection or if the personal protective equipment used has been damaged or if its incorrect use is found
• person who stayed (as a resident) or was a member of staff in a care / long-term care facility where transmission of COVID-19 was confirmed.

Case classification

Possible case
• any person meeting the clinical criteria

Probable case
• any person meeting the clinical and epidemiological criteria
OR
• any person meeting the clinical criterion of sudden onset loss of smell and / or sudden onset loss or disturbance of taste
OR
• any person meeting the diagnostic imaging criteria

Confirmed case
• any person meeting the laboratory criteria for a confirmed case

Laboratory diagnostics should be performed for each person showing symptoms of acute respiratory infection (taking into account the clinical criteria given in the definition, as well as less specific symptoms: headache, muscle pain, chills, fatigue, vomiting and / or diarrhoea) and additionally on the basis of an individual assessment of the ordering physician or sanitary and epidemiological service staff. 

Contact tracing using epidemiological interviews is carried out for people who may have had contact with an infected person according to the epidemiological criteria of COVID-19 case explained above. Data are gathered by the local sanitary inspection units. The Minister of Health publishes aggregated information about new cases, deaths and recoveries via its Twitter account. Data is not disaggregated into age groups or by geographic location. 
 
Source:
https://www.gov.pl/web/gis/definicja-przypadku-covid19-na-potrzeby-nadzoru-epidemiologicznego-nad-zakazeniami-wirusem-sars-cov-2-definicja-z-dnia-31102020