Case definitions, the reporting protocols and the surveillance methodology of COVID-19 are updated periodically by the National Centre for the Surveillance and Control of Communicable Diseases. In May, the asymptomatic institutionalized individuals were added to a priority testing group, upon admission to a residential centre, or return to the residential centre from a health unit or from family care. Surveillance guidelines were last updated on June 19 and July 23, with adjustments made to the priority testing groups. (see Section 1.5.). The last update on September 18 broadened the definition of suspects to include any person with a sudden onset of fever and cough, or anyone with a sudden onset of any three or more of the following signs and symptoms: fever, cough, asthenia, headache, myalgia, sore throat, coryza, dyspnoea, anorexia /nausea /vomiting, diarrhoea, altered mental status, recent onset of anosmia (loss of smell) or ageusia (loss of taste) in the absence of an identified cause.
In addition, the last update of COVID-19 case definitions, reporting protocols, and surveillance methodology introduces, for the first time, the definition of a ‘probable case’ (next to the definitions of suspect and confirmed case and close/direct contact). A ‘probable case’ refers to (a) a patient who meets the clinical criteria of a suspect case and is in contact with a confirmed case or can be linked to an outbreak area with at least one confirmed case; (b) a suspicious case with pulmonary imaging suggestive of COVID-19 through X-ray, CT scan, or pulmonary echography; (c) a person who died without a clear cause, with respiratory failure preceding the death, and who was in contact with a confirmed case or who or can be linked to an outbreak area with at least one confirmed case.
During the State of Alert, continuity of the activity is mandatory in residential centres for older people, children, and adults, with and without disabilities, as well as residential centres for other vulnerable groups. The residential social service providers must organize their program and the work schedule of their employees according to the local epidemiological context and in compliance with the national and local rules for preventing and controlling the Covid-19 epidemic. The authorities have also undertaken supporting measures, such as increasing the number of employees with six months of fix-term working contracts and extending the validity of expired certificates and authorizations. Free face masks, gloves, hygiene products, and food are distributed to those residential centres for older people, children, and adults with disabilities and other vulnerable groups. Protocols, guidelines, and recommendations for the residential centres during the State of Alert were developed and disseminated.
At the community level, an Ordinance from the Ministry of Health endorses the role of the community nurses, Roma mediators, and midwives in providing support, food and care, including medicines and surveillance of isolated older people that are alone at home as well as other vulnerable populations, alongside a 30 RON (around 6.2 EUR) allocation per vulnerable person for food. Community nurses receive free protective equipment and benefit of the risk allowance of 2500 RON (around 516.3 EUR) allocated by the government to the healthcare and social workers working in at-risk conditions due to the COVID-19 epidemic. On May 26, the Ministry of Labour and Social Protection launched an EU funded program named “Support for vulnerable people in the context of the COVID-19 epidemic”, to select communities aiming at providing for the next six months, services to around 100,000 vulnerable people over 65 years old and people with disabilities, particularly from rural settings.
Case definitions have evolved with the epidemic. An initial procedure for the identification and management of symptomatic and asymptomatic cases arriving from the countries/localities with a high rate of infections was issued by the National Committee for Special Emergency Situations on February 28. Four scenarios, for varying rates of infection, were developed. For each scenario there are assignments for authorities, the epidemiology teams from the District Public Health Authorities and hospitals. The National Centre for the Surveillance and Control of Communicable Diseases was nominated to develop and update definitions of ‘asymptomatic case’, ‘contact case’ and ‘suspected case’, alongside methodologies and reporting protocols.
Definitions of ‘suspected case’, ‘asymptomatic case’ and ‘close contact’ were established. Contact tracing was implemented for all confirmed cases according to clear procedures.
On March 30, when the number of cases passed 2000, Romania entered scenario four and social distancing measures have been tightened. Case definitions, the reporting protocols and the surveillance methodology of COVID-19 are updated periodically by the National Centre for the Surveillance and Control of Communicable Diseases. They were updated on April 3, 2020 (introduction of active-passive case-based system), April 16 and April 28, and May 14. Furthermore, the case definition and recommendations for testing prioritization were also updated. Institutionalized individuals, including those in long-term care facilities, remained among the testing priority groups. Staff of residential centres/long-term care facilities was also added as a priority testing group (see Section 1.5). Individuals in long-term care facilities are mentioned as a high-risk group in official government communication and various long-term care facilities are often featured as hotspots of COVID 19 infections in mass media reports. By May 16, Romania registered approximately 10% of the total deaths caused by Covid-19 among residents in centres for older people and people with disabilities. There are 122 deaths due to COVID-19 registered in residential centres for older people and adults with disabilities, and no deaths among institutionalized children. Yet, 640 adults and 17 children are still infected, alongside 360 employees of the residential centres, and two registered deaths. The most affected counties are Suceava, Galati and Neamt. The authorities have undertaken supporting measures for the residential centres, such as increasing the number of employees with six months of fix-term working contracts and extending the validity of expired certificates and authorizations.