Policy responses for Romania - HSRM

Romania


Policy responses for Romania

1.5 Testing

The surveillance methodology is regularly updated (June 4, June 19, July 23, August 10, September 18). The update on June 19 made the following adjustments to the priority testing groups:

1. Symptomatic persons, including medical staff according to the case definition.
2. Asymptomatic close contacts of confirmed cases (6-7 days after the last contact with the confirmed case.
3. Asymptomatic patients before the transplant procedure and donors of hematopoietic organs  tissues, and stem cells before donation (tested at maximum 48 hours before the procedure); patients with transplants of hematopoietic organs, tissues and stem cells undergoing immunosuppressive therapy, before each hospitalization during the post-transplant monitoring period - 2 tests at 24-hour intervals.
4. Asymptomatic patients with immunosuppression in the context of the disease or drug-induced hospitalization – tested at maximum 48 hours before hospitalization.
5. Asymptomatic cancer patients undergoing chemotherapy (tested at maximum 48 hours before each cure or visit), or radiotherapy (tested at maximum 48 hours before the procedure and each 14 days till the cure is completed).
6. Asymptomatic cancer patients before surgery or invasive interventions (tested at maximum 48 hours before the procedure).
7. Asymptomatic haemodialysis patients (twice a month).
8. Symptomatic haemodialysis patients.
9. Asymptomatic institutionalized individuals (twice a month).
10. Staff of residential centres/long-term care facilities (twice a month).
11. Asymptomatic pregnant women in quarantine/home isolation or close contact with a confirmed case (day 14 if still asymptomatic).
12. Asymptomatic healthcare personnel who have been in direct contact with a confirmed case, in the 6th or 7th day since the last contact.
 
The update from July 23 added medical teams who transport transplant organs as priority testing group (they can be tested every two weeks). The last update, from September 18, notes that all symptomatic direct contacts of confirmed cases should be tested.

Testing capacity has increased to 57 public and private testing centres (see Section 2.1 Physical infrastructure).

From June to September 2020, around 30,000 people will be tested in a national seroprevalence study coordinated by the National Institute of Public Health / the Centre for Surveillance and Control of Communicable Diseases. Asymptomatic people of all age groups who consent will be included in the study, and three to five selected testing centres in each county and the capital city of Bucharest will report the results based on a standardized methodology. In addition, the Bucharest’s City Hall announced a testing programme for around 10,500 city residents sampled from all residential areas and age groups.

Based on the initial case definition, all people arriving from countries/localities with a high infection rate were screened for COVID-19. All symptomatic cases, people in quarantine and close contacts of confirmed cases have been tested since the beginning of March. Due to the evolution of the epidemic and the community spread of the infection, on March 23rd the National Centre for the Surveillance and Control of Communicable Diseases issued a new testing protocol, based on the EC recommendation at the ECDC advice. The new protocol sets up the priorities of testing as follows:

1. Symptomatic people with a history of international travel;
2. Symptomatic close contacts of confirmed cases;
3. Symptomatic healthcare personnel;
4. Cases of pneumonia without other aetiology, from all age categories and all hospitals;
5. Cases of Severe Acute Respiratory Illness (SARI) without other aetiology, from all age categories and all hospitals;
6. Symptomatic institutionalized people;
7. All patients due to undergo a transplant procedure (asymptomatic), and all hematopoietic stem cell donors before donation.

The updated case definition and surveillance methodology published April 16 and April 28, and on May 14 (see Section 1.4) set testing priorities as follows:

1. Symptomatic persons, including medical staff according to the case definition;
2. Symptomatic close contacts of confirmed cases;
3. Asymptomatic patients before the transplant procedure and donors of hematopoietic organs, tissues and stem cells before donation; patients with transplants of hematopoietic organs, tissues and stem cells undergoing immunosuppressive therapy, before each hospitalization during the post-transplant monitoring period - 2 tests at 24-hour intervals;
4. Asymptomatic patients with immunosuppression in the context of the disease or drug-induced hospitalization - 2 tests at 24-hour intervals;
5. Asymptomatic cancer patients undergoing chemotherapy and / or radiotherapy - twice a month;
6. Asymptomatic cancer patients before surgery or invasive interventions;
7. Symptomatic haemodialysis patients;
8. Asymptomatic haemodialysis patients who have been in contact with a confirmed case, 2 tests at 6-7 days interval between them; during this period they will be dialyzed in separate sessions from the rest of the patients;
9. Symptomatic institutionalized individuals;
10. Asymptomatic pregnant women in quarantine/home isolation or close contact with a confirmed case;
11. Staff of residential centres/long-term care facilities – twice a month;
12. Asymptomatic healthcare personnel who have been in direct contact with a confirmed case, in the 6th or 7th day since the last contact.
13. (Added on May 14th) Asymptomatic institutionalized individuals, upon admission to a residential centre, or return to the residential centre from a health unit or family care.

Public laboratories use the PCR testing method. COVID-19 testing is done based on a referral from a specialist physician. The authorities have committed to increasing national COVID-19 testing capacity. Testing capacity remains low compared to other countries, but facilities are being developed. At the end of February, Romania had just one testing centre; this number has now risen to 35 (see Section 2.1).

References:
https://www.cnscbt.ro/index.php/1574-algoritm-testare-internare-externare-23-03-2020/file
https://www.cnscbt.ro/index.php/1697-definitii-de-caz-si-algoritm-de-testare-pentru-covid-19-actualizare-28-04-2020-1/file
https://www.cnscbt.ro/index.php/info-medical/1728-metodologia-de-supraveghere-a-covid-19-actualizare-14-05-2020-2
https://www.cnscbt.ro/index.php/informatii-pentru-personalul-medico-sanitar/1781-metodologia-de-supraveghere-a-covid-19-actualizare-04-06-2020
https://www.cnscbt.ro/index.php/lex/1779-ordinul-nr-979-2020-pentru-aprobarea-efectuarii-studiului-de-seroprevalenta-a-infectiei-sars-cov-2-pe-teritoriul-romaniei
https://www.agerpres.ro/administratie/2020/05/24/firea-maine-vom-da-startul-proiectului-de-testare-de-tip-anticorpi-pe-un-esantion-de-10-500-de-bucuresteni--511136
https://www.cnscbt.ro/index.php/legislatie_cov/1780-ordinul-nr-978-2020-pentru-modificarea-si-completarea-ordinului-ministrului-sanatatii-nr-807-2020-pentru-stabilirea-atributiilor-in-activitatea-de-testare-in-vederea-depistarii-infectiei-cu-virusul-sa/file
https://www.cnscbt.ro/index.php/info-medical/1809-metodologia-de-supraveghere-a-covid-19-actualizare-19-06-2020/file
https://www.cnscbt.ro/index.php/info-medical