No 9 - 2020

COVID-19 – Update

Since last week’s COVID-19 update was published in EPI-NEWS 7-8/20, the situation has changed. Now, more areas/countries outside of China are recording signs of sustained transmission of SARS-CoV-2. This currently applies to South Korea, Japan, Singapore, Hong Kong, Iran and the following four Italian regions: Emilia-Romagna, Lombardy, Piedmont and Veneto.

In step with the increasing global spreading of COVID-19, the probability increases that cases will also be recorded in Denmark. Therefore, on 24 February 2020 the Danish Health Authority amended its guideline on the handling of COVID-19. The guideline includes appendices giving a preliminary overview of the countries/areas where SARS-CoV-2 infection is currently spreading .

These areas are covered by the case definition establishing when COVID-19 should be suspected. Today, the ECDC has updated its risk-area delimitation . As from now, these risk areas will also form part of the Danish case definition. The ECDC will, if possible, specify which sub-areas of the four Italian regions are associated with a special risk.

Under the new case definition, more patients will be suspected of having COVID-19, and therefore the guideline allows patients to be admitted to more departments of infectious medicine, and foresees that suspected people who do not require admission to hospital may - based on a specific assessment - be discharged to receive their test results and undergo continued observation in their homes.

Assessment of suspected COVID-19 cases

As from now, patients suspected of COVID-19 who meet the criteria for suspicion must, without delay, be referred for assessment at and possibly admission to a department of infectious diseases in one of the following hospitals:

• Copenhagen University Hospital, Rigshospitalet (Blegdamsvej)
• Hvidovre Hospital
• Aarhus University Hospital (Skejby)
• Aalborg University Hospital (South)
• Zealand University Hospital (Roskilde)
• Odense University Hospital (Odense).

Handling of patients visiting GPs, emergency medical clinics, emergency departments, etc.

In line with the criteria of the case definition, people who are suspected of COVID-19 should be assessed by phone. The following information should be collected: travel destinations, infection risk, symptom onset and symptoms. To avoid having patients visiting their GP, emergency medical clinics and emergency departments, etc. before being assessed, it is important to establish a medical history that includes any exposures to SARS-CoV-2. Patients must be referred by phone directly to a department of infectious disease medicine.

If a patient meeting the criteria for suspicion sees his or her GP anyway, the following hygiene precautions are to be observed:

• The patient is admitted to a one-person room or seen behind room dividers only visited by the required staff.
• A standard surgical mask with no expiration valve is handed out. The mask is placed over the face by the patient him- or herself.
• If possible, the patient’s medical history and general condition are assessed from a distance.
• In stable patients, the staff avoids close contact whenever possible.

Home treatment in isolation

What we currently know indicates that many COVID-19 patients, and particularly those who are young and otherwise healthy, may expect to experience mild symptoms that do not require treatment at a hospital. Following specific assessment by an infectious disease specialist, suspected and confirmed cases of COVID-19 may be discharged for observation in their homes, even while they are still presumably infectious. This is so, among others, to avoid transmission at hospitals and to free hospital capacity for more severely ill patients.

Laboratory diagnostics

SARS-CoV-2 laboratory diagnostics should generally be performed following specific assessment by an infectious disease specialist. Generally, laboratory diagnostics should not be done for persons who are symptom free; this includes asymptomatic contacts.

Patient samples are marked “ALERT, obs. COVID-19” and - until further notice - submitted using the SSI sample collection service. SARS-COV-2 analyses are conducted daily at 8 am. and 8 pm.

Differential diagnostics are done at local departments of clinical microbiology (DCMs). The DCMs associated with the six hospitals mentioned above are expected to have sufficient capacity to diagnose SARS-CoV-2 rapidly.

Notification

Confirmed COVID-19 cases must be notified by phone to the Danish Patient Safety Authority (DPSA) and on Form 1515 to the DPSA and to Statens Serum Institut (SSI).

Handling close contacts

The Danish Patient Safety Authority is in charge of tracking and handling healthy, close contacts to patients with confirmed COVID-19. When delimiting the risk of infection, it is standard practice to include close contacts to confirmed COVID-19 patients seen in the two days leading up to symptom onset.

(Danish Health Authority, Danish Patient Safety Authority and Statens Serum Institut)

Individually notified diseases 2019

The annual report includes the number of individually notifiable diseases with onset in 2019. The figures may be adjusted due to late notifications and new information. For comparison, we give totals for 2018 and the annual average for the 5-year period 2014-2018, along with the lowest and highest number of annual cases during this period. No cases of haemorrhagic fever, group A meningococcal disease, plague, polio, rabies or rubella were notified.

See the 2019 Annual Report (pdf).

(Department of Infectious Disease Epidemiology and Prevention)