Công văn 7963/SYT-NVY

The Government promulgated Resolution No. on Provisional Guidelines on “Safe, flexible adaptation, and effective control of COVID-19” on October 11, 2021;

Ministry of Health promulgated Decision No. 4800/QD-BYT providing Provisional guidelines on medical specialty in implementation of Resolution No. 128/NQ-CP dated October 11, 2021 of the Government on October 12, 2021;

In implementing “Safe, flexible adaptation, and effective control of COVID-19” strategy of the Government, procedures for identifying and handling F0 in the community are amended to suit epidemic control situation.

At request of CDC of the City, Department of Health provides provisional guidelines on Procedures for identifying and handling F0 in the community which serve as the basis for enabling medical centers of districts and Thu Duc City to consult Steering Committees for COVID-19 Prevention and Control of districts and Thu Duc City for implementation.

Request Steering Committees for COVID-19 Prevention and Control of districts and Thu Duc City to organize drills for scenarios where confirmed COVID-19 cases are identified in the community, submit drill plans to Department of Health and CDC of the City to enable the recipients to assign participants, and report to People’s Committee of the City.

Assign CDC of the City to provide specific guidelines on implementation for entities; monitor and provide support for procedure implementation in administrative divisions; acknowledge difficulties and consult Department of Health to amend the procedures if necessary.

Difficulties that arise during implementation should be reported to Department of Health.

 (Attached documents:

- Procedures for identifying and handling confirmed COVID-19 cases in the community;

- Community infection cluster handling drills)./.

PROCEDURES FOR IDENTIFYING AND HANDLING CONFIRMED COVID-19 CASES (F0) IN THE COMMUNITY

 (Attached to Official Dispatch No. 7963/SYT-NVY dated October 28, 2021 of Department of Health)

1. Step 1: Identify F0

- In case an F0 is identified via RT-PCR or quick antigen test by:

+ Screening of individuals with suspected symptoms and/or epidemiology factors (such as making close contact with another F0 or coming from areas under level 4 epidemic) in medical facilities, workplaces, manufacturing facilities, service providers, etc.

+ Irregular and regular test in areas with high risks or multiple risk levels.

+ Epidemic control affairs in family infection clusters, community infection clusters, enterprise infection clusters, school infection clusters, etc.

+ The general public who test and inform medical stations.

- Individuals who are tested positive via RT-PCR test or quick antigen test are considered F0 and subject to care and management. In case the general public conducts the test by themselves, if ground for identifying F0 is insufficient, perform quick antigen test.

- Assign:

+ Steering Committees for COVID-19 Prevention and Control of wards and communes shall assign specialized personnel or medical stations to implement.

+ All laboratories and medical facilities, upon identifying positive test results to COVID-19, must immediately input information onto the infection chain management software (CDS).

2. Step 2: Dealing with “Household infection cluster”

- Residence of an F0 is considered as a “household infection cluster” and must be handled promptly after F0 information is identified.

- Perform quick antigen test for all family members and quarantine the household for 14 days from the date on which the first F0 in the household is identified; place a warning sign that reads “ĐỊA ĐIỂM CÁCH LY Y TẾ PHÒNG, CHỐNG DỊCH COVID-19” (LOCATION UNDER MEDICAL QUARANTINE FOR COVID-19 PREVENTION, CONTROL) (red background and yellow letters) in front of the house.

- Care for F0: examine, assess symptoms of respiratory failure, and immediately call fast responders if the F0 experiences rapid breathing, dyspnea, or SpO₂ less than 96% in order to transfer the F0 to a hospital. If F0 experiences no symptoms or mild symptoms, allow home quarantine (if eligible) and issue medicine packs A-B, C. If F0 experiences no symptoms or mild symptoms while being ineligible for home quarantine (lacking caregivers or lacking infection prevention measures among the family), the F0 shall propose appropriate quarantine location (in quarantine facilities of enterprises, manufacturing facilities, charging quarantine facilities, local concentrated quarantine facilities).

If more than 10 households in a ward or commune contain F0, employ 1 mobile medical station to manage and care for F0 at home; if more than 50 to 100 households in a ward or commune contain F0, employ additional mobile medical stations.

- Instruct household members under quarantine to implement preventive measures and protect individuals with high risk (individuals > 65 years of age, individuals > 50 years of age and suffering from underlying medical conditions, obese individuals with BMI > 25, pregnant women or women during 2 weeks of postpartum period); immediately test individuals who experience symptoms during quarantine period.

- Test the whole family again by the end of the 14-day period in order to decide on completion of quarantine period.

Note: If additional F0 are identified in a household, do not add to quarantine period of other household members.

3. Step 3. Investigate and handle “Community infection cluster”

- A “community infection cluster” is a residential area where at least 2 household contain F0.

- Immediately after identifying “household infection cluster”, immediately review and investigate epidemic information in the area, if other “household infection clusters" occur in the same area, conduct basic investigation to diagnose “community infection cluster” based on the following criteria:

+ At least 2 households contain F0 and are located in the same area

+ Level of contact in the area (small, narrow alleys, densely populated areas, habits, routines, etc.)

+ Level of contact with the outside (inhabitants of the area are delivery persons or working in areas with high infection risks such as markets, supermarkets, restaurants, shopping malls, medical centers, etc.)

+ Vaccination status of the inhabitants

+ Previously identified as an infection cluster

Note: basic investigation must be conducted on the basis of available knowledge, information on the area and physical inspection in order to localize infection cluster.

- Temporarily isolate the “community infection cluster” area (according to identified range) in 24 hours in order to:

+ Inform the inhabitants about the community infection cluster, instruct the inhabitants, and request compliance with regulations on infection cluster management.

+ Mobilize forces to conduct quick antigen test within 2 - 4 hours for all inhabitants in the infection cluster to assess risk level.

- On the basis of “community infection cluster” screening test and characteristics of residential areas, classify risk of the infection cluster depending on risk levels of assessment criteria:

+ An infection cluster shall be classified with “low risk” when all criteria are in low risk level (yellow).

+ An infection cluster shall be classified with “very high risk” when 2 of the first 3 criteria are in very high risk level (red) (e.g. an area where more than 30% of the local households contain F0 and level of contact in the area is high even though contact with the outside is moderate, percentage of inhabitants adequately vaccinated reaches above 80%, and was previously identified as an infection cluster in the past 6 months shall still classified with “very high risk”)

+ The other cases shall be classified as “high risk” (orange).

- Handle infection cluster based on risk classification:

+ Low risk infection cluster: test inhabitants of the infection cluster (except for households which house F0) once every 5 days (quick antigen test with group sampling for every household) until no more F0 is identified. Individuals who are tested negative may move around, go on with their routines regularly without engaging in activities with more than 20 people, monitor their health, and inform local medical stations immediately after experiencing symptoms in order to be tested.

+ High risk infection cluster: test inhabitants of the infection cluster (except for households which house F0) once every 3 days (quick antigen test with group sampling for every household) until no more F0 is identified. Individuals who are tested negative may move around, be subject to limited contact, keep track of people whom they make contact and location where they make contact during the quarantine, must not engage in activities with more than 10 people, monitor their health, perform medical declarations on a daily basis, and test immediately after experiencing symptoms.

+ Very high risk infection cluster: strictly quarantine the entire infection cluster, test once every 2 days for at least 3 times until no more F0 is identified at which point the quarantine is dismantled (except for households that house F0 shall remain under quarantine). Strictly manage quarantine area and guarantee absolute isolation between households.

- Care for F0 and isolate, test household members of households that house F0 according to regulations on handling household infection clusters.

- During management of community infection clusters, investigate and assess epidemic situation on a regular basis in order to expand or narrow infection clusters.

- Assign:

+ Medical centers of districts:

● Provide specialized support for the Steering Committees for COVID-19 Prevention and Control of communes, wards, and ward-level towns to assess and identify risk level of infection clusters.

● Direct and assist medical stations in performing specialized measures in infection clusters. If necessary, request assistance from hospitals of districts and cities (to conduct test, etc.) or from CDC of the City (to manage complicated infection clusters, etc.).

+ Steering Committees for COVID-19 Prevention and Control of districts and CDC of the City shall inspect, supervise management of community infection clusters, and adjust scope, risk level of infection clusters when necessary. In case an infection cluster involves at least 2 wards, communes, and/or ward-level towns, Steering Committees for COVID-19 Prevention and Control of districts shall decide on radius of infection clusters and coordinate cooperation between communes, wards, and ward-level towns in infection cluster management.

+ Steering Committees for COVID-19 Prevention and Control of communes, wards, and ward-level towns: identify radius of local infection clusters, directly coordinate infection cluster handling coordinates, and submit reports regularly and irregularly to Steering Committees for COVID-19 Prevention and Control of districts and district-level cities.

+ The community COVID teams are responsible for supervising compliance and providing security packages for individuals under home quarantine.

COMMUNITY INFECTION CLUSTER HANDLING DRILLS

 (Attached to Official Dispatch No. 7963/SYT-NVY dated October 28, 2021 of Department of Health)

♦ Scenario 1:

Medical station of Ward X, District Y receives information on 1 case of a 50-year-old woman who is tested positive to SARS-CoV-2 via RT-PCR test conducted and notified by Hospital A on the CDS system.

Initial investigations acknowledge that the patient’s residence is located in a market while the patient runs a business at home. In the past week, 2 household members of the patient coughed and experienced fever but had been relieved naturally. The patient herself also coughed, experienced fever, and visited a hospital for examination and testing for her diabetes. The patient reveals that members of neighboring households also cough, experience fever, fatigue. Most of the local inhabitants have been adequately vaccinated against COVID-19.

♦ Scenario 2

By means of random screening in form of quick antigen test, a company identifies a worker who is positive to SARS-CoV-2 and immediately informs medical station of ward where said worker resides.

Initial investigation reveals that the patient resides in a dorm with multiple walkways and surrounded by a residential area. Further investigation reveals more than 20 people experiencing suspected symptoms and living in the dorm and neighboring residential units.

♦ Scenario 3

Mr. C, 40 years of age, arrives at a medical station to inform about positive test result produced via quick test. Initial investigation reveals that Mr. C is not entirely sure whether or not he has made contact with any confirmed COVID-19 case in the past 2 weeks. Medical station personnel have collected RT-PCR test samples and handled infection cluster in Mr. C’s household while waiting for RT-PCR test results.

Epidemiological investigation reveals that Mr. C residence is located in the area adjoining Ward X and Ward Y simultaneously with high migrant density and unidentified vaccination record. Neighboring inhabitants inform that multiple locals have been coughing, experiencing fever, loss of taste - smell in the past week. The medical station records 70 households containing F0 stretching across 5 neighborhoods.

♦ Scenario 4

During the morning in Industrial Park A while workers are performing medical declaration prior to entering working station, 5 workers who are coughing, experiencing fever and fatigue are immediately tested with quick antigen test where they are positive to COVID-19.

These 5 workers are later revealed to be working in 2 different workshops. Enterprises then test all workers working in those 2 workshops where 200 F0 are identified. All of these F0 are currently being quarantined in the workshops.

♦ Scenario 5

An infection cluster involves 3 households containing F0 initially; 2 further tests reveal another infection cluster with more than 100 households containing F0 located in the area adjoining 2 wards of a single district within 7 days.

♦ Requirements for drills:

Drill scenarios must depict realistic activities and specific responsibilities for every person. Activities required to be depicted in the drills including:

 (1) Methods of receiving information on F0.

 (2) Investigation on F0 and preparation of lists of F1.

 (3) Identification of radius of infection cluster: describe the radius on the basis of the scenario being prepared based on a realistic location.

 (4) F0 management: manage F0 in communes and wards; Methods of managing F0 data; Coordination and assignment to guarantee care and management of F0 as per the law.

 (5) Activation time of mobile medical station(s). Number of medical station employed.

 (6) Organization of tests at the infection cluster: choose a fixed location within the vicinity of the infection cluster and request each household to arrive for testing; mention plans for mobilizing personnel to conduct quick antigen test within 2-4 hours for all inhabitants in the infection cluster.

 (7) Adjustment of infection cluster radius based on epidemiological supervision results and screening results at the infection cluster.

 (8) Quarantine of households housing F0: place signs, supervise compliance with medical declarations of household members, and assignment of home quarantine management.

 (9) Supervision and identification of suspected cases within the infection cluster.

 (10) Announcement on infection level for local inhabitants.

 (11) Supervision of infection cluster inhabitants’ compliance with restrictive measures.