They order to stop testing some of the suspected cases in the province and there is controversy

An official communication sent by the director of epidemiological surveillance and epidemic control of Buenos Aires to the director of the district hospitals, reveals a bottleneck in the ability to perform specimens and diagnostics of coronaviruses in a timely manner given the sharp increase in cases.

The document to which you had access Bugle bears the signature of Teresa Beatriz Varela to Juan Riera, who commands limit the use of tests to confirm positive cases of coronavirus. He speaks of “new guidelines and reinforcement of those already in force for the purposes of optimize the use of diagnostic resources in the resolution of suspected cases of Covid-19 “.

Among other problems, the measure stipulates to stop testing possible suspected cases of coronavirus which are asymptomatic. On this point is based one of the criticisms that the measure has received from certain infectologists. For the detractors of the official decision, this criterion would be delicate because Covid would be allowed to spread uncontrollably.

Varela’s argument is “avoid laboratory saturation diagnosis, which may lead to a loss of chance in issuing the corresponding test results in the epidemiological context recently configured “.

The official explains that “last week there was a general increase in suspected cases for the province almost 50%, with an even higher proportion in the AMBA region which has doubled the number of samples received by the network of public laboratories for the surveillance of COVID-19 in the province located in this region. This can be clearly visualized with the confirmation of 8063 cases on Friday March 31, which constitutes about half of the daily cases in the country “.

<< In this context of health emergency, all health teams are invited to confirm by clinical epidemiological criterion (do not take a sample-) in cases which respect:

– Criterion 1: any suspected case who has at least 2 of the following symptoms: fever, cough, odynophagia, respiratory distress, vomiting / diarrhea / headache / myalgia and who in the last 14 days before symptom onset has been in contact narrow one laboratory-confirmed case.

– Criterion 2: Anyone who, in the absence of any other identified cause, begins with a sudden loss of taste or smell.

They except the following groups:

– Patients who present clinical criteria for hospitalization.

– Patients with risk factors (age ≥ 60 years, diabetes, chronic cardiovascular or respiratory disease, renal failure, cirrhosis, immunocompromised, obesity).

– Pregnant people.

– Health workers.

– Essential staff.

– Deceased persons, with no known cause.

The communication indicates that “only those which constitute a suspect case according to the current protocol will be studied by laboratory. In other words, they will not be studied by laboratory for asymptomatic persons, nor presenting symptoms which do not correspond to the definition of case “.

And he adds: “It is essential to focus on the quarantine of close contacts in 14 days from your last contact with a confirmed case, without this behavior being able to be modified by a complementary study, since it is the only effective mechanism to stop the chain of transmission of the virus ”.

Controversy

Arnaldo Casiró, head of infectious diseases at Alvarez hospital, warned that as part of the second wave of Covid “It is a very dangerous measure”. He said that “it is not known what will happen to people who have two of the symptoms mentioned but do not know if you were in contact with someone positive. There’s a gray left over there. “

Eduardo López, infectologist and member of the expert committee advising the government, said that “the definition of criterion 1 is incomplete, because this leads to those who were in a group and did not know if they were in contact with an asymptomatic person, for example. And these parties are the most common places of contagion“.

López added that “if these patients are not studied, there is a risk that the disease continues to be transmitted. Above all, it is when in these group meetings there are super-transmitters and super-propagators of the virus. “

Detect asymptomatic cases was one of the key strategies to try during the pandemic stop the chain of infections. The DetectAr plan is based on this logic. In other words, the detection of positives for their immediate isolation.

On the other hand, Casiró raised another issue: “The bottleneck that exists today for performing diagnostic tests will be in the medical human resource. The health personnel trained to perform a clinical assessment are not the same as those who today limit themselves to ordering a test. “

The third point raised by Casiró is that with this measure “there is a risk that more cases of coronavirus stay out of SISA (the system that centralizes all information on the pandemic in Argentina). If now there are a lot of positive points that cannot be resolved – and I say this because I checked – with this new criterion, the problem can be deepened.

Sources from the hospital management said Bugle that cases diagnosed by a medical clinic and not by tests will always be included in HIFIS. And they added that “the link diagnosis it has been implemented for some time in places where the virus is spread in the community. “

Consulted by Bugle, Varela said the measure communicated now is based on “criteria already in force from September 2020, which is the last approved protocol. “

The director of epidemiology explained that “people with two or more characteristic symptoms of the disease and in close contact with a laboratory confirmed case can be confirmed by clinical epidemiological criteria. The same goes for cases due to loss of taste or smell. All of this must be notified in SISA, which provides for this possibility of notification “.

PS