DECISION

ISSUANCE OF “PROVISIONAL GUIDELINES SUPERVISION AND COVID-19 EPIDEMIC MANAGEMENT”

MINISTER OF HEALTH

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of Government on functions, tasks, powers, and organizational structure of Ministry of Health;

At request of Director General of General Department of Preventive Medicine, Ministry of Health

HEREBY DECIDES

Article 1. Attached to this Decision are “Provisional guidelines supervision and COVID-19 epidemic management”.

Article 2. The “Provisional guidelines for supervision and COVID-19 epidemic management” shall be applied in preventive medical facilities and medical examination and treatment on a nationwide scale.

Article 3. This Decision comes into effect from the date of signing; replaces Decision No. 963/QD-BYT dated March 18, 2020 of Ministry of Health on issuance of Provisional guidelines for supervision and COVID-19 epidemic management and Decision No. 1619/QD-BYT dated April 9, 2020 on issuance of Annex to replace Annex 1 “Collecting, preserving and transporting specimen” attached to Decision No. 963/QD-BYT dated March 18, 2020 of Ministry of Health on issuance of “Provisional guidelines for supervision and COVID-19 epidemic management”.

Article 4. Chief of the Ministry Office, Chief Ministry Inspectorate, Director General, Directors of General Departments and Departments affiliated to Ministry of Health, Directors of Institutes of Hygiene and Epidemiology, Pasteur Institutions, Directors of hospitals affiliated to Ministry of Health, Directors of Health Departments in provinces and central-affiliated cities; heads of medical sector and heads of relevant entities are responsible for implementing this Decision././.

PROVISIONAL GUIDELINES

SUPERVISION AND COVID-19 EPIDEMIC MANAGEMENT
(Attached to Decision No. 3468/QD-BYT dated August 7, 2020 of Ministry of Health)

I. COMMON CHARACTERISTICS

COVID-19 is a Class-A acute communicable disease caused by a virus called SARS-CoV-2. This is a contagious disease that spreads from person to person. Its incubation lasts for about 14 days. Patients infected with this disease will develop typical symptoms, such as fever, cough, difficulty breathing, which may lead to severe acute respiratory infection, acute respiratory failure and eventually death, particularly in individuals with pre-existing medical conditions, chronic medical conditions and old people. About 40% of individuals infected with SARS-CoV-2 display no clinical symptoms and may be the source of infection in community which hinders supervision and epidemic management. Until now, specific medication and vaccines have not been developed.

The first confirmed case was recorded in Wuhan City, Hubei Province, China on December 3, 2019. On March 11, 2020, WHO acknowledged COVID-19 as a global epidemic. Until August 7, 2020, the world has recorded 19,266,075 cases of COVID-19 in 215 countries and territories, 717,787 cases of which have deceased. Vietnam has recorded 750 cases of COVID-19 in 40 provinces and cities in all 4 regions of northern region, middle region, southern region and the central highlands with 346 cases of infection come from multiple countries and 404 cases are domestic infection.

These provisional guidelines are developed based on situations of the epidemic to enable provinces, cities, health entities and relevant bodies to implement on a local level.

II. GUIDELINES FOR SUPERVISION

1. Definition of cases and close contacts

1.1. Suspected case (supervised case)

Refers to an individual who displays any of following symptoms: fever; cough; sore throat; dyspnea; prostration, body pain, feeling cold; reduced or loss of sense of taste or sense of smell; pneumonia and has any of following  epidemiological factors:

- Has arrived/passed/stayed/returned from countries or territories recorded with COVID-19 cases according to World Health Organization within 14 days prior to the date of entry.

- Has arrived/stayed/returned from areas with active hotspots in Vietnam within 14 days prior to the start of the illness.  Epidemiology Institutes and Pasteur Institutes shall consolidate lists of active hotspots within their competence on a daily basis and submit to General Department of Preventive Medicine to inform other areas.

- Has made close contact with a confirmed case or suspected case within 14 days prior to the start of the illness.

1.2. Confirmed case

Refers to a suspected case or any individual receiving positive test result (discovery of genetic materials or antigen) for SARS-CoV-2 virus performed by testing facilities permitted by Ministry of Health.

1.3. Close contact

Close contact refers to an individual within 2 meters with a confirmed case or suspected case in the period from 3 days prior to the start of the illness of the confirmed case or suspected case to the date in which the confirmed case or the suspected case are medically quarantined. In case of carriers, the date in which the illness starts shall be the date in which specimen tested positive to SARS-CoV-2 is collected. The illness starts from the date in which irregular symptoms that can be felt by the patients appear, namely: prostration; body pain, coldness, reduced or loss of sense of taste, sense of smell; fever; cough; sore throat, etc.

Close contact includes:

a) Individuals living in the same households, houses or rooms.

b) Individuals directly taking care of, visiting or receiving treatment in the same room with confirmed case(s)

c) Individuals in the same teams or workplaces.

d) Individuals in the same groups with confirmed/suspected case(s): travel groups, work trip, entertainment, parties, meetings, classes, religious gatherings, clubs, etc.

dd) Individuals taking seats in the same row or up to 2 rows away in the same transport (trains, automobiles, aircrafts, ships, etc.). In some particular cases, depending on epidemical investigation results, health agencies shall decide to expand list of close contact with passengers on the same transports.

e) Any individual making close contact with a confirmed case or suspected case in any other circumstance in the period from 3 days prior to the start of the illness of the confirmed case or suspected case to the date in which the confirmed case or the suspected case are medically quarantined.

2. Definition of hotspots

2.1. Hotspot: an area (hamlet, commune, neighborhood, etc.) where at least 1 case is confirmed.

2.2. Deactivated hotspot: when no new cases are confirmed for 28 days from the date on which the latest confirmed case are medically quarantined.

3. Supervision in details

The epidemic development may vary from province and city to province and city. Some provinces and cities have recorded cases while others have not. Depending on epidemic development in each province and city, proceed as follows:

3.1. When no confirmed cases have been indentified in provinces and cities

Request early detection of first suspected cases to quarantine and collect specimen to prematurely identify the case to prevent the epidemic from infiltrating the community. Details of supervision consist of following activities:

- Supervise closely in border checkpoints as well as in medical facilities and in community while focusing on supervising border checkpoints for passengers entering from countries and territories where confirmed cases have been acknowledged via temperature measurement, regular observation and other methods as guided by Ministry of Health.

- Supervise and investigate epidemiologically, collect test specimen, prepare list of confirmed cases, suspected cases and close contacts with confirmed cases using Forms 1, 2, 3, 4 and 6 under Annex 3.

- Implement medical quarantine and closely monitor close contact in 14 days from the date of latest contact.

- Supervise cases of severe pneumonia possibly due to the virus, severe acute pneumonia and flu, initiate supervision based on events to prematurely detect suspected cases in medical treatment facilities and public. Such individuals must be collected for SARS-CoV-2 test specimen.

- Report as specified under Section 3.5 in these provisional guidelines.

3.2. When a confirmed case has been identified but has not spread in the community of province or city

Request immediate detection of suspected cases, new confirmed cases and close contacts; implement medical quarantine; thoroughly deal with hotspots to minimize possibility of the epidemic spreading in the community. Details of supervision consist of following activities:

- Continue to supervise to detect suspected cases in border checkpoints, treatment facilities and public according to guidelines of Ministry of Health.

- Supervise and investigate epidemiologically, collect test specimen, prepare list of confirmed cases, suspected cases and close contacts with confirmed cases using Forms 1, 2, 3, 4 and 6 under Annex 3.

- Extensively supervise cases of severe pneumonia possibly due to the virus, severe acute pneumonia and flu, initiate supervision based on events to prematurely detect suspected cases in medical treatment facilities and public. Such individuals must be collected for SARS-CoV-2 test specimen.

- Report as specified under Section 3.5 in these provisional guidelines.

3.3. When the epidemic has widely spread within the community

Epidemic is confirmed to have widely spread in the community when more than 50 cases of secondary infection are recorded in at least 2 districts/townlets/towns in a province/city in 14 days.

Request maintaining prematurely detection of hotspots in the community and thoroughly dealing with new hotspots, continue to suppress active hotspots and minimize epidemic widespread in the community. Details of supervision consist of following activities:

- Continue to supervise to detect suspected cases in border checkpoints, treatment facilities and public according to guidelines of Ministry of Health.

- In districts/townlets/towns where no confirmed cases have been identified: Supervise and investigate epidemiologically, collect test specimen, prepare list of confirmed cases, suspected cases and close contacts.

- In districts/townlets/towns where confirmed cases have been identified:

+ Supervise and investigate epidemiologically, and collect test specimen to verify at least 5 confirmed cases in the new hotspots. In subsequent cases, collect specimen depending on epidemic development.

+ In verified and active hotspots, suspected cases must be considered to be clinical cases, quarantine, epidemic prevention and reporting regime must be implemented.

- Implement medical quarantine and closely monitor close contact in 14 days from the date of latest contact.

- Extensively supervise cases of severe pneumonia possibly due to the virus, severe acute pneumonia and flu, initiate supervision based on events to prematurely detect suspected cases in medical treatment facilities and public. Such individuals must be collected for SARS-CoV-2 test specimen.

- Report as specified under Section 3.5 in these provisional guidelines.

3.4. Collect, preserve and transport specimen: Specified under Annex 1.

3.5. Communications and reports

Consolidate daily reported figures; figures shall be collected from 12 o’clock of the previous day to 12 o’clock of the following day.

- Disease Control centers of provinces and cities shall manage the lists and monitor medical condition of confirmed cases, suspected cases, close contacts, individuals making contact with close contacts, number of quarantined individuals in provinces and cities (including all closed medical treatment establishments in the areas); report consolidated figures using Form No. 7 under Annex 3 and confirmed cases, suspected cases using Form No. 4 under Annex 3 and submit to Institutes of Hygiene and Epidemiology, Pasteur Institutions before 2 p.m. daily. 

- Institutes of Hygiene and Epidemiology, Pasteur Institutions shall manage the lists and monitor medical condition of confirmed cases, suspected cases, close contacts and number of quarantined individuals in areas within their responsibilities; report consolidated figures using Form No. 7 under Annex 3 and confirmed cases, suspected cases using Form No. 4 under Annex 3 and submit to General Department of Preventive Medicine before 3 p.m. daily.   General Department of Preventive Medicine shall report to heads of the Ministry and National Steering Committee before 5 p.m. daily.

- Testing facilities including public and private hospitals and medical examination and treatment establishments must submit reports on test figures, test results, number of specimens collected daily, number of tests, etc. to Disease Control centers of provinces/cities before 1 p.m. daily. Disease Control centers of provinces and cities shall report to regional Institutes of Hygiene and Epidemiology, Pasteur Institutions before 2 p.m. daily. Institutes of Hygiene and Epidemiology, Pasteur Institutions shall consolidate reports on test result, number of specimens collected daily, number of tests, etc. using Form No. 8 under Annex 3 and submit to General Department of Preventive Medicine before 3 p.m. daily. General Department of Preventive Medicine shall report to heads of the Ministry and National Steering Committee before 5 p.m. daily.

- In case of specimens that are tested positive to SARS-CoV-2 by testing facilities permitted by Ministry of Health, testing facilities shall immediately update information on the case, submit test results in automatic patient numbering system of Ministry of Health, inform senders of test specimens and report to Departments of Health, General Department of Preventive Medicine, Institutes of Hygiene and Epidemiology, Pasteur Institutions in the areas.

- In case of specimens that are tested negative to SARS-CoV-2, testing facilities shall inform senders of test specimens.

- Implement communication and reports for group A infectious diseases as specified under Circular No. 54/2015/TT-BYT dated December 28, 2015 of Ministry of Health providing guidelines for declaring, communicating and reporting infectious diseases.

III. PREVENTIVE MEASURES

1. Non-specific preventive measures

Actively perform following measures:

- Do not enter infected areas. Refrain from going to crowded places. If going to crowded places is required, implement personal protective measures such as wearing face masks, washing hands and maintaining distance, etc.

- Refrain from making contact with persons infected with acute respiratory tract illness (fever, cough, dyspnea); if making contact is required, properly wear medical face masks and maintain a distance of at least 2 meters.

- Suspected individuals must stay at home, wear face masks and immediately inform the nearest medical facilities in order to be consulted, examined and treated promptly. Call the medical facilities prior to arriving to inform symptoms and itineraries in recent days in order to receive proper response measures; do not go to crowded areas. Students, learners and workers must temporarily leave schools and/or work and inform medical authorities immediately upon showing signs of infection.

- Ensure personal hygiene and wash hands regularly under running faucets with soap or regular sanitizers for at least 20 seconds; rinse mouth and throat with mouthwash and refrain from touching eyes, nose or mouth to prevent infection.

- Cover mouth and nose when coughing or sneezing, best when covering with cloth, handkerchiefs, disposable tissues or sleeves to reduce spread of respiratory droplets; wash hands with soap and water or sanitizers after coughing or sneezing. Do not spit in public places.

- Ensure food safety and only consume cooked food.

- Do not trade or make contact with wild animals.

- Keep body warm, improve overall health by adequately eating, resting, carrying out daily routines and participating in sports.

- Enhance ventilation of houses by opening doors and windows, restrict the use of air conditioners.

- Regularly clean residence, offices, schools, factories, etc. by mopping the floor, door knobs and surfaces of household interiors with soap, regular cleaning substances and other disinfectants as instructed by medical sector.

- Regularly clean and sanitize transports: aircrafts, trains, ships, automobiles, etc.

2. Specific preventive measures

Specific vaccines have not been developed so far.

3. Border medical check

- Supervise passengers making entry and adopt regulations on medical declaration according to Decree No. 89/ND-CP dated June 25, 2018 of Government on elaborating to Law on preventing infectious diseases regarding implementing border medical check and guidelines of National Steering Committee and Ministry of Health.

- Implement quarantine and medical procedures in border checkpoints as specified under Decree No. 101/2010/ND-CP dated September 30, 2010 of the Government on elaborating to Law on infectious diseases regarding adoption of medical quarantine, enforced medical quarantine and specific epidemic prevention during epidemic the guidelines of National Steering Committee and Ministry of Health.

4. Medicine, materials, chemicals and equipment for disease prevention

Provinces and cities shall actively prepare adequate medicine, materials, chemicals, surveillance and testing equipment for local epidemic prevention.

IV. EPIDEMIC PREVENTION MEASURES

1. Implement measures specified under Part III

2. Additional measures

2.1. Medical quarantine and procedures

2.1.1. Confirmed case

- Closely quarantine and provide treatment in medical facilities to minimize complications and fatality.

- Restrict transferring patients to prevent infection unless treatment is beyond current facilities' capacities.

- Provide treatment and quarantine according to guidelines of Ministry of Health.

2.1.2. Close contacts with confirmed cases (first contacts):

- Organize investigation and trace close contacts upon receiving information about the cases. Prepare list of close contacts to receive information on house address, residence, personal phone number and name, phone number of relatives to inform when necessary.

- Quarantine all close contacts in quarantine zones in 14 days from the date of the latest contact with a confirmed case.  Separate quarantine zones should be established for close contacts since these individuals have a higher chance of being infected than other quarantined individuals. In case of no separate quarantine zones, designate separate areas in quarantine zones for close contacts. Individuals living in the same households, houses, rooms or offices with confirmed cases must be quarantined separately from others since they pose the highest possibility of being infected.

- Collect specimens to test SARS-CoV-2 with PCR method at least twice during quarantine period.

- Collect specimens the first time once the individuals have been quarantined:

+ If PCR test results come positive to SARS-CoV-2, treat as confirmed cases.

+ If PCR test results come negative to SARS-CoV-2, continue to quarantine and monitor health daily (measure body temperature and detect symptoms) in quarantine zones for 14 days from the date of the latest contact with a confirmed case.  If symptoms suspected to be due to the disease are present, continue to collect specimens and test for SARS-CoV-2.

- Collect specimens the second time once quarantine ends:

+ If PCR test results come positive to SARS-CoV-2, treat as confirmed cases.

+ If PCR test results come negative to SARS-CoV-2, end the quarantine.

2.1.3. Contacts with close contacts (second contacts)

- Request quarantining at home and provide guidelines for self-disease prevention and medical monitor while waiting for PCR test results of first contacts:

+ If PCR test results of the first contacts come positive to SARS-CoV-2, the second contacts shall become the first contacts.

 + If PCR test results of the first contacts come negative to SARS-CoV-2, the second contacts may end the quarantine.

2.1.4. Suspected cases

Have the patients wear face masks and quarantine then provide treatment at medical facilities separate from treatment areas of confirmed patients.

- Collect specimens for the first time to test for SARS-CoV-2 by PCR method immediate after hospitalization:

+ If PCR test results come positive to SARS-CoV-2, treat as confirmed cases.

+ If PCR test results come negative to SARS-CoV-2, move the patients to quarantine zones, provide treatment separately and continue to quarantine for 14 days from the date of the latest contact with sources of infection.

- Collect specimens to test SARS-CoV-2 with PCR method for the last time on the date in which the quarantine period ends.

+ If PCR test results come positive to SARS-CoV-2, treat as confirmed cases.

+ If PCR test results come negative to SARS-CoV-2, end the quarantine.

2.1.5. Close contacts with suspected cases

Request quarantining at home and provide guidelines for self-disease prevention and medical monitor while waiting for PCR test results of suspected cases:

- If PCR test results of the suspected cases come positive to SARS-CoV-2, quarantine the close contacts as first contacts.

- If PCR test results of the suspected cases come negative to SARS-CoV-2, the close contacts may end quarantine.

2.1.6. Individuals epidemiologically related to confirmed cases in other scenarios

In case of individuals who are not close contacts to confirmed cases but only present in the same major events or on the same transports as the confirmed cases, medical authorities shall inform in many forms: phone calls, messages, social networks or other mass media to enable relevant individuals to contact local medical authorities to receive instructions on performing medical declarations, monitoring health and informing medical authorities upon signs of infection.

2.2. Supervise and publicize active epidemic prevention in the community

- Form “Community COVID-19 supervising and publicizing team” (or “Community COVID-19 team”) in neighborhoods in infected areas and neighboring communes. With adequate resources, form these teams in other areas.

- Each team shall consist of 2-3 people who are officials of neighborhoods, hamlets, unions and volunteers in urban areas. Each team shall be in charge of 30-50 households and specifically designated.

- Mission of the team: “search each block, knock each house and scout each individual” daily to:

+ Publicize, mobilize and remind the people of disease prevention measures in each household: wearing face masks; washing hands with soaps; keeping distance; restricting contact, staying at home, avoiding going outside unnecessarily.

+ Question, supervise, detect and inform local governments and medical authorities immediately in case of suspected COVID-19 cases in households with symptoms like: fever; coughing, sore throat, fever and fatigue; flue or chest dyspnea to quarantine and collect specimens promptly.

2.3. Infection prevention for medical employees

- Thoroughly adopt personal protective measures such as wearing specialized medical face masks; eyeglasses; gloves; protective suit; protective hats; shoe cover, etc. when contacting patients.

- Wash hands immediately with soap and disinfectants before and after each session of physically meeting/examining patients or entering/leaving patient rooms.

- Restrict personal contact and minimize contact with patients.

- Prepare list and monitor daily health of medical employees making contact with patients. If epidemic symptoms appear, quarantine, treat and collect specimens as per the law.

- Do not assign expecting medical employees, employees who are raising children under 36 months of age or employees having chronic illnesses (bronchial asthma, cardiovascular, renal failure, liver failure, heart failure, cancer, diabetes mellitus, immunodeficiency, etc.) to participate in affairs that involve direct contact with confirmed cases or suspected cases.

2.4. For family of patients

- Adopt measures under Section 1 Part III

- Adopt hygienic practices, ventilate houses, regularly mop floor, door knobs and surfaces of interiors with regular cleaning substances such as soap and other disinfectants.

2.5. For community, schools, factories and offices

- Implement measures adopted by households.

Depending on practical situations of each area, Epidemic Management Steering Committees of provinces shall decide on implementing following measures:

- Do not hold crowded events.

- Restrict or suspend areas with high risk of infection such as: cinemas, bars, dance clubs, video game avenues, massage facilities, theaters, karaoke revenues, music clubs, gyms, sport facilities, enclosed religion facilities, etc.

- Adopt other disease prevention measures.

2.6. Infection prevention in treatment facilities

Closely implement classification of patient examination, quarantine and treatment; infection prevention and control measures according to Decision No. 468/QD-BYT dated February 19, 2020 of Ministry of Health.

2.7. Environmental disinfection and remediation of hotspots

- Patients’ households and neighboring households must be disinfected by cleaning or spraying floor, door knobs and interior surfaces with disinfectants containing 0.05% active chlorine (ensure surface contact period of 10 minutes) or 0.1% active chlorine (ensure surface contact period of 1 minute). Spray other areas such as kitchen areas, sanitation areas, yards, etc. with disinfectants containing 0.1% active chlorine. Sufficiently cover the surfaces that need to be processed. Number of spray sessions shall depend on actual pollution situation in hotspots.

- Best to close gates/doors of patients’ houses to prevent outsiders from entering or exiting the houses when patients and their family members are receiving quarantine in medical facilities.

- Transports carrying patients must be sterilized and disinfected with disinfectants containing 0.1% active chlorine.

- Disinfection of other relevant areas by spraying disinfectants containing 0.1% active chlorine shall be decided by epidemiology employees on the basis of physical investigation as long as all polluted areas or potentially polluted areas that than spread diseases must be dealt with.

Depending on development of COVID-19, epidemiology, virology and clinical investigation and research results and recommendations of WHO, Ministry of Health shall continue to update and adjust the guidelines accordingly./.

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