HumanitarianResponse



STANDARD OPERATING PROCEDURE (SOP) FOR COVID-19 SURVEILLANCEBackground/IntroductionThe novel coronavirus was first detected in Wuhan city, China in December 2019. As with many novel respiratory pathogens, a lot of the key epidemiological, and virological parameters of the virus and the outbreak dynamics are unknown at the beginning.Following the rapid escalation of the outbreak and spread to countries outside China, WHO declared the outbreak a ‘Public Health Emergency of International Concern’ On 30 January 2020. As at 17th February 2020, there were 71,429 confirmed cases, 1772 reported deaths, 26 affected countries. While majority of disease cases are currently mild, approximately 20% of patients are progressing toward severe diseaseCase definitionSuspected case: Any person with acute respiratory illness, (including severely ill patients who have been hospitalised) presenting with fever(≥380C), cough, difficulty breathing AND who within 14 days before onset of illness has any one of the following exposuresHistory of travel to areas with Covid-19 outbreak 14 days prior to symptoms onset ORClose contact with a confirmed case of COVID-19 infection ORExposure to healthcare facility in a country where hospital associated nCoV infections have been reportedProbable case:A suspect case for whom testing for COVID-19 is inconclusive or for whom testing was positive on a pan-coronavirus assayConfirmed case:Any person with laboratory confirmation of COVID-19 infection with or without signs and symptomsActions to take if you have a suspected caseIf you have a case that meets the case definition above, the following actions are recommended:A trained clinician wearing appropriate PPE (N95 respirator, gloves and gown) should assess the suspected case for more information and travel history, potential exposures, symptoms and possible alternative diagnosis and determine if the patient meets the definition for a suspected caseReach out to NCDC on 07032864444Contact the nearest National Influenza Sentinel site to your State (NISS) Lagos, Kano, Abuja and Awka for sample collection. Samples to be taken are either nasal swab, throat swab or nasopharyngeal swab. Appropriate PPE (N95 respirator, gloves & gown) should be used before collecting specimen Samples in triple packaging should be sent to the national reference laboratory, Gaduwa through Tranex. Other labs currently that can process samples include Lagos University Teaching Hospital (LUTH) and Irrua Specialist Teaching Hospital IrruaAdvise the suspected case to self-isolate for 14 days and call NCDC if any symptoms are noticedContact of confirmed caseIndividuals who are associated with some sphere of activity of the case and may have similar or other exposures as the case. Contacts can include household members, other family contacts, visitors, neighbours, colleagues, teachers, classmates, co-workers, social or health workers, and members of a social groupCategories of contact based on type of contact with a case. Contact category Close contact: Any person who had contact (within 1 meter) with a confirmed case during their symptomatic period, including one day before symptom onset.Social and health care workers contact: Any social or health care worker, who provided direct personal or clinical care, or examination of a symptomatic confirmed case of 2019-nCoV or within the same indoor space, when an aerosol generating procedure was implementedHousehold (or closed setting) contact: Any person who has resided in the same household (or other closed setting) as the primary COVID-19 caseEvery effort should be made to include all known close contacts, including infants and children, of the confirmed case to generate the specimen and data sampling time frame for follow-up. Ask each contact to report any signs and symptoms compatible with COVID-19 to the relevant Health authorities Any contact with clinical symptoms within 14 days of the last exposure/contact with the primary case should be considered as a symptomatic contact and so a suspected case, and therefore managed as such. Contacts found to be infected with COVID-19 would be re-classified as confirmed cases and follow-up would occur as described in the case investigation algorithm. The fact that a close contact becomes a confirmed cases , may not retrigger the data collection process, depending on the country resources and the type of contact (ex: if the contact is a health care worker, then it might be worth investigating further to inform public health action) Contact tracingContact tracing is defined as the identification and follow up of any person(s) who may have come into contact with an infected person. Identification of the contacts is done through interrogating the activities of the case or the activities and roles of the people around the case since onset of symptoms. While some of the information can be obtained from the case, a great deal of information will come from people around the case. If the case has died, contact tracing team should visit home/health facility of the deceased to carry out contact investigation. Contact identification and listing During a COVID-19 outbreak, all contacts of suspected, probable and confirmed cases should be systemically identified and listed in the contact listing form. Each contact should be assigned a category using the criteria as described above Efforts should be made to physically identify every listed 10 contact classified as “close contact”, “social or health care worker contact” and “household or closed setting contact” and monitored for 14 days (the maximum incubation period of COVID-19) from the last day of contact with the case. The LGA DSNO should be responsible for informing the contacts of their status and should introduce the contact follow up team to the contacts. Contact identification and listing should start as soon as a suspected case or death is detected. However, if a suspected case eventually tests negative for nCoV when test result is released, the contact list should be discarded. Note that 14 days follow up for contacts categorized as “No risk” is not advised. Therefore, effort should be made to correctly categorize contacts during contact listing. The LGA DSNO should assemble a competent team to undertake the contact follow up. These should comprise of community health workers, volunteers to follow up all the listed contacts. The contact tracers and their supervisors should be trained in a one-day orientation workshop using standardized materials. The purpose of this training is to familiarize the team on the basic information on COVID-19, procedures and tools for contact tracing as well as the required safety precautions. Trained health workers should be included in the community structure for contact follow-up. After conducting orientation, contact follow-up teams should be equipped with all the necessary tools e.g. contact follow up and reporting forms. The contact tracing team should do a physical assessment as well as take vital signs of contacts completing the 14-day follow-up period on the last day. In the absence of any symptoms, contact persons should be informed that they have been cleared from the follow-up; and can resume normal activities and social interactions.Active case searchActive case search should complement contact tracing in the detection of any suspected case not on the contact list. It therefore enables the early identification of individuals in the community not listed as contacts but who have developed symptoms compatible with COVID-19. Active case search should be initiated within 48 hours after a COVID-19 case has been confirmed in a location. Active Case Search in the CommunityActive case search in the community is a form of community-based surveillance. It is the process of identifying unreported symptomatic individuals, who may fulfil the suspected case definition of COVID-19 by actively searching for the cases within communities. The communities of interest will be determined based on the travel or contact history of the case. Active case search should include visiting different community centers that are often utilized (such as churches, clinics, medicine stores, mosques), visiting and interviewing community members in places people are known to frequent such as shop keepers, home based care professionals, herbalists, block leaders, school teachers and the community chair. If a sick person is identified, the active case search team should notify the LGA DSNO immediately who will ensure the sick person is referred to a healthcare facility or treatment centre and followed for further investigation. Detailed report of the case should be submitted for documentation and follow –up.Active Case Search in the Health facility The general objective of conducting active case search in healthcare facilities is to assess the ability of these facilities to identify and report suspected COVID-19 cases and ensure that no suspected cases have been missed. Healthcare facilities should be prioritized based on risk category (No, low, High). Risk classification should be based on where the case was identified or has visited, proximity to identification site, volume of patients attending the facility, IPC practices, or other factors as the situation might dictate. The methods used to obtain data/information during active case search include record review and interview with relevant health care workers in the health facility. Using WhatsApp application for Active Case Search One of the ways to ensure reporting of suspected COVID-19 cases 12 Signal surveillance The NCDC Connect Centre undertakes rumor (signal) surveillance as part of routine surveillance activities. This involves receiving calls, WhatsApp and SMS messages directly from the public as well as scanning media outlets reporting on COVID-19. Signal of alert cases not previously reported to NCDC are recorded in the signal log. The LGA DSNO where signal is reported should be contacted to investigate such signal and present a report within 48 hours.Surveillance at POEPort Health Services is responsible for the screening of all travelers at the POE. Passengers who have fever or show signs and symptoms of respiratory illnesses will be referred to the health desk for further evaluation. All passengers will fill in a self-reporting form, those arriving from high risk countries and who have sign and symptoms of fever and respiratory illness on the form will be evaluated at the health desk.Passengers who are apparently healthy but had history of travel from high risk countries will be monitored the for the period of 14 days the monitoring toolFlow chart for triaging at POECOVID-19 Outbreak A single case of confirmed COVID-19 is considered an outbreak. Clinicians should have a high index of suspicion when managing febrile illnesses; especially cases with; 1. Acute respiratory illness presenting with fever, cough and difficulty breathing 2. A compatible history of travel to China or an area with an ongoing outbreak, contact with a confirmed case of COVID-19.Roles and Responsibilities Regarding outbreak response, clear roles must be defined for each level of government. The outbreak response operation in Nigeria consists of State and National teams. In line with the national IDSR guidelines, the plans are as follows:National 1. Strengthening case management and laboratory diagnosis a. Provide technical support to states in terms of strategy and strengthen COVID-19 outbreak response. NCDC will also provide supportive supervision in all aspects of COVID-19 response: administrative, logistics and financial management for operations. b. Coordinate and support the activation of previously identified COVID-19 isolation centers and promote access to free treatment for patients with COVID-19. c. Coordinate organizational support for health-care workers and deployed staff that are at high risk of being infected. d. NCDC will work with its partners and relevant stakeholders to deploy additional technical resources, epidemiologists and field officers to address immediate priorities and sustain support in the field. 2. Data management and resource allocation a. Enhance management as well as centralize the collection and sharing of data to relevant stakeholders for decision-making, response assessment, and resource mobilization. States and LGAs States should activate the EOC/RRT. The RRTs will coordinate the COVID-19 response activities at the respective levels of operations. In every state, RRTs are in charge of supporting local response operations and should be adaptable to the evolving situation. States and LGAs should work in line with national guidelines and be the first to initiate and institute actions on issues of disease prevention, control and response. State level 1. The State Commissioner for Health should provide logistic and other support to the State rapid response teams for prompt verification of COVID-19 outbreaks and in instituting immediate response interventions. 2. The State Epidemiologist should manage all data collected to inform, guide response and conduct risk assessment for COVID-19 in areas of high risk. 3. The Rapid Response Teams should comprise of different professionals from all relevant sectors. Persons with prior experience on pandemic influenza response should be included if available. The RRTs should adapt the respective case definition for use Notification of COVID-19 occurrence, the response to a COVID-19 case requires an efficient and coordinated communication at all levels (LGAs, States and National). Reporting of COVID-19 cases should follow the IDSR reporting flow. 1. Reporting to the LGA DSNO If the patient’s illness is compatible with the probable, suspected or confirmed case definition of COVID-19, the attending physician should inform LGA DSNO where the health facility is located immediately within 24 hours. The LGA DSNO should immediately notify the State Epidemiologist and the LGA Rapid Response Team (RRT) should visit the health facility and the community of residence of the patient for further investigations within 24 hours following notification receipt. Contact tracing and other appropriate course of actions should be taken in line with the national guidelines. Appropriate documentation should be made on the IDSR forms (IDSR 001A, B and C) and Surveillance Outbreak Response Management and Analysis System (SORMAS) and all case investigation forms should be properly filled 2. Reporting to the State Epidemiologist and NCDC The State Epidemiologist on receipt of notification from the LGA DSNO should immediately notify NCDC at the National. The State Rapid Response Team (SRRT) will collaborate with the LGA DSNO, the LGA RRT, clinician (s) managing the patient, the laboratory and NCDC for further implementation of the appropriate course of action. 3. International Health Regulation 2005 (IHR 2005) requires the IHR National Focal Point (NFP) thatmis NCDC to report to WHO any cases(s) of COVID-19 due to the potential risk of international spread Case Investigation Case Investigation is an important component of epidemiologic investigation carried out for all cases meeting the standard case definitions of COVID-19. These cases are classified as suspected, probable or confirmed. In addition, epidemiologic investigation is conducted for all deaths, either in the community or health facility attributable to COVID-19. The process of verifying the cause of death is called verbal autopsy, aimed to establish the likely cause of death and identify chains of transmission. The tools for conducting epidemiologic investigation is the case investigation form. Case investigation forms should be completed for all suspected COVID-19 cases and deaths meeting the standard case definitions using the hardcopy forms and the SORMAS device. Active case search and contact tracing shall be conducted in all communities where COVID-19 case is reported by the LGA and State surveillance teams led by the State Epidemiologist. COVID-19 cases detected via the standard case definition should be reported using the notification channel. Information should be collected on each case using the IDSR 001A, B & C and update SORMAS device. The purpose of epidemiological surveillance is to: 1. Confirm the outbreak 2. Identify all cases and contact subjects 3. Detect patterns of epidemic spread4. Estimate the potential for further spread of the disease and 5. Determine whether control measures are working effectivelyData Collection formsSee appendix for adapted from FFX protocolcase investigation forms1 close contact reporting forms1line listing forms1passenger self-reporting forms,Annexes 1 – Case investigation formnique Case ID / Cluster Number (if applicable): Current Status□ Alive □ Dead Data Collector InformationName of data collectorData collector InstitutionData collector telephone numberEmailForm completion date (dd/mm/yyyy)___/___/___3a. Case Identifier Information Given name(s)Family nameSex□ Male □ Female □ Not knownDate of Birth(dd/mm/yyyy)___/___/___ □ UnknownTelephone (mobile) numberAge (years, months)___ years ___ months□ UnknownEmailAddress National social number/ identifier (if applicable)Country of residenceCase status □ Suspected □ Probable □ Confirmed3b. Interview respondent information (if the persons providing the information is not the patient)First name Surname Sex□ Male □ Female □ Not knownDate of Birth (dd/mm/yyyy)___/___/___Relationship to patientRespondent addressTelephone (mobile) number4. Patient symptoms (from disease onset) Date of first symptom onset (dd/mm/yyyy)___/___/___□ No symptoms □ UnknownFever (≥38 °C) or history of fever□ Yes □ No □ UnknownSore throat□ Yes □ No □ UnknownRunny nose□ Yes □ No □ UnknownCough□ Yes □ No □ UnknownShortness of Breath□ Yes □ No □ UnknownVomiting□ Yes □ No □ UnknownNausea□ Yes □ No □ UnknownDiarrhea□ Yes □ No □ Unknown5. Initial sample collection Date respiratory sample collected (dd/mm/yyyy)___/___/___What type of respiratory sample was collected?□ Nasal swab □ Throat swab □ Nasopharyngeal swab □ Other, specifyHas baseline serum been taken?□ Yes □ No □ UnknownIf yes, date baseline serum taken (dd/mm/yyyy) ___/___/___Were other samples collected? □ Yes □ No □ UnknownIf yes, which samples: If yes, date taken (dd/mm/yyyy) ___/___/___6. Clinical Course: ComplicationsHospitalization required?□ Yes □ No □ UnknownIf yes, name of hospitalICU (Intensive Care Unit) admission required□ Yes □ No □ UnknownAcute Respiratory Distress Syndrome (ARDS)□ Yes □ No □ UnknownPneumonia by chest X-ray□ Yes □ No □ Not applicable (no X-ray performed)□ Date ___/___/___Other severe or life-threatening illness suggestive of an infection□ Yes □ No □ UnknownIf yes, specify:Mechanical ventilation required□ Yes □ No □ UnknownExtracorporeal membrane oxygenation (EMO)□ Yes □ No □ Unknown7. Human exposures in the 14 days before illness onsetHave you travelled within the last 14 days domestically? □ Yes □ No □ UnknownIf Yes, dates of travel (DD/MM/YYYY):___/___/___ to ___/___/___Regions: Cities visited:Have you travelled within the last 14 days internationally?□ Yes □ No □ UnknownIf Yes, dates of travel (DD/MM/YYYY):___/___/___ to ___/___/___Countries visited: Cities visited:In the past 14 days, have you had contact with a anyone with suspected or confirmed 2019-nCoV infection? □ Yes □ No □ UnknownIf Yes, dates of last contact (DD/MM/YYYY):___/___/___ Patient attended festival or mass gathering□ Yes □ No □ UnknownIf yes, specify:Patient exposed to person with similar illness□ Yes □ No □ UnknownLocation of exposure□ Home □ Hospital □ Workplace □ Tour group □ Unknown □ Other, specify:Patient visited or was admitted to inpatient health facility□ Yes □ No □ UnknownIf yes, specify:Patient visited outpatient treatment facility□ Yes □ No □ UnknownIf yes, specify: Patient visited traditional healer □ Yes □ No □ UnknownIf yes, specify type:Patient occupation (specify location/facility)□ Health care worker □ Working with animals □ Health laboratory worker□ Student □ Other, specify:For each occupation, please specify location or facility:______________________________________8. Status of form completionForm completed□ Yes □ No or partially If no or partially, reason :□ Missed □ Not attempted □ Not performed □ Refusal □ Other, specific: Annex 2- Contact(s) investigation form Confirmed Case ID / Cluster Number (if applicable): Contact ID Number (C…): Note: Contact ID numbers should be issued at the time of completion of Form A1. Name of confirmed case Data Collector InformationName of data collectorData collector InstitutionPhone numberEmailForm completion date (dd/mm/yyyy)___/___/___2. Interview respondent information (if the persons providing the information is not the contact)First name Surname Sex□ Male □ Female □ Not knownDate of Birth___/___/___Relationship to patientRespondent addressTelephone (mobile) number3. Contact Details (Details of the contact)Given name(s)Family name Sex□ Male □ Female □ Not knownDate of Birth___/___/___Relationship to caseAddress (village/town, district, province/region)Telephone numberEmail addressPreferred mode of contact □ Mobile □ Work □ Home □ EmailNationalityCountry of residence National social number/ identifier (optional)Have you travelled within the last 14 days domestically? □ Yes □ No □ UnknownIf Yes, dates of travel (DD/MM/YYYY):___/___/___ to ___/___/___Regions: Cities visited:Have you travelled within the last 14 days internationally?□ Yes □ No □ UnknownIf Yes, dates of travel (DD/MM/YYYY):___/___/___ to ___/___/___Countries visited: Cities visited:In the past 14 days, have you had contact with a anyone with suspected or confirmed 2019-nCoV infection? □ Yes □ No □ UnknownIf Yes, dates of last contact (DD/MM/YYYY):___/___/___ Occupation (specify location/facility)□ Health care worker □ Working with animals □ Health laboratory worker□ Student □ Other, specify:For each occupation, please specify location or facility:______________________________________Note for next 2 sections:Complete Section 4 if the contact is a Health Care Worker (HCW). Complete Section 5 if the contact is. NOT a Health Care Worker (HCW)4 Exposure Information (if the close contact is a Health Care Worker)Job title (specify)Place of workDirect physical contact with the confirmed case (e.g. hands-on physical contact)□ Yes □ NoHas the HCW had prolonged face-to-face contact (>15 minutes) with a symptomatic confirmed case in an health facility? □ Yes □ No If yes, what type of protective equipment was used by the health care worker?□ Gown □ Surgical/medical mask □ Gloves □ NIOSH-CERTIFIED N95, AN EU STANDARD FFP2 □ FFP3 □ Eye protectionHas the HCW had prolonged face-to-face contact (>15 minutes) with an asymptomatic confirmed case in a health facility?□ Yes □ NoIf yes, What type of protective equipment was used by the health care worker?□ Gown □ Surgical/medical mask □ Gloves □ NIOSH-CERTIFIED N95, AN EU STANDARD FFP2 □ FFP3 □ Eye protectionWas the contact present while any aerosol generating procedures took place?□ Yes□ NoIf yes, specify procedure and date Procedure: ___/___/___Procedure: ___/___/___Was the contact wearing any type of a mask at this/these procedures?□ Surgical/medical □ NIOSH-CERTIFIED N95, AN EU STANDARD FFP2 □ FFP3 □ None5. Exposure Information (if the close contact is NOT a HealthCare Worker)Type of contact□ Household □ Other, specify: ____________State dates of contact and duration of contact with the confirmed case from first contact, while the primary case was symptomatic(Add as many dates, as required)Date __/__/___(dd/mm/yyyy)Duration ______(mins)Setting□ Home/ household □ Hospital / health care□ Workplace□ Tour group □ Other, specify:_______State dates of contact and duration of contact with the confirmed case from first contact, while the primary case was asymptomatic(Add as many dates, as required)Date __/__/___ (dd/mm/yyyy)Duration ________(mins)Setting□ Home/ household □ Hospital / health care□ Workplace□ Tour group □ Other, specify: _________6a. Symptoms in contactHas the contact experienced any respiratory symptoms (sore throat, cough, running nose, shortness of breath) in the period from 10 days before onset in the confirmed case until the present? □ Yes□ NoHas the contact experienced any respiratory symptoms (sore throat, cough, running nose, shortness of breath) in the period up to 10 days after last contact or until the present date, whichever is the earliest?□ Yes□ NoCurrently ill□ Yes □ No Date and time of first symptom onset___/___/___□ AM □ PMMaximum temperature °C □ NA6b. Respiratory symptomsSore throat□ Yes □ No □ UnknownIf yes, date ___/___/___Cough□ Yes □ No □ UnknownIf yes, date ___/___/___Runny nose□ Yes □ No □ UnknownShortness of breath□ Yes □ No □ UnknownIf yes, date ___/___/___6c. other symptomsChills□ Yes □ No □ UnknownVomiting□ Yes □ No □ UnknownNausea□ Yes □ No □ UnknownDiarrhea□ Yes □ No □ UnknownHeadache□ Yes □ No □ UnknownRash□ Yes □ No □ UnknownConjunctivitis□ Yes □ No □ UnknownMuscle aches□ Yes □ No □ UnknownJoint ache□ Yes □ No □ UnknownLoss of appetite□ Yes □ No □ UnknownNose bleed□ Yes □ No □ UnknownFatigue□ Yes □ No □ UnknownSeizures□ Yes □ No □ UnknownAltered consciousness□ Yes □ No □ UnknownOther neurological signs□ Yes □ No □ Unknown If Yes, specify:Other symptoms□ Yes □ No □ UnknownIf yes, specify:7. Outcome/status of contact (Only complete if contact has been ill or is currently ill)Status□ Recovered, if yes specify date symptoms resolved___/___/___□ Still ill□ Dead, if yes specify date of death___/___/___□ Unknown/ Lost to follow-upHospitalization ever required?□ Yes □ No □ Not UnknownIf yes, date of hospitalization and date of discharge (dd/mm/yyyy) ___/___/___ - ___/___/___(NB. If the information below is not currently available, please leave blank and send through an update as soon as results are available)If dead, contribution of 2019-nCoV to death:□ Underlying/primary □ Contributing/secondary□ No contribution to death□ UnknownIf dead, was a port-mortem performed?□ Yes □ No □ UnknownIf dead, cause of death on Death certificate (specify)If dead, results of post-mortem’s report where available:8. Contact pre-existing condition(s)Pregnancy□ Yes □ No □ UnknownIf yes, specify trimester: □ First □ Second □ Third □ NAObesity□ Yes □ No □ UnknownHeart disease□ Yes □ No □ UnknownAsthma requiring medication□ Yes □ No □ UnknownChronic lung disease (non-asthma)□ Yes □ No □ UnknownChronic liver disease□ Yes □ No □ UnknownChronic haematological disorder□ Yes □ No □ UnknownChronic kidney disease□ Yes □ No □ UnknownChronic neurological impairment/disease□ Yes □ No □ UnknownOrgan or bone marrow recipient□ Yes □ No □ UnknownOther pre-existing condition(s)□ Yes □ No □ UnknownIf yes, specify:Comments if appropriateAnnex 4 – Passenger self-reporting form ................
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