MINISTRY OF
HEALTH
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|
SOCIALIST
REPUBLIC OF VIETNAM
Independence – Freedom – Happiness
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No. 3468/QD-BYT
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Hanoi, August 7,
2020
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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.
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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././.
PP. MINISTER
DEPUTY MINISTER
Do Xuan Tuyen
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.
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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
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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.
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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.
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- 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.
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- 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.
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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
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- 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.
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- 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
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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.
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- 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.
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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
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- 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.
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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.
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- 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.
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- 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./.