1. Management of positive cases:
Upon notification of a positive result following a Rapid antigen test or PCR test (molecular test), the virus positive person must:
- immediately put himself/herself in self-isolation, - inform his/her Personal Physician, - inform his/her close contacts, employer, school, camp, etc, - exit from self-confinement only after the days stipulated in the release protocol have elapsed and after receiving a release sms.
Travel by any means of public transport (bus, taxi, airplane and boat) is forbidden in order to prevent dispersal.
Travel by any means of public transport (bus, taxi, airplane and boat) is forbidden in order to prevent dispersal. Positive cases who have planned travel are not allowed to make the trip until they have been officially discharged by their Personal Physician or Ministry of Health discharge team. For citizens or tourists staying in hotels and for persons who cannot maintain isolation at home, provision is made for free state quarantine and transportation by means provided by the Ministry of Health. If they do not wish to stay in state quarantine, such persons may choose to rent at their own expense private accommodation (apartment, house, villa) and be transported by private vehicle to spend their period of self-confinement there, after consultation with the Unit for the Epidemiological Surveillance and Control of Infectious Diseases (MEE&ELN), but for no reason may they continue to stay in a hotel.
Please note that the results from the rapid test sampling points are communicated to the ICU&ELN after the tests are completed and within 24 hours persons with a positive result receive a text message (sms) with the self-isolation instructions for confirmed COVID19 cases on the mobile phone they declared during their test. The virus positive person must follow the self-isolation instructions they receive. In case the person is a minor, a mobile phone of a guardian and not of the child should be declared.
In the same sms, the positive case receives passwords and a link to confirm his/her details, to declare his/her contacts and Personal Physician to be able to monitor and release him/her and to be able to issue the necessary release certificates when the quarantine is completed. The social and family contacts of the case are immediately declared through the online platform after being reported by the positive case and subsequently receive self-limitation instructions and their sampling is scheduled by the coordination of the Public Health Clinics.
In the instructions received by the positive case, there is a relevant table where the case can declare additional close contacts after completing the online form and send them by email to contacttracing@moh.gov.cy.
The Personal Physician is responsible for monitoring the health of his/her patients/beneficiaries and releasing confirmed cases according to the release protocol and no earlier than 10 days from diagnosis or onset of symptoms. Individuals who do not have a Personal Physician are released by the M&E Release Team. Upon release, all cases receive a text message indicating the release date and may be used for Safe Pass purposes. Alongside their release (10 days after a positive result), individuals who were coronavirus positive can be issued a European Digital Recovery Certificate to travel within the European Union via the portal https:/www.eudcc.gov.cy/.
Sick leave is granted by the Personal Physician.
All data collected by the ME&ELN is used exclusively to identify the source of infection of the positive case, trace its contacts and understand the behaviour of the virus.
For general information, positive cases can call 1474 (Monday to Sunday 08:00-20:00), while for reporting worsening symptoms, medical assessment or need for transfer to a hospital they can call 1420 24 hours a day.
If a person has been diagnosed positive for coronavirus and has not received a text message with instructions within 24 hours, they should contact the laboratory or individual who performed the test to ensure that their positive result was reported and that the contact details held by the laboratory are correct (e.g. wrong telephone number).
It is understood that if the positive results are not declared by the laboratory or the individual who carried out the test to the Ministry of Health, the positive case will not be able to receive the required instructions, monitor his/her health status, declare his/her contacts and receive all the documents to which he/she is entitled upon release (e.g.SafePass, EU Digital Covid Certificate).
For release issues, positive cases can contact the Release Team at covidfollowup@moh.gov.cy or phone 22605306.
Cases with a positive coronavirus test who have completed their vaccination or have recovered in more than 3 months follow the procedure as normal and are not exempt from self-limitation.
Antibody tests and self-test results are not acceptable methodologies for diagnosing a positive case.
Management of close contacts of cases
Close contacts are defined by specific criteria according to the following:
- Person living with a confirmed case - Person who has had direct physical contact with a confirmed case (e.g. BR\]- Person who had unprotected contact with infectious excretions of a confirmed case (e.g. saliva) - Person who had face-to-face contact with a confirmed case at a distance of less than 2 metres and for a duration of more than 15 minutesχ. classroom, cinema, hospital waiting areas, etc. with a confirmed case for more than 15 minutes and at a distance of less than 2 metres - Health care professional or other person who provided health care to a COVID-19 case or laboratory personnel who handled a sample of a confirmed case without using appropriate protective equipment or if there is a breach in integrity - Passenger on an aircraft, persons travelling with or caring for the patient, crew members who served the section of the aircraft where the patient was seated (possibly all passengers seated in the same section of the aircraft and even all passengers on the flight may be considered close contacts if due to the presence of severe symptoms of the patient and movement of the patient within the aircraft involves more extensive exposure)
It is emphasised that: Close contact within educational establishments is defined by a relevant circular of the Ministry of Health and it is the responsibility of the school management to declare close contacts. Close contact within the workplace shall be declared by the Health and Safety Manager of the company. For Nursing staff the return to work instructions may be different and subject to conditions set by the Infection Committee of the Nursing Department.
What applies on a case by case basis to close contacts:
- Booster dose of vaccine, effective from the same day as the booster dose: No obligation to self-limit, provided that Personal Protection Measures are observed (mask, hand hygiene, keeping distance from other persons, reducing contact, self-monitoring for symptoms). Recommendation for *free Rapid Antigen Test on the 3rd and 5th day after contact through the tracing procedure.
- Full vaccination with any vaccine recognised by the Republic of Cyprus (2 doses of vaccine or 1 dose of monovalent vaccine + 14 days) and 7 months have not elapsed since the last dose:
He/she is not required to self-limit, provided that Personal Protection Measures (mask, hand hygiene, keeping distance from other persons, reducing contact, self-monitoring for symptoms) are observed. Mandatory free* Rapid Antigen Test on the 3rd and 5th day after contact through the tracing procedure. Recommendation for PCR on the seventh day after contact .
- Individuals previously diagnosed/infected as positive cases by PCR or Rapid Antigen Test and 90 days have not elapsed since release: Not required to self-limit, provided that Personal Protection Measures (mask, hand hygiene, keeping distance from other persons, reducing contact, self-monitoring for symptoms) are followed. Mandatory free* Rapid Antigen Test on the 3rd and 5th day after contact through the tracing procedure. Recommendation for PCR on the 7th day after contact.
- Complete vaccination with any vaccine recognized by the Republic of Cyprus (2 doses of vaccine or 1 dose of monovalent vaccine + 14 days) but 7 months have elapsed since the last dose: Mandatory self-limitation for 14 days after contact with a confirmed case. Release earlier than 14 days can be done by PCR test (with negative result) on the 7th day after contact or later at a cost paid by the person concerned. Mandatory free* Rapid Antigen Test on days 3 and 5 of contact via tracing procedure.
- Individuals with no history of vaccination or disease or who have not completed their vaccination regimen (e.g. only one dose of a bivalent vaccine): Mandatory self-limitation for 14 days after contact with a confirmed case. Release earlier than 14 days can be done by PCR test (with a negative result) on day 7 of contact or later at a cost paid by the individual. Mandatory free* Antigen Rapid Test on the 3rd and 5th day of contact through the tracing process.
*Scheduling for free rapid test on the 3rd and 5th day of contact is scheduled by the Ministry of Health and the person concerned will be informed by sms phone message of the sampling location and time at predetermined locations to be notified. At these points they will be required to show the sms indicating that they are a close contact and provide the code sent along with some form of identification (ID, passport or ARC). A prerequisite for the close contact to receive the sms with the appointment is that the positive case must have declared the contact through the online platform or the board received when the contact was positively identified. Note that if day 3 of the contact has elapsed, only the day 5 test will be scheduled and if day 5 has also elapsed then no appointment will be scheduled and the contact will have to be tested through another route at their own expense.
For children under 6 years of age a free PCR test will be scheduled by telephone appointment by the Public Health Clinic Coordination in their province of residence.
For verification of the above the CYP may require vaccination certificates or release certificates.
For Nursing staff the return to work instructions may be different and subject to conditions set by the Infectious Diseases Committee of the Nursing Department.
For all of the above categories of close contacts it is understood that when they present with symptoms compatible with COVID-19 they should contact their Personal Physician for assessment and scheduling of free PCR testing through the Public Health Clinics.
For close contacts identified as contacts of a variant of concern (e.g. "omicron" variant or other) the guidelines may be modified. In such cases, they will be notified by telephone by a state official of any variations in procedures.
Those who are required to self-limit may remain self-limiting in their place of residence as specified below. If the below cannot be applied, quarantine provision is available - at an additional cost covered by the person concerned - in an appropriate quarantine hotel and can be arranged by telephone on 22691345 (This cost is fully covered by the Ministry of Tourism if the close contact was a co-passenger of a case on an airplane and telephoned for instructions by a Ministry of Health official). In any case, self-limitation in any hotel beyond the appropriate is prohibited due to the risk of spread. Private accommodation should be arranged or close contact should be transferred to the appropriate hotel.
Home isolation guidelines - Ideally, the person should stay alone at home. If this is not possible, the suspected case is isolated in a room that the other members will not use under any circumstances. If there are other suspected and/or confirmed cases in the house they should be isolated separately from each other. - The room in which the suspected case resides should be adequately ventilated. - No exit from the house shall be permitted. Self-containment in the house may be supervised either by on-site or telephone checks. Persons under house arrest are obliged to comply with the relevant decree. In case of non-compliance, they will be held criminally liable. - No visits are allowed. - The use of separate household utensils is recommended. If this is not possible, then disinfecting before and after each use with common detergent or soap, rinsing and drying. - The use of separate bathrooms and toilets is recommended. If this facility is not available, then disinfection should be carried out in accordance with health department guidelines (https:/www.pio.gov.cy/coronavirus/pdf/4_3.pdf). - If there is a planned trip prior to release, it is NOT permitted. An exception can be made if the permanent residence is outside Cyprus, always in consultation with the Epidemiological Surveillance Unit for information and instructions, with a necessary negative PCR test with sampling less than 48 hours before the trip and provided that the person does not present any clusters. - Travel is ONLY allowed in the event of a medical emergency and after contacting the Personal Physician or 1420. Whenever possible, travel should be unescorted and by personal vehicle only (not by bus or taxi). - Until the end of the period of home self-limitation, waste should be placed in a double bag and kept for 72 hours in a separate area from the designated collection area. At the end of the 72 hours they may be placed in their normal collection area.
- If the suspected case is under 15 years of age or is a person in need of care and is not self-sufficient, then a parent/guardian/caregiver may self-limit with the suspected case to care for it and also request special permission. For the person who chooses to remain in self-limitation with the suspected case, the same guidelines for self-limitation at home and isolation from other housemates and the wider environment apply as for the suspected case. - The only exception for removal of self-isolation is for the purpose of examination in public health clinics.
- No close contact is allowed to remain in a hotel beyond the appropriate hotels of the Ministry of Tourism. Private accommodation should be arranged or transferred to the appropriate hotel.
Next update/ Sampling/ Release - The isolation period is set at 14 days. A person designated as close contact may be released from quarantine earlier than 14 days if they have a PCR test at a contracted laboratory on the 7th day after contact with a confirmed case or later (considering the day of contact as day zero) and have a negative result. The negative PCR result should be sent to contacttracing3@moh.gov.cy. - Quarantine starts from the last day of contact with the outbreak and not from the day of notification. The day of contact is defined as day zero and the days of self-limitation start counting from the following day.
- If close contacts are not isolated from the positive case (e.g. parents caring for a minor child, caregivers caring for persons who are not self-sufficient, etc.), then the last day of contact (day zero) is considered the day of release of the positive case, since until the last day before release the positive person is potentially contagious and the self-limitation days are renewed. - Once a person has been declared as a close contact by the confirmed case, a Public Health Clinic Coordination Officer will contact the suspected case by telephone within a few days for information as to sample testing. Instructions on where and how to go will be given by telephone. From the tracing procedure, a free test is warranted at each close contact. - The result of the test will be communicated within 72 hours by text message. - If the person designated as a close contact is not invited for a test or does not wish to take the test, he/she may return to his/her activities after 14 days from the last contact with the outbreak, provided he/she has no symptoms. - Quarantine is automatically lifted at the end of the self-limitation days without further notification.
Personal Physician - There is no need to notify the Personal Physician at the outset, except if symptoms develop. Then the physician may schedule another sampling if deemed necessary. - Daily thermometry by the individual is recommended.
- In the absence of a personal physician, direct registration is recommended. If this is not possible, the individual may contact the 1420 line for reporting and assessment of symptoms.
Special leave - It is possible to secure a work permit from the Ministry of Health for individuals assessed as having had close contact with a confirmed case. The relevant file can also be completed electronically in the following way: 1. At https:/www.pio.gov.cy/coronavirus/, under the Information/Instructions tab, there is a file entitled Application for a Medical Certificate for Public Health Purposes. 2. It is completed and sent after the quarantine period by fax (22771496) or email (cycomnet1@cytanet.com.cy) as indicated on the form. The certificate will be sent back in the same way. 3. The Certificate of Absence from Work for Public Health reasons issued by the Ministry of Health should be submitted to the Employer or Social Security Services.
For general information, call 1474 (08:00-20:00). For any additional instructions on how to register your close contacts and clarification on the tracing process, contact the Tracing Team at 22514264, 22514258, 22514259, 22771923 or email contacttracing2@moh.gov.cy (Monday-Sunday 08:00-00:00). To report symptoms, call your personal physician or 1420 (24 hours).
(AF)
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Views & opinions expressed are those of the author and/or PIO
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