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Posted by Lisa McHugh ·

Case Definition

How is everyone handling serology? We are placing them in a holding area until we know more. I've heard from several other states who are doing the same thing. 
 
How is everyone interpreting the probable case definition "Meets clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19." I think identifying a person as a close contact during an investigation is easy to classify in this regard but given the epi criteria also contains a criteria for "sustained community transmission" that would technically mean everyone with compatible illness is a probable case and this is not easily identified in public health reporting systems. Would love to know how others are interpreting. 
  

Comments & Events

Lynn Sosa Lynn Sosa
Hi Lisa, We in Connecticut are struggling with the same thing.  I think we need to get some clarity on the case definition and if we want to count these serology tests or not; also need to have a timeline on these serology tests as people are likely to get multiple tests and what to do if the same person has a negative PCR result at any time and if that impacts interpretation.  Right now thinking we will keep these as "suspect" until we have a better way forward.  But please others jump in would love to hear how everyone is approaching this!
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molly molly
Hi all. ND is struggling with the same thing. We need a timeline for going back and looking for symptoms for positive serologies. Also, are other states only counting serologies from FDA approved tests?
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Jeff Engel, Senior Advisor for COVID-19 at CSTE Jeff Engel, Senior Advisor for COVID-19
CSTE (me) is working on a revision of the case definition, especially the probable classification. We are trying to balance these real issues related to PH surveillance with emerging science, challenges of counting cases of a community respiratory illness (e.g. for H1N1 pandemic, we stopped counting at about 50,000 cases nationally), and serology tests where there are practically no data. 
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Lynn Sosa Lynn Sosa
That's great to hear Jeff.  We will be on the lookout!!
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Jennifer Miller Jennifer Miller
I’d be interested in visiting with you about this issue if you are willing. I’m with MT DPHHS in the CDEpi section. My phone number is 406-444-3165.


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Jen R. Miller, RN, CPH
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Communicable Disease Control and Prevention Bureau
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406.444.3165 | fax 406.444.0272
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Stephen Pont Stephen Pont
Hi Jeff, 
What is the ETA for a potential revised CSTE/CDC definition? 
Thanks!
Stephen
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Lynn Sosa Lynn Sosa
Hi Jen,

Sure—early next week?

Lynn

Lynn Sosa, MD
TB/STD Control Programs Medical Director
Deputy State Epidemiologist
Connecticut Department of Public Health
410 Capitol Avenue, MS #11 TUB
PO Box 340308
Hartford, CT 06134-0308

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Jeff Engel, Senior Advisor for COVID-19 at CSTE Jeff Engel, Senior Advisor for COVID-19
ETA next week for Board review. But we need to ask ourselves: how often should the PS be revised given the changing science, coordinating with CDC/CSELS on NNDSS, and long term feasibility of case-counting a community respiratory virus infection? 
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Lisa McHugh, Assistant Bureau Director, Bureau of Epidemiology Lisa McHugh, Assistant Bureau Director, Bureau of Epidemiology
We have decided against counting serology for now. We are receiving via ELR and they are going into our system for local health to view but we are not requesting action on them. We have found it difficult if not impossible to weed FDA approved from not so if they are sending we are processing. 

Also struggling with those meeting the probable case definition (symptomatic and epi linked) but test negative. This has been an issue in long term care facilities. Right now calling them not a case for surveillance but suspect cases as part of outbreak numbers. 

Aside from the issue that started this post is that there needs to be some clarity on time frames. For example, how long between illness/test and date of death to attribute the case as a COVID death. In the flu world, we tend to say if there is a period of recovery between illness and death than it would not be flu-associated death. I think some language is needed around this - not sure if for the case definition or elsewhere. 
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aapostolou aapostolou
We are wondering if there is an update on the timeline for the updated case definition. Are the edits impacting only the probable component of the case definition?

Thank you
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Jeff Engel, Senior Advisor for COVID-19 at CSTE Jeff Engel, Senior Advisor for COVID-19
We are working with the CSTE Board and CDC now. Earliest would be June-July. We're avoiding serologic definitions for confirmed now until better science exists.
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