Sunday 7 June, 2020

What is "‘further epidemiological investigation"?: The CMO explains

In Thursday night’s update from the Ministry of Health noted that one more patient had died of the COVID-19 disease.

However, unlike previous announcements of fatalities, the Ministry did not provide a short profile of the patient. Instead, a note was included that the most recent case required “further epidemiological investigation”.

In a press conference hosted by the Ministry of Health on Friday, the Chief Medical Officer (CMO) Dr Roshan Parasram sought to explain what is meant by “epidemiological investigation” and why additional investigation may be required in some cases.

The CMO explained that when the lab reports on a case they receive a lab reporting form.

The form details the patient’s name, the hospital that has referred the patient for testing, checkboxes for symptoms the patient may have exhibited such as a fever or a cough.

There is a blank box that the physician may include details on a patient like recent travel history. In some cases, those boxes may be left blank.

In the case where the boxes are not filled out, once a positive result is returned on that particular patient, the epidemiology unit of the Ministry of Health has to consult with the primary physician, as well as the patient, where possible, relatives of the patient and so on and ask the relevant questions.

They will try to ascertain if the patient had a travel history, whether there was contact with a suspected case, and they will begin contact tracing backward. 

Therefore, when updates to the public include terms like “further epidemiological investigation” and “epidemiological review pending”, it means the epidemiological team is now investigating the matter further to see if there is a link between this case and a history of travel or history of contact with another case.  

Dr Parasram cautioned against people who are exhibiting flu-like symptoms waiting too long to seek medical attention. He said while he understood that people who might have mild symptoms would be apprehensive about being warded or quarantined, waiting too long to get tested and seak treatment could result in death. 

“We have seen cases that people wait too long and they're coming with very severe symptoms and they have actually died…You need to present yourself - especially if you’re in those high-risk groups - to us as early as possible so we can see what we are dealing with and make sure that is not COVID from an early date and put the preventative medical measures in place to support your care as early as possible and prevent mortality.”

Dr Parasram also confirmed that the Ministry of Health has been liaising with general practitioners (GPs) through the Trinidad and Tobago Medical Association, as well as the Medical Board.

He said they have been working to ensure that GPs know what to do if they see a patient with a suspected case of COVID-19.  They have been advised to liaise with the County Medical Officers of Health in all regions and Dr Parasram said there would also be an additional tier to the hotline system, where doctors can call in to get additional advice.

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