Thread by @RyanKemper10

@ClareCraigPath > Asimismo, la realización de Pruebas Diagnósticas de Infección Activapor SARS-CoV-2 ... debe estar dirigida fundamentalmente a la detección precoz de los casos con capacidad de transmisión, priorizándose esta utilización frente a otras estrategias

@ClareCraigPath The above says that they're directing their efforts at identifying cases with transmission capability. Need to keep reading to see how they'll actually achieve that (could it be a more sane Ct threshold? A man can dream...)

@ClareCraigPath They go on further down to talk about the need to differentially diagnose COVID-19 from Flu and other illmesses given the spike in flu cases in fall & winter months

@ClareCraigPath Okay so continuing on, they define suspected cases vs probable cases vs confirmed cases. Critically, they define confirmed cases as meeting criteria for a suspected case AND having a positive test (rapid antigen or PCR)

If they actually follow that, that seems pretty significant

@ClareCraigPath The definition for a suspected case involves the expression of actual symptoms: "any person with a clinical picture of sudden onset acute respiratory infection of any severity that includes, among others, fever, cough or feeling of shortness of breath..."

@ClareCraigPath So taken together that means they will only consider something an active case if they're symptomatic and test positive. That does line up with the stated goal of actually optimizing for transmissibility. That's a pretty good sign...

@ClareCraigPath Note they also define a recovered case as seropositive regardless of PCR/rapid antigen. So in summary:

Suspected: sars-like symptoms
Probable: radiological signs with negative test or symptoms w/ inconclusive test
Active: Symptoms AND positive test
Resolved: Seropositive

@ClareCraigPath Page 8 out of 29 shows a flowchart for their whole case flow. It should be somewhat accessible for non-spanish-speakers.

One thing I noted is they have an actual process for a "discarded case". So if you're a suspected case and they do a bunch of testing you can be ruled out

@ClareCraigPath Page 11 has a footnote about CT threshold:

> Por consenso se admite que un Ct>30-35 equivaldría a una carga viral sin capacidad infectiva. Sin embargo,este criteriodebe ser validado porel laboratorio responsable en cada caso

@ClareCraigPath The above says that if your CT is above 30-35 (they give a range not a definite number) then it's generally recognized to not be infectious. They say regardless the criteria needs to be validated by the lab, although I'm not sure quite how to interpret that

@ClareCraigPath On that same page (page 11) they say workers who were suspected cases can return to work 10 days after symptom onset provided they are asymptomatic for at least 3 days AND have EITHER a negative PCR test or a high-ct PCR test (where high would be >30-35 depending on lab I think)

@ClareCraigPath There's a couple other flowcharts of alternate algorithms but they more or less resemble the flow on page 8.

On page 26 of 29 there's an excellent table comparing each different test (nasophyrngeal RT-PCR, saliva RT-PCR, respiratory sample RT-PCR, rapid antigen)

@ClareCraigPath I skipped over some stuff that seemed to be about how to define a "contact", etc, but that's the gist.

This seems like a positive development. It feels like they're returning to an actual reasonable standard of what a case is.

@ClareCraigPath Most of the world has abandoned the pathological vs physiological distinction (e.g. the oxymoron "asymptomatic COVID-19"). It's a violation of how cases are treated for any other disease, and these new guidelines seem to move back towards sanity. Pretty encouraging!

@ClareCraigPath Ah, I see. Basically they have one flowchart for those presenting with symptoms (page 8), one for an asymptomatic person who has had close contact with a covid case (pg 14), and one for asymptomatics being randomly screened (I think) (pg 17).