HPA revises case definitions for Covid-19

During a drill held by the Health Protection Agency (HPA) regarding Covid-19. | Photo: One Online.

Male’, Maldives- The Health Protection Agency (HPA)y, on Saturday, revealed updated case definitions for Covid-19 that have been adapted from the updated WHO case definitions for the disease.

“As the epidemiological situation within the country evolves and additional risks such as new, more transmissible variants emerge, coupled with increased visitors including tourists, there is a need to update guidance, and for healthcare workers, island taskforces and management of healthcare facilities and tourist establishments to be aware of and adhere strictly to these” said HPA in the statement.

The new guidelines included information on the clinical and epidemiological criteria, which are to be referred when determining cases. HPA has revealed the following information on this:

Clinical criteria

A person is to considered to meet the clinical criteria if they have the following symptoms:

  • cough
  • fever
  • shortness of breath
  • sudden onset (new onset) of anosmia (loss of smell) or ageusia (loss of taste) in the absence of any other identified cause.

Or any two more of the following symptoms:

  • Myalgia
  • headache
  • sore throat
  • runny nose
  • generalized weakness/ fatigue
  • nausea/vomiting
  • diarrhea
  • altered mental status. (Symptoms separated with slash (/) are to be counted as one symptom)

Epidemiological Criteria

If any of the following is true, an individual falls under the epidemiological criteria:

• A history of travel to or residence or working in a location with risk of transmission of COVID-19 during the 14 days prior to symptom onset.
• A person who is a close contact of a traveler coming from an area with risk of transmission of COVID-19
• In the past 14 days having visited or worked at a health care facility

HPA’s new guidelines define Covid cases into 3 types; Suspected, Probable and Confirmed, and stressed that healthcare providers should be familiar with the case definitions of these, and assess all patients accordingly.


According to the new definitions, a suspected COVID-19 case is a person who fulfils criteria A, B or C below:

  • A- A person who meets the clinical AND epidemiological criteria
  • B- A patient with severe acute respiratory illness (SARI: acute respiratory infection with history of fever or measured fever of 38 degree Celcius AND cough; with onset within the last 10 days; AND requires hospitalization.
  • C- Death in a person who meets the clinical AND epidemiological criteria.


Probable COVID-19 case is a person who fulfils any of the criteria below:

  • A. Patient who meets clinical criteria AND is a contact of a probable or confirmed case, or linked to a COVID-19 cluster.
  • B. A suspected case with chest imaging showing findings suggestive of COVID-19 disease.
  • C. Death, not otherwise explained, in a person who meets the clinical criteria AND was a contact of a probable or confirmed case or linked to a COVID-19 cluster.

For ALL suspected or probable cases of the Covid-19, HPA has advised that a sample must be taken for a Covid- 19 PCR test. They added that they have recently come across cases where individuals with symptoms compatible with Covid- 19 clinical and epidemiological criteria have received treatment at facilities, but had not been tested for Covid-19- which has led to outbreaks.


A person with laboratory confirmation of COVID-19 by detection of SARS-CoV-2 RNA (positive PCR test) in a clinical specimen is considered to be a Confirmed case of COVID-19, regardless of clinical signs and symptoms.

In their statement, HPA advised that management of healthcare facilities, tourist establishments and industrial areas must ensure that their healthcare providers, if present, are informed of these updates and to facilitate them to quickly follow this guidance.

In the absence of healthcare workers, staff or guests exhibiting symptoms compatible with Covid as referred to in the new case definition must immediately submit samples for testing, noted HPA.

HPA said that “Any death in a person under quarantine must be informed to HPA and must be tested for COVID-19. Any unexplained death in a city or island where there is local or community transmission of COVID-19 or in any tourist establishment or in any island under development must be informed to HPA and must be tested for COVID-19.”

Adding that they do not recommend Antigen-RDTs for confirmation of COVID-19 infection as of right now, the agency advised healthcare providers to remain vigilant, and to ensure no suspected or probable case is missed

This comes after GA. Dhevvadhoo went into monitoring status two days ago, and a nationwide announcement calling for anyone travelling from the island after the 30th of November to test for Covid and to remain in quarantine till a negative result is confirmed.

After more than 10 people tested positive for Covid on the island, a community spread has been confirmed on the island- which according Dhevvadhoo councilor Maumoon Ibrahim, did not occur due to any quarantine violation.

While 25 people tested positive for the virus today, 29 people have completely recovered from the virus over the past 24 hours. Along with these 29 recoveries, the total recoveries has now reached 13,308. The recovery rate has increased rapidly from less than 60% to 94% over the past months.

Up to date, 49 people have passed away from Covid-19 in Maldives. The deceased are 42 Maldivian nationals, 6 Bangladeshi nationals and a Filipino national.