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Country/agency/regionSourceDate accessed Description of case definitionsCriteriaComments (editorial)
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WHO
https://www.who.int/publications/i/item/10665-331501
10 August 2020Suspected, probable, confirmed casesSuspect case
A. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough,
shortness of breath), AND a history of travel to or residence in a location reporting community transmission of
COVID-19 disease during the 14 days prior to symptom onset.
OR
B. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19
case (see definition of contact) in the last 14 days prior to symptom onset;
OR C. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g.,
cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that
fully explains the clinical presentation.
Probable case
A. A suspect case for whom testing for the COVID-19 virus is inconclusive.
a. Inconclusive being the result of the test reported by the laboratory.
OR
B. A suspect case for whom testing could not be performed for any reason.
Confirmed case
A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.
• Technical guidance for laboratory testing can be found here		Technical guidance on laboratory confirmation was not easy to identify. Most recent interim guidance appears to be from 19 March 2020, accessed https://www.who.int/publications/i/item/10665-331501 This publication does not mention how to interpret PCR tests in terms of cycle count or viral load.
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European Union
https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition
10 August 2020Case definition for coronavirus disease 2019 (COVID-19), as of 29 May 2020Clinical criteria

Any person with at least one of the following symptoms [1]:

cough
fever
shortness of breath
sudden onset of anosmia, ageusia or dysgeusia
Diagnostic imaging criteria

Radiological evidence showing lesions compatible with COVID-19

Laboratory criteria

Detection of SARS-CoV-2 nucleic acid in a clinical specimen [2]

Epidemiological criteria

At least one of the following two epidemiological links:

close contact [3] with a confirmed COVID-19 case in the 14 days prior to onset of symptoms
having been a resident or a staff member, in the 14 days prior to onset of symptoms, in a residential institution for vulnerable people where ongoing COVID-19 transmission has been confirmed
Case classification

Possible case:
Any person meeting the clinical criteria
Probable case:
Any person meeting the clinical criteria with an epidemiological link
OR
Any person meeting the diagnostic criteria
Confirmed case:
Any person meeting the laboratory criteria [1] Additional less specific symptoms may include headache, chills, muscle pain, fatigue, vomiting and/or diarrhoea.

[2] Further guidance on laboratory issues on the page: Laboratory support

[3] Close contact defined according to the ECDC guidance document ‘Contact tracing: Public health management of persons, including healthcare workers, having had contact with COVID-19 cases in the European Union’		Case definition is not for public health surveillance. Looking at the additional laboratory guidance there is no information on interpreting PCR tests in relation to cycle count or viral load.
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UK government
https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection
10 August 2020definition of a possible case, clinical contextInpatient definition Patients who meet the following criteria
requiring admission to hospital (a hospital practitioner has decided that admission to hospital is required with an expectation that the patient will need to stay at least one night)
and

have either clinical or radiological evidence of pneumonia
or

acute respiratory distress syndrome
or

influenza like illness (fever ≥37.8°C and at least one of the following respiratory symptoms, which must be of acute onset: persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing
or

a loss of, or change in, normal sense of taste or smell (anosmia) in isolation or in combination with any other symptoms
Note: Clinicians should consider testing inpatients with new respiratory symptoms or fever without another cause or worsening of a pre-existing respiratory condition. Patients who meet the following criteria and are well enough to remain in the community
new continuous cough
or

high temperature
or

a loss of, or change in, normal sense of taste or smell (anosmia)
Individuals with any of the above symptoms but who are well enough to remain in the community should follow the stay at home guidance and get tested.

Clinicians should be alert to the possibility of atypical presentations in patients who are immunocompromised.

Alternative clinical diagnoses and epidemiological risk factors should be considered.		Diagnosis is not using a PCR test (clinical symptoms instead). Testing is recommended among community cases who have relevant symptoms.
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US CDC
https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/
10 August 2020probable, confirmedClinical Criteria
At least two of the following symptoms: fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder(s)

OR

At least one of the following symptoms: cough, shortness of breath, or difficulty breathing

OR

Severe respiratory illness with at least one of the following:

Clinical or radiographic evidence of pneumonia, OR
Acute respiratory distress syndrome (ARDS).
AND

No alternative more likely diagnosis

Laboratory Criteria
Laboratory evidence using a method approved or authorized by the U.S. Food and Drug Administration (FDA) or designated authority:

Confirmatory laboratory evidence:
Detection of severe acute respiratory syndrome coronavirus 2 ribonucleic acid (SARS-CoV-2 RNA) in a clinical specimen using a molecular amplification detection test
Presumptive laboratory evidence:
Detection of specific antigen in a clinical specimen
Detection of specific antibody in serum, plasma, or whole blood indicative of a new or recent infection*
*Serologic methods for diagnosis are currently being defined. Probable
Meets clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19.
Meets presumptive laboratory evidence AND either clinical criteria OR epidemiologic evidence.
Meets vital records criteria with no confirmatory laboratory testing performed for COVID-19.
Confirmed
Meets confirmatory laboratory evidence.
6
China
https://www.chinadaily.com.cn/pdf/2020/1.Clinical.Protocols.for.the.Diagnosis.and.Treatment.of.COVID-19.V7.pdf
25 August 2020suspected case, confirmed caseV. Case Definitions
1. Suspect cases
Considering both the following epidemiological history and clinical manifestations:
1.1 Epidemiological history
1.1.1 History of travel to or residence in Wuhan and its surrounding areas, or in other communities where cases have been reported within 14 days prior to the onset of the disease;
1.1.2 In contact with novel coronavirus infected people (with positive results for the nucleic acid test) within 14 days prior to the onset of the disease;
1.1.3 In contact with patients who have fever or respiratory symptoms from Wuhan and its surrounding area, or from communities where confirmed cases have been reported within 14 days before the onset of the disease; or
1.1.4 Clustered cases (2 or more cases with fever and/or respiratory symptoms in a small area such families, offices, schools etc within 2 weeks).

1.2 Clinical manifestations
1.2.1 Fever and/or respiratory symptoms;
1.2.2 The aforementioned imaging characteristics of NCP;
1.2.3 Normal or decreased WBC count, normal or decreased lymphocyte count in the early stage of onset.
A suspect case has any of the epidemiological history plus any two clinical manifestations or all three clinical manifestations if there is no clear epidemiological history.

2. Confirmed cases
Suspect cases with one of the following etiological or serological evidences:
2.1 Real-time fluorescent RT-PCR indicates positive for new coronavirus nucleic acid; 2.2 Viral gene sequence is highly homologous to known new coronaviruses.
2.3 NCP virus specific Ig M and IgG are detectable in serum; NCP virus specific IgG is detectable or reaches a titration of at least 4-fold increase during convalescence compared with the acute phase.
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Italy
https://snlg.iss.it/wp-content/uploads/2020/03/CircolareMinSal_DefinizioneCasoCOVID19.pdf
10 September
Probable case, confirmed case
Probable Case
A suspected case in whom results of test for SARS-CoV-2 is unclear or inconclusive on the basis of specific protocols for Real Time PCR of SARS-CoV-2 in the designated regional reference laboratories or is positive to a pan-coronavirus test.
Confermed case
A case with laboratory confirmation of SARS-CoV-2, carried out either in the national reference laboratories of the Istituto Superiore di Sanità (ISS, e.g. Italian NIH ) or in the designated regional reference laboratories fulfiling the criteria at Annex 3, indipendently from clinical symptoms or signs. Definitions dated 9 March, but Annex 3 was updated on 3 april: http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=73799&parte=1%20&serie=null
Annex 3 lists certified sub-regional laboratories authorised to carry out PCR testing for SARS CoV 2. Accreditation with the dedicated regional laboratory is based on concordance of the first 5 positive and 10 negative specimens
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Spain
https://www.mscbs.gob.es/en/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Estrategia_vigilancia_y_control_e_indicadores.pdf
11 SeptemberSuspicious case
1. Suspicious case : 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. Other symptoms such as odynophagia, anosmia, ageusia, muscle aches, diarrhea, chest pain or headaches, among others, can also be considered symptoms of suspected SARS-CoV-2 infection according to clinical criteria.
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Confirmed case with active infection
Probable case : person with severe acute respiratory infection with clinical and radiological symptoms compatible with COVID-19 and negative PCR results, or suspected cases with inconclusive PCR
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Confirmed case with resolved infection
2 Confirmed case
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Case ruled out 2A with active infection :
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−Person who meets clinical criteria for a suspected case and has a positive PCR.
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−Person who meets the clinical criteria for a suspected case, with a negative PCR and a positive result for IgM by high-throughput serology (not by rapid tests).
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−Asymptomatic person with positive PCR with negative Ig G or not performed.
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2B with resolved infection :
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−Asymptomatic person with positive Ig G serology regardless of the PCR result (PCR positive, PCR negative or not performed). Case ruled out: suspected case with negative PCR and negative IgM, if this test has been performed, in which there is no high clinical suspicion.
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3 Case ruled out : suspected case with negative PCR and also negative IgM, if this test has been performed, in which there is no high clinical suspicion.
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page 3 and 4
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France, Agence nationale de santé publique
https://www.santepubliquefrance.fr/content/download/228073/file/COVID-19_definition_cas_20200313.pdf
11 SeptemberPossible case, probable case, confirmed casePossible case
Anyone, who may or may not have been in contact at risk with a confirmed case within 14 days of symptom onset, presenting clinical signs suggestive of COVID-19: acute respiratory infection with fever or a feeling of fever, or any other following clinical manifestation, of sudden onset, according to the opinion of the HCSP relating to the clinical signs of diagnostic orientation of COVID-19:
In the general population: unexplained asthenia; unexplained myalgia; headaches other than a known migraine pathology; anosmia or hyposmia without associated rhinitis; ageusia or dysgeusia.
In people aged 80 and over: deterioration of general condition; repeated falls; new or worsening of cognitive disorders; delirium; diarrhea; decompensation of a previous pathology.
In children: all the above-mentioned signs in the general population; deterioration of general condition; diarrhea; isolated fever in children under 3 months of age.
In patients in emergency or intensive care: recent heart rhythm disturbances; acute myocardial damage; serious thromboembolic event.

1 Definition of a contact:
In the absence of effective protective measures throughout the duration of the contact: hygiaphone or other physical separation (glass); surgical mask or FFP2 worn by the case or contact; consumer mask manufactured according to the AFNOR standard or equivalent worn by the case and the contact,

Contact at risk: any person
Having shared the same place of life as the confirmed or probable case;
Having had direct contact with a case, face to face, within 1 meter, regardless of the duration (eg conversation, meal, flirtation, hugs, hugs). On the other hand, people crossed in the public space in a fleeting way are not considered to be contacts at risk;

Having provided or received acts of hygiene or care;
Having shared a confined space (office or meeting room, personal vehicle ...) for at least 15 minutes with a case or having remained face to face with a case during several episodes of coughing or sneezing;
Being a student or teacher in the same school class (nursery, primary, secondary, tutorial group at the university).
Negligible risk contact:
All other contact situations;
Already identified COVID-19 cases, confirmed by RT-PCR or serology as part of a salvage diagnosis, cured or still ill, taking into account the instructions for confirmed cases if the patient is still ill.

These definitions do not apply to the assessment of risky contacts of a hospital healthcare professional occurring in a healthcare context, for which a specific assessment must be carried out by the occupational physician and the operational hygiene team.

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France cont'dprobable caseAnyone with clinical signs and visible signs on thoracic tomodensitometry suggestive of COVID-19.
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France cont'dconfirmed caseAnyone, symptomatic or not, with a laboratory result confirming infection with SARS-CoV-2, by RT-PCR or by serology as part of a catch-up diagnosis, in accordance with HAS recommendations.
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