Health Department outlines SA's preparedness for COVID-19

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On Wednesday, 26 February Spotlight and Daily Maverick report that they sent a combined list of 22 questions about South Africa’s state of preparedness for COVID-19 (Coronavirus Disease 2019) to the Health Department and the National Institute for Communicable Diseases (NICD).

“The response was sent to us by Dr Lwazi Manzi, Health Minister Dr Zweli Mkhize’s spokesperson.”

Daily Maverick and Spotlight said that, as well as the answers to the questions, they have included the full statement delivered by Mkhize at a press conference on Sunday 1 March 2020. They said that this statement was delivered four days after their list of 22 questions were sent and as such could not be taken into account in the formulation of the 22 questions.

Minister Mkhize’s statement:
In December 2019 Chinese authorities announced the emergence of a novel coronavirus that was the causative agent for an outbreak of respiratory disease. It is believed the outbreak originated in a food market in Wuhan City, China. This virus has now come to be known as COVID-19. The symptoms are largely respiratory which can range from mild upper respiratory tract manifestations to respiratory failure, multi-organ failure and death. The mortality rate is around 3% and evidence shows that the vast majority of fatalities are patients who are immunocompromised either due to extremes of age or pre-existing conditions. Whilst there are ongoing studies, there is no proven cure and there is no vaccine.

On 30 January 2020, due to the emerging worldwide spread of the virus, the World Health Organisation declared coronavirus a Public Health Emergency of International Concern. This set in-motion pre-determined global policy implementation that enables the co-operation of governments, the private sector and multi-lateral organizations to optimize the response to the spread of the virus and ensure its early detection and containment in any territory around the world. This includes the ability to strengthen public health systems in territories that are under-resourced. I would like to take this opportunity to thank the World Health Organisation for the critical leadership provided.
We have been very fortunate that, to date, there has been no case of COVID-19 in South Africa.
However, as you have now heard, 2 South Africans who were crew members of the Princess Diamond ship tested positive for coronavirus.

We are in constant contact with our embassy in Japan and the Diamond Princess parked off the coast of Yokohama

Those citizens from the cruise liner are receiving direct contact with our team to monitor their progress. We have been assured that they are recovering. When they test negative they will be free to return except those going through quarantine. Thereafter they will return without restrictions

South Africa’s State of Readiness
The South African Government has worked hard to optimize our state of readiness with the resources and capability we have in the event that we should have a case of COVID-19.
– The Multisector National Outbreak Response team (MNORT) is responsible for tracking and tracing outbreaks around the world, monitoring and analysis of developments, advising all relevant authorities on the country response to the outbreak and ensuring our state of preparedness.
– The NICD had very early on picked up on the COVID-19 outbreak and MNORT had convened twice by the time the WHO announcement was made to ensure that there was a standard operating procedure in place for the early detection, containment and management of a possible outbreak in South Africa. This included up-capacitation of our ports of entry to be able to screen incoming passengers, especially those from China and other affected countries and preparing tertiary institutions to be referral centres for the isolation and management of COVID-19 patients as well as to take advantage of their research capabilities
– On the eve of the WHO announcement I held a press briefing detailing these measures, which included the activation of the Emergency Operation Centre in the event of a WHO public health emergency announcement. When that announcement was made the EOC was immediately activated- many of the media had an opportunity to see the EOC and learn of its inner workings.
– A 24-hour clinician hotline was set up as well as a working hours hotline set up for the public. The Public Hotline number is 0800 029 999 and operates from 8.00 to 16.00. If South Africa were to confirm a case of coronavirus the public hotline will convert to a 24-hour hotline. These hotlines have been extremely busy fielding calls from clinicians and the public and a second line has been linked to the clinician’s hotline.
– An Inter-Ministerial Committee was formed by the following ministers: Health; Defence; Home Affairs; International Relations and Co-operation; Justice; Social Development; and Police.

This ensures there is co-ordinated collaboration across different departments and each is able to directly respond to specific needs that may be required from it.
– Since the outbreak our government has issued daily statements with situational updates for South Africa. As at 26 February 121 people have been tested for coronavirus and all the results were negative

On the first week of the outbreak the number of citizens wishing to return was negligibly low and contact was a challenge as many South African citizens do not report their whereabouts to the embassy or DIRCO. We must commend DIRCO and the embassy staff as well as Chinese authorities for assisting to locate our citizens in China. We gave a directive that every citizen must be frequently contacted directly personally and their concerns recorded This has enabled government to properly evaluate their needs hence the well-informed decision taken.

Earlier government intervened to assist with advices and instances where there were special requirements for medical supplies and concerns of low food supplies. In all instances the Chinese authorities have been helpful and supportive hence we were happy with the condition of our citizens. Many reported challenges in personal resources and anxiety to return home and requests started to increase and government now has identities and precise location of our citizens.

Government has prioritised the needs of our citizens
Accusations that the government prioritised diplomatic relations with China and accusations that government is sending mixed messages are ill informed, mischievous and are attempt to create sensation and controversy on a matter that requires single minded focus of all to ensure the safety of all South African citizens.

Decision to evacuate citizens from Wuhan/ Hubei
Following the President’s directive for the repatriation of asymptomatic South African citizens in Wuhan City, where the epicentre of the outbreak is, such contingency plans are now being effected as a matter of extreme urgency. We have noted that other areas of China do not represent a high risk for exposure to Covid-19 and so the citizens under lockdown in Wuhan have been prioritised.

We have been able to ascertain that there are approximately 199 South Africans living in Wuhan and, of those, 147 have indicated a wish to be repatriated. Amongst these are students who have completed studies and students whose studies were interrupted by the lockdown.

Citizens indicated they do not wish to return – There was also a South African citizen who elected to be repatriated with Indian citizens who were recently evacuated by the government of India.

In response to the plea by our citizens to return home, Cabinet instructed the inter-ministerial committee to effect plans to evacuate and repatriate the citizens. At this stage, through the DIRCO, we are making an effort to locate the remaining thirty-six (36) South Africans in Wuhan. We are making a special appeal to the families who may have relatives in Wuhan to contact DIRCO at 012 351 1754 and 012 351 1756, and

The Repatriation Process is implemented in three phases namely Evacuation, Quarantine ad Re-unification. We are guided by the WHO guidelines and the relevant South African laws and policy framework.

I will now go into each phase in a bit more detail:

This will be an exercise undertaken by the Military in co-operation with DIRCO and Chinese authorities.
All South African citizens from Wuhan City that wish to be repatriated will be accommodated and brought back in a chartered aircraft under strict quarantine protocols that will be enforced.
There will be a Multi-Disciplinary Medical Team on board the aircraft that will be responsible for pre and inflight screening and medical care. All nationals that do not meet the Medical Screening Requirements during pre-screening will be referred to the Chinese Health System. A Port of Entry has been prepared for the receipt of RSA Nationals, flight crew and medical team.
All support staff coming into direct contact with the repatriates will also fall into the quarantine protocol

The very nature of the quarantine exercise is to isolate a group of Covid negative people who have been exposed to a high-risk environment, remove them from that high risk environment, and then allow the determined incubation period to lapse before being integrated into virgin society. Human contact and mixing of groups will be limited in the entire process.
– A quarantine facility that meets all the requirements has been identified – There will be a perimeter line that will be guarded by the military. Within that perimeter the area will be declared a no entry zone and a no flight zone- Those under quarantine will not be allowed to exit the perimeter but will be allowed to move freely within the perimeter
– No-one will be allowed to enter the Zone. There will be a “no man’s land” strip to accommodate the collection of goods whereby there is zero contact between the deliverers and the collectors.
– I must reiterate that no family members, friends or associates of those under quarantine may visit the Zone.
– We plead with the media to respect the boundaries and not make attempts to enter the quarantine zone
– Support staff in the facility will also be subject to quarantine protocols
– The entire quarantine period will be 21 days duration to allow for arrival and phased exit.
– Legal action will be taken against any individual that goes against the stipulated regulations in relation to quarantine
– There will be a medical facility installed as per standard military procedures and the quarantine facility will be collaborating closely with the designated facilities for coronavirus in the country.
– On arrival all quarantine members will be briefed and tested and there will be screening done at predetermined intervals.
– Should someone develop symptoms they would be immediately isolated for further testing
– Should the patient test positive for coronavirus they would immediately be transferred to a designated referral facility
– Should there be multiple cases of coronavirus the project would be escalated to a multi-isolation system whereby quarantine members would then be confined to their rooms for the entire duration
– For every incident of confirmed coronavirus, the quarantine period starts again at D- Day (or day one).

Assuming the quarantine period is incident free:
– The final day of quarantine is denoted by all members testing negative for coronavirus
– The members would then be given the final counselling and then granted leave to depart
– There will be continued contact with the citizens thereafter.
– All affected equipment, venues, facilities etc will be subjected to decontamination protocols

Reflection on the state of the coronavirus outbreak worldwide and what the future holds
Whilst it can never be possible to predict what will happen in South Africa if the virus were to be introduced to our territory, it is a useful exercise to survey the current global status and start to formulate projections that can help us guide public policy.
We continue to monitor the development in other countries and are in touch with our embassies

We are concerned that when we first reported this matter there were 4,500 cases reported largely in China. Today the coronavirus has spread to 50 countries worldwide with devastating consequences

We are in touch with and receive twice daily updates from our embassies and authorities in several countries where the infections are rising rapidly
South Korea has rapidly rising COVID-19 cases – they have over 2000 cases and 13 deaths. The city of Daegu, 300km from Seoul, is the epicentre.

Iran is an area of concern. We understand that both Algeria and Nigeria have infections that have no history of travel to China – they seem to have originated from Italy.

Reports of a death in US and infection on individuals that cannot record any contact with a known COVID-19 case mean that we are seeing COVID-19 as a disease prevailing in communities with no direct link with China

We have to get ready as there is no country that has a formula to prevent the coronavirus from infecting its people. In the long term we have to prepare for readiness for resident coronavirus that may arise in any part of the country – that is the advice from the WHO.

Research has to be done to ascertain how soon after the patient is tested negative of COVID-19 does it stop being infectious. Common experience suggests that once the test is negative there should be no possibility of transmitting the virus. This point is important as we monitor those who return home after they have contracted and were treated and recovered from COVID-19.

However, there are positive developments.
The manner in which China has managed the outbreak has many lessons for the global community on what works and what mistakes to avoid, as they have treated around 80,000 patients with proven COVID-19.

Approximately 32,000 have recovered and around 46,000 are still on treatment and there have been 2,900 deaths. Relatively speaking this mortality is low at around 3%.
Furthermore, in China the number of recoveries is exceeding the number of new infections day to day and the rate of infection is declining. This points to a very positive picture of a virus that can be managed at both clinical and public policy level.

To conclude, it is important to bear in mind the highly dynamic nature of the global coronavirus phenomenon. There is no start or end to the work that must be done. There are more robust studies needed and medical precision needs to be sharpened. Our level of vigilance continues to be at the highest level in the wake of the WHO announcement of a Public Health Emergency of International Concern.

We will issue constant situational updates in the form of media statements. We wish to advise that there will be some measure of control as to what information the quarantine members can communicate to the media and on social media platforms as a matter of security and to that end we appeal for co-operation in this regard.

Ultimately, we must remember that we are dealing with a group of healthy people who had built lives in Wuhan but found themselves disrupted by an extraordinary situation.

As this operation unfolds it is most important to protect their safety and dignity and also public safety. Our citizens have been through a lot already in Wuhan, but they have conducted themselves with incredible stoicism and solidarity with the Chinese, co-operating with Chinese regulation and authority. Their dignified manner of partnering with China and also ourselves through the embassies should set an example and tone for the rest of us to follow as we engage in this process in the interest of public safety. We have taken note of countries that have reported increased numbers of coronavirus cases. We therefore call on all travellers to immediately seek medical attention should you develop symptoms consistent with coronavirus.

The South African government was "upping its game" at ports of entry with every province ready to treat people showing symptoms of the coronavirus, News24 reports Mkhize told MPs. "We can treat any patient who would land in this country and we have every province ready to treat such people," Mkhize said while briefing Parliament's Portfolio Committee on Health.

The minister said 13 hospitals have been designated to isolate and treat people with symptoms of the virus. The department was ensuring the floors and arrival halls of ports of entry were being disinfected and has recommended that all immigration officials wear masks and gloves.

President Cyril Ramaphosa has ordered the repatriation of SA citizens from Wuhan, China, reports Business Day. There were 199 South Africans estimated to be in Wuhan, and 132 of them had expressed a desire to be repatriated, the president said in a statement issued on Thursday evening. They would be quarantined for 21 days, he said, but did not disclose the location nor when they would arrive.

None of the affected people had been diagnosed with the virus or shown any symptoms of the disease, he said. “The 21 days is all inclusive of arrivals and leaving the quarantine area and administration to ensure there is a clear 14-day period of actual quarantine,” said Manzi.

Manzi said that 12 SA crew members who had been working on board the Princess Diamond cruise ship when it was affected by the coronavirus. Two have been infected, and are being treated in Japan, she said.

The NICD said it was ready to receive the South Africans being repatriated to the country from China, reports The Times. The NICD welcomed Ramaphosa's announcement. “The detailed logistics are being finalised and the NICD is preparing to support the initiative in collaboration with all other involved government departments to ensure the containment of the virus,” the institute said in a statement.

“The NICD is working with international partners to learn from their experiences, to keep the public and the repatriated persons well and healthy.”

The institute said the chances of the country being hit by the deadly virus were increasing. “As such, we continue to monitor trends of COVID-19 globally and in the African region to improve our knowledge of the disease and to continually enhance our surveillance and response.”

COVID-19 news from elsewhere:
The coronavirus crisis shifted increasingly westward toward the Mideast, Europe and the US on Tuesday, with governments taking emergency steps to ease shortages of face masks and other supplies for front-line doctors and nurses, says a Market Watch report.
“We are concerned that countries’ abilities to respond are being compromised by the severe and increasing disruption to the global supply of personal protective equipment, caused by rising demand, hoarding and misuse,” said the WHO’s director-general, Tedros Adhanom Ghebreyesus. “We can’t stop COVID-19 without protecting our health workers.”

Around the world, deaths in Italy surged to 79, making it the deadliest reported outbreak outside China. Twenty-three members of Iran’s Parliament and the head of the country’s emergency services were reported infected. South Korea started drive-through testing. And in Spain’s Basque region, at least five doctors and nurses were infected and nearly 100 health care workers were being held in isolation.

The mushrooming outbreaks contrasted with optimism in China, where thousands of recovered patients were going home and the number of new infections dropped to the lowest level in several weeks.

Worldwide, more than 92,000 people have been sickened and over 3,100 have died, the vast majority of them in China. The number of countries hit by the virus reached at least 70, with Ukraine and Morocco reporting their first cases.

Virus clusters in the US led schools and subways to sanitise, quickened the search for a vaccine and spread fears among nursing home residents, who are especially vulnerable. The number of the infections in the US topped 100 and the death toll climbed to nine. All of the deaths were in Washington state, and most of them were residents of a Seattle-area nursing home.

The US Federal Reserve announced the biggest interest-rate cut in over a decade to try to counter the expected damage to the economy, and stocks rose briefly on Wall Street in reaction before slumping again. Fed chair Jerome Powell said the virus “will surely weigh on economic activity both here and abroad for some time.” Other Group of Seven countries appeared reluctant to follow suit with their own cuts, probably because many of their interest rates are already near or below zero.

The US Food and Drug Administration gave health care workers the OK to use an industrial type of respirator mask often used to protect construction workers from dust and debris.

Iran’s supreme leader ordered the military to assist health officials in fighting the virus, which authorities said has killed 77 people. Among the dead are a confidant of Ayatollah Ali Khamenei, Iran’s former ambassador to the Vatican and a recently elected member of Parliament. Iran’s judiciary chief, Ebrahim Raisi, said some people are stockpiling medical supplies for profit and urged prosecutors to show no mercy. “Hoarding sanitising items is playing with people’s lives, and it is not ignorable,” he said.

France’s president announced the government will take control of current and future stocks of face masks to ensure they could go to health workers and coronavirus patients, and the finance minister warned that binge-shopping for household essentials could trigger shortages. The country reported a total of more than 200 cases and four deaths. “In this period we’re going through – we have entered a phase that will last weeks and, undoubtedly, months – it is indispensable to have clarity, resilience, sang-froid and determination to stop the epidemic” French President Emmanuel Macron said during a visit to the government’s virus crisis centre.

South Korea saw its largest daily increase in new cases Tuesday, with 851 more infections reported, largely in and around the south-eastern city of Daegu. In all, about 5,200 people in South Korea have tested positive for the virus. In the capital of Seoul, drive-thru virus testing centres began operating, with workers dressed head-to-toe in white protective suits leaning into cars with mouth swabs, a move meant to limit contact with possible carriers of the illness. Troops were also dispatched across the city to spray streets and alleys with disinfectant.

In China, the count of new cases dropped again Tuesday, with just 125 reported. It is still by far the hardest-hit country, with over 80,000 infections and about 95% of the world’s deaths.

Excerpts from the address by WHO director general on 03.03.2020
While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection, and some will suffer severe disease.

Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected. We have vaccines and therapeutics for seasonal flu, but at the moment there is no vaccine and no specific treatment for COVID-19. However, clinical trials of therapeutics are now being done, and more than 20 vaccines are in development.

We don’t even talk about containment for seasonal flu – it’s just not possible. But it is possible for COVID-19. We don’t do contact tracing for seasonal flu – but countries should do it for COVID-19, because it will prevent infections and save lives. Containment is possible.

To summarise, COVID-19 spreads less efficiently than flu, transmission does not appear to be driven by people who are not sick, it causes more severe illness than flu, there are not yet any vaccines or therapeutics, and it can be contained – which is why we must do everything we can to contain it. That’s why WHO recommends a comprehensive approach.

These differences mean we can’t treat COVID-19 exactly the same way we treat flu. But there are enough similarities to mean that countries are not starting from scratch. For decades, many countries have invested in building up their systems to detect and respond to influenza.

Because COVID-19 is also a respiratory pathogen, those systems can, should and are being adapted for COVID-19. But we are concerned that countries’ abilities to respond are being compromised by the severe and increasing disruption to the global supply of personal protective equipment – caused by rising demand, hoarding and misuse.

Shortages are leaving doctors, nurses and other front-line healthcare workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons. We can’t stop COVID-19 without protecting our health workers. Prices of surgical masks have increased six-fold, N95 respirators have more than tripled, and gowns cost twice as much. Supplies can take months to deliver, market manipulation is widespread, and stocks are often sold to the highest bidder.

WHO has shipped nearly half a million sets of personal protective equipment to 27 countries, but supplies are rapidly depleting. WHO estimates that each month, 89m medical masks will be required for the COVID-19 response; 76m examination gloves, and 1.6m goggles.

WHO has guidelines on how to rationalise the use of personal protective equipment in health facilities and manage supply chains effectively. We’re also working with governments, manufacturers and the Pandemic Supply Chain Network to boost production and secure supplies for critically affected and at-risk countries.

Globally, it is estimated that PPE supplies need to be increased by 40%. We continue to call on manufacturers to urgently increase production to meet this demand and guarantee supplies. And we have called on governments to develop incentives for manufacturers to ramp up production. This includes easing restrictions on the export and distribution of personal protective equipment and other medical supplies.

University of Minnesota Centre for Infectious Disease Research and Policy COVID-19 update 03.03.2020

The WHO's director-general today warned that shortages of personal protective equipment (PPE) such as gowns are masks could leave front-line health workers unprotected from the COVID-19 virus, which comes as the epicentre shifts from China to three nations on three different continents.

Tedros said China over the past day reported its lowest number of new cases of the novel coronavirus disease since Jan 20. Of nearly 2,000 cases reported in the rest of the world yesterday, though, 80% were from South Korea, Iran, and Italy.

Disruptions in the supply of PPE are severe and increasing because of hoarding, misuse, and increased demand, he said. Surgical mask prices have increased six-fold, N95 respirator prices have tripled, and gown costs have doubled. The WHO has shipped 500,000 sets of PPE to 27 countries, but supplies are rapidly depleting. It estimates that PPE supplies need to increase by 40%, and Tedros again called on manufacturers to rapidly scale up production and urged governments to offer incentives to boost supplies, including easing restrictions on the export and distribution of PPE and other medical supplies.

"This cannot be solved by WHO alone, or one industry alone. It requires all of us working together to ensure all countries can protect the people who protect the rest of us," he said.

Iran outbreak poses tough challenges
Iran's health ministry today reported 835 new cases, along with 11 more deaths, lifting its respective totals to 2,336 cases and 77 deaths. Dr Mike Ryan, who directs the WHO's health emergencies programme, said that, of the recent hot spots, health officials are most concerned about Iran, including about the supply of equipment such as ventilators. He said a WHO mission is in its second day there and added that a team from China is on hand to assist.

Ryan said the country has a tough challenge, because the virus is well established in many cities. "It's not impossible to root out, but it is difficult work, and medical supplies are essential."

South Korea spike continues
South Korea today reported 600 more cases, plus 2 more deaths, raising its overall total to 4,812 illnesses, 28 of them fatal.

In China, the country's National Health Commission (NHC) today reported 125 more cases, 114 of them in Hubei province, and of those, 111 are in Wuhan. China's overall total is now 80,151 cases. The NHC also reported 31 more deaths and 304 fewer serious cases, bringing those respective totals to 2,943 and 6,806.

In another development, China yesterday reported 7 cases imported from Italy, all involving people who worked at the same restaurant as a woman who got sick after returning from Italy. China's state media has reported that travellers from other COVID-19 hot spots, such as South Korea, Japan, Iran, and Italy, will be quarantined for 14 days in some parts of China.

Meanwhile, Japan's health ministry today reported 16 more cases in eight prefectures, raising its total to 257. However, it lists its overall total as 284, with 27 asymptomatic carriers. And Singapore today reported 2 new cases, 1 of them linked to a workplace cluster, raising its total to 110.

Italy cases surge; outbreak expands in Europe
Italy today reported 466 new cases, along with 27 more deaths, boosting its total to 2,502 cases, 79 of them fatal. The health ministry's latest report shows that 1,520 of the country's cases are from the hard-hit Lombardy region.

Elsewhere in Europe, the UK – which has 51 cases now – has published its coronavirus response plan, which has a four-tiered approach that starts with the current containment phase. It said the next phase involves delaying the spread to avoid overlap with the flu season and an added burden to the health system.

Elsewhere, Spain announced its first COVID-19 death, in a patient from Valencia. The country has at least 145 cases, including 49 in Madrid. And Ukraine reported its first case, which involves a man who had travelled from Italy.

Community transmission in Australia
Australia today reported its first case involving community transmission, in a doctor with no relevant travel history or connection to a confirmed case. Government officials signalled plans to use a rarely used law to enforce quarantine.

The US Agency for International Development (USAID) has announced $37m targeted to 25 affected or high-risk countries. It said the support is the first funds committed from an earlier pledge of up to $100m.

Three more countries reported their first cases: Gibraltar, Chile, and Argentina. All involved travellers from Italy. The WHO's Pan American Health Organisation (PAHO) yesterday announced the rollout of an online platform to help with case and contact data for COVID-19 in Latin American countries.

Full Daily Maverick report

Tracking COVID-19 cases

Tracking COVID-19

Latest NICD update

Full News24 report

Full Business Day report

Full report in The Times

Full Market Watch report

WHO material

Rolling updates of COVID-19

CIDRAP material

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