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COVID-19 in Southern Africa

MSF's response to COVID-19 in Southern Africa

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Regional overview

  • South Africa

    Context

    South Africa has 24,264 confirmed COVID-­‐19 cases and 524 deaths. (WHO 27/05)

    The Western Cape Province now has the highest number of positive cases (15,829) and deaths (363). Khayelitsha, where MSF runs a project, is among the worst affected sub-­‐districts, with over 2,000 cases. The president has announced that the entire country will move to Level 3 lockdown, including hotspots of infection such as Cape Town and Johannesburg. Nevertheless, the hotspots will have additional surveillance, testing and treatment capacity. 

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    MSF patient receives a medical check-up from Dr Kirsten Arendse before being switched to an HIV treatment that the government has ample stocks of, meaning patients don’t have to return for resupply for a full four months. Photo: Barry Christiansen

    COVID-19 activities and adaptations:

    In Eshowe, in KwaZulu-­‐Natal, MSF continues to promote strategies to decongest the health facilities, like providing extended refills and refills to patients outside of the health centre. Eshowe is also finalizing the plans to launch a 25-­‐bed treatment centre as part of the Eshowe District Hospital COVID-­‐19 response. As the virus is spreading slower in the Eshowe area, the opening of this site is not planned until sometime near July.

    In Khayelitsha, the Department of Health anticipates that peak transmission in the Western Cape will come sooner than expected (end of June rather than early August). The wards in Khayelitsha District Hospital are already filling up with suspected and confirmed cases. The MSF supported treatment facility is nearly ready and expects to receive its first patient on June 2nd, with the launch of the facility happening on May 29th.

    In Rustenburg, the MSF team continues to support screening and testing, particularly at a large hospital named JST. MSF is involved in providing strategic support to the local health authorities and training to staff on the frontline.

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    During a mass screening and testing, MSF contact tracer Bhelekazi Mdlalose places a test swab in a bag which is sent to South Africa’s National Laboratory Services to be tested for COVID-19. Photo: Tadeu Andre/MSF

    The Johannesburg team now supports four shelters. The introduction of a clinical psychologist has exposed the massive need for mental health services amongst the population in the shelters. Drug use and trauma are the main associated factors with mental health needs.

    In Tshwane, the MSF team has been doing methadone distribution as part of their primary health care services in four shelters. Some shelters experience security challenges and this presents operational issues regarding how the team can effectively provide services.  The team is looking at moving to an outreach-­‐ based model as well, that will target undocumented migrants outside of the shelters.

  • Eswatini

    Context

    Eswatini has 261 confirmed COVID-­‐19 cases and 2 deaths. (WHO 27/05)

    Activities: 

    We are providing support to the MoH by assisting with infection control and triage at health facilities. We are also part of technical advisory groups to the MoH and are implementing adjusted models of care for patients living with HIV, TB and non-­communicable diseases in order to reduce their risk of infection. Teams are doing health education in the communities on a daily basis.

  • Malawi

    Context:

    Malawi has 101 confirmed COVID-­‐19 cases and 4 deaths.  (WHO 27/05)

    Since the first three COVID-­‐19 cases were confirmed on 2 April in Lilongwe, approximately 3324 people have been tested. While a 21-­‐day lockdown was set to begin on 18 April, it has been delayed by a court injunction. The constitutional court will review the case. There were previous strikes of health care workers (due to lack of PPE), as well as strikes of prison staff, and protests concerning lockdown in locations across the country that caused significant disruption. After junior staff were promoted, these strikes stopped. There is concern over how  COVID-­‐19  will impact access to  HIV  and  TB  services, as well as  HR  policies and allocation among districts. Reduced numbers of patients are accessing OPD and IPD services in Nsanje. While a  new election  (after the 2019 election was invalidated by the constitutional court in  February  2020)  was originally scheduled for May, the election is now delayed to the 2nd of July.

    COVID-19 activities:

    The Female Sex workers (FSW) Project is supporting MoH in the COVID-­19 response in the three districts where they work; Neno, Dedza and Nsanje. The project focuses on continuing provision of services to FSWs, in the community and health facilities, and on the provision of prevention messages and measures to prevent COVID-­19 transmission among FSWs and in the community. Community sensitization with FSW‐ adapted health messages on COVID-­19 has been conducted, as well as installation of handwashing points in key areas and provision of technical and direct assistance to ensure set-­‐up of the COVID-­19 patient flow at health facilities and IPC. In Zalewa Health Center, the screening of beneficiaries with respiratory symptoms and fever is ongoing.

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    A sex worker on a grass mat in a rented room where she lives that is also used for clients in a compound in Nsanje. Photo: Isabel Corthier/MSF

    During the past two weeks, 1304 beneficiaries have been screened and  72  have undergone dedicated triage and consultation.

    The prison project continues supporting authorities at Chichiri Prison in Blantyre through health promotion, installation of hand-washing points, staff training and infection prevention and control (IPC). As of 8 May, there were 1,666 inmates remaining in Chichiri prison after two releases of 211 and 56 inmates in April and May respectively.

    The Prison Project continues to support prison authorities at Chichiri Prison in Blantyre through continued delivery of health promotion messages on a daily basis by a counsellor and peers, installation of handwashing points,  training of prison staff and the clinical staff on  COVID-­19  and providing technical support with IPC.

    As of  21 May  2020,  there were no cases of confirmed  COVID-­19  at  Chichiri  Prison. During the reporting period, there were no released prisoners, however, on average, there are 12 new inmates entering the prison per day. All prison staff are reporting for duty. At Chichiri prison there is continuous implementation and adaptation of activities on COVID-­‐19 preparedness; ongoing implementation and monitoring of rational use of PPE among health staff and peers, and of the use of reusable 3-­‐ply linen face mask (including disinfection), and continued PPE donations.

    For the  Nsanje project the main  COVID-­19  activity,  in order to prevent spreading in  high-­risk  areas,  to protect staff and the most vulnerable patients in Nsanje District Hospital (NDH), includes direct daily support of the COVID-­19 patient flow.   This activity officially started the 6th of May with (pre-­) screening and triage, waiting areas, consultation zone, health promotion, internal ambulance service and a separated laundry area (with EHA essential & standard precaution measures IPC measures), provision of linen masks to staff, patients and visitors and gap filling of essential drugs in the COVID-­19 consultation.

    Adaptations to MSF activities:

    Advanced HIV Disease (AHD) mentoring activities in the eight pilot site health centres and in the different wards of Nsanje District Hospital remain on hold during the COVID-­19 intervention. Human resources have been shifted towards the COVID-­19 response in the hospital. Community awareness related to COVID 19 and access to health facilities (especially Nsanje District Hospital) is a focus.

    The Female Sex Worker Project is providing longer prescription refills. In Dedza and Zalewa, the comprehensive one-­‐stop services at health facilities are available (HIV and SRH) every weekday. A basic emergency package delivered by peers is available at distribution points in the community (condoms, lubricants, OST, PEP, emergency contraception and STI single-dose treatment for SGBV cases), on fixed days in Nsanje and all weekdays in Dedza and Zalewa. The team also ensures follow up with beneficiaries by telephone.

  • Mozambique

    Context

    Mozambique has 213 confirmed COVID-­‐19 cases and 1 death. (WHO 27/05).

    The country has switched from sporadic transmission to clusters of cases with a total of 9 provinces affected. Community transmission might already be ongoing in certain areas. The state of emergency declared by the Government is scheduled to end 30 May. It’s very likely it will be extended a third time or the government will reinforce the current preventive measures.

    COVID-19 activities:

    We are still providing support to the MoH by assisting with IPC, triage and influencing the design of the response at health facilities, as well as participating in COVID-­19 coordination meetings and technical groups at national and project level.

    In Maputo, we have been authorized by the MoH to start taking samples from suspected COVID-­19 cases at project level. Patient flows have been adapted and we hope to start this week at the Centro de Referência do Alto-­Maé (CRAM) after our staff is trained by the National Institute of Health. We have extended our MoU with Maputo City MoH to continue our support at the Polana Caniço Isolation Centre in terms of IPC, patient flows, and training. So far only 1 single patient has been admitted to the Isolation Center. We would like to be present when the number of cases increase in order to quickly identify gaps and support the facility accordingly.

    In Beira, MSF is supporting MISAU to screen all individuals for COVID-­‐19 who are visiting the health centre for consultations. MSF is supporting four Health Centers. All individuals are triaged and screened in order to identify possible  flu-­like  cases and suspected cases of  COViD-­19. Since the first case was laboratory-confirmed in Beira, all cases are now suspected to be COVID-­19 until results are delivered. 

    In Pemba, the activities remain focused on preparing the isolation centres in 18 de Outubro (30 beds) and 10 Congresso (100 beds). MSF will provide support for around 10 beds in the Isolation centre at 10 Congreso. MSF has provided training, reinforced preventive measures and triage. We have also organized health promotion activities on COVID-­19 related IPC in nine Health Centers.  MSF has identified urgent needs at the Health Centers in Natite, Cariaco, Eduardo Mondlane and Paquetiquet.  We will create a dedicated safe zone and provide support on the waste zone, waiting for area  and  Health Promotion activities. Medical activities will be focussed at Cariaco and Pquitiguete Health Centers through patient flow, triage, training and case management support, as needed.

    Adaptations to MSF activities:

    In  Maputo, we would like to begin providing  take-­home doses of methadone.  Due to the lack of public transport and fear of exposure to  COVID-­19,  patients are facing increasing barriers incoming for daily treatment. We have requested authorisation from the MoH and are awaiting approval to proceed.

    Respiratory triage is functional in all our project locations however we have not diagnosed yet any COVID-19 cases among our patients or noticed an increase in the number of patients with respiratory tract infection. In Beira and Pemba we have reinforced hygiene measures and triage trained staff and worked on awareness with our staff, patients and partners in all projects.

    In Beira we are reinforcing proper use of masks, we continue with weekly condom distribution & assessment and reinforce COVID-­19 prevention messages (physical distancing). We are also providing dedicated training to the Munhava and Macurungo nurses about the management of  COVID-­19 patients in maternity, CPN and Post-­delivery, and family planning.

    In Pemba, we have reinforced hygiene measures and triage trained staff on IPC and worked on awareness with our staff, patients and partners in all projects. Work is now starting in four Health Centers where we plan to improve infection control, waste management, patient flows (waiting area, triage zone, COVID-19 consultation space), and access to water and sanitation.

     

  • Zimbabwe

    Context

    Zimbabwe has 56 confirmed COVID-­‐19 cases and 4 deaths. (WHO 27/05)

    A total of 36 538 (21 202 RDT and 15 336 PCR) tests have been carried out as of 23 May. The sharp increase of 20 cases since the last update two weeks ago is attributed to an increase in the number of repatriated residents especially with the opening of the Beitbridge border post which saw the return of residents from South Africa, Mozambique, Malawi, Botswana and Lesotho between April and May.

    The county is now on  second-­level  indefinite lockdown,  which may change if the current status of the pandemic evolves. Formal businesses are operational, most are observing the stipulated conditions such as practising safe distancing, observing stipulated operating hours and compulsory wearing of prescribed masks. Handwashing/sanitising and control on the number of people being attended to is observed. Public transport use is still restricted to the government-operated bus service, ZUPCO, although more and more taxies are reportedly transporting people at odd hours when authorities are not present on the roads, and in the outskirts where they are not present.

    The government withdrew its earlier directive that businesses arrange to test their staff and the cost be borne by the businesses following a public outcry to consider the cost and the accuracy of the RDT, which is already questionable.

    The country continues to receive returning residents.  Of serious concern is the increase in the COVID-­19 cases where most of the new cases are from returning residents.  The situation at the Beitbridge port of entry is of great concern. Hundreds of returning residents spend up to  24  hours being processed.  Returning residents quarantined at the Beitbridge quarantine centre mingle freely,  sometimes without masks.  They also move freely between rooms.

    Following the confusion on the number of days to quarantine returning residents, it has been clarified and set at 21 days. Witnesses at some quarantine centres report being placed in spaces with no proper IPC and wash requirements. COVID cases have been reported from quarantine centres and more cases should be expected in the coming weeks. Security is limited to
    non-­existent. There are cases of returnees who have escaped and have not been traced as they falsified their places of residence in-­country.

    There are also many cases of residents illegally crossing the border, most notably from South Africa.

    PPE availability remains low. Morale and motivation is low and psychological safety for workers is almost non-­existent (experiences reported in MSF projects). Some non-­profit organisations and private companies have made donations in an attempt to ensure COVID-­19 preparedness at designated health centres.

    COVID-19 activities:  

    The MSF Migration Project based in Beitbridge is working with the MoHCC and other partners supporting the repatriation of residents. With more residents expected to return from neighbouring countries, MSF is providing support to screen, collect samples for testing and provide non COVID-­19 health care services and health promotion.

    MSF’s  Regional  Environmental  Health  Project is drilling two boreholes in  Harare’s  Mbare  high-­‐density suburb. The project has numerous  awareness-­‐raising,  public health promotion,  provision of masks,  water and soap in designated places activities in the suburb. The project is advocating for the provision of water in Harare, Chitungwiza and Bulawayo towns where residents have gone for several days without water.

    MSF remains present at Wilkins and Beatrice Road Infectious Disease hospitals in Harare, providing health workers, WASH support, and technical assistance including case management and training.

    MSF continues its work in projects such as the Gutu CC, HIV project in Masvingo, and the Manicaland NCD, which provides hypertension, diabetes drugs and care to rural communities in Chipinge and Mutare.

    Adaptations to MSF activities:

    MSF continues its work in projects such as the Gutu, the HIV project in Masvingo, and the Manicaland NCD project, which provides hypertension, diabetes drugs and care to rural communities in Chipinge and Mutare. 

Visit the South African National Department of Health’s online resource and news portal for more information regarding COVID-19: www.sacoronavirus.co.za