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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 394,948 confirmed cases of COVID-19 and 5,940 deaths (WHO 23/07)

    The confirmed cases in South Africa represent over 68% of the total number of confirmed cases in the entire southern Africa region (474,594 cases) and 57% of the regional deaths (8210). South Africa has the sixth-highest number of total confirmed cases in the world. (WHO 16/07)

    Gauteng has overtaken Western Cape as the province with the highest number of positive cases (133617 – 36.7%), although the Western Cape has experienced a higher number of reported deaths (2619 ). Facilities in Gauteng and Eastern Cape are struggling to provide sufficient oxygen, and the leader of an expert Ministerial team sent to Eastern Cape to assess the state of public medical facilities reported that the situation was “beyond distressing”. MSF has sent a team to Butterworth in the Eastern Cape to investigate the possibility of intervening in one of the most under-resourced, high-risk provinces in South Africa. MSF currently has no presence in Eastern Cape.

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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 medicine refills to patients in community-based pick-up points. Plans to launch a 20-bed treatment centre as part of the Eshowe District Hospital COVID-19 response have been suspended, in light of the local Department of Health’s decision to repurpose a District TB hospital, Catherine Booth, for the treatment of moderate to severe COVID-19 positive patients. MSF will instead provide support to Eshowe and Mbongolwane hospitals, in the form of staff trainings and equipment.

    In the Western Cape, where transmission peaked in June/July, hospital admissions have flattened and pressure on the health system is decreasing. MSF decided to reduce the capacity of its field hospital in Khayelitsha by 50 %, and to loan items of equipment, including oxygen concentrators, to actors working in a more pressurized context, either in Gauteng or Eastern Cape.

    In Rustenburg, MSF has embarked on a pilot project to make 1st trimester choice of termination of pregnancy available to service users by way of telemedicine, in an effort to ensure that this essential service remains available in this time of limited mobility, and to reduce service users’ risk of COVID-19.

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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 is seeing decreasing numbers in the shelters it serves, due to relaxed mobility regulations. Infection control is uppermost in mind as certain COVID-19 shelters are in the process of being shut down.

    In Tshwane, the MSF team has shifted from a strong focus on providing services in shelters for street-based people, an outreach-based model as well, that will target undocumented migrants outside of the shelters.

  • Eswatini

    Context

    Eswatini has 1,938 confirmed cases of COVID-19 and 25 deaths. (WHO 23/07)

    Activities: 

    We are providing support through information and education as we have included COVID–19 education in all our community outreach awareness activities and trainings of all health care workers. Furthermore, we have distributed PPE commodities regionally in support of the response team. MSF has supported the MoH in providing home-based care and lab activities by car donations and fuel for HBC. We have provided testing tents and extra screening room for a few health facilities. We’ve continued focus on DRTB home-based care and video observed therapy to protect them from COVID infection.

  • Malawi

    Context:

    Malawi has 3,302 confirmed cases of COVID-19 and 76 deaths. (WHO 23/06)

    Lazarus Chakwera sworn in as Malawi president after a historic win. The rerun election was a hailed as a victory for democracy and justice by regional and international media. Chakwera defeated incumbent Peter Mutharika with 58.57% of votes.

    Deportations and repatriations from South Africa and Zimbabwe are contributing to the rapid increase in the number of cases in Malawi. 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.

    COVID-19 activities:

    In Malawi, MSF is implementing COVID-19 related activities in line with the three running projects: Female Sex Worker (FSW) project, Prison Project and Nsanje Advance HIV Disease (AHD) Project.

    The 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 the set-up of the COVID-19 patient flow at health facilities and IPC. In Zalewa health centre, the screening for beneficiaries with respiratory symptoms and fever is ongoing. During the past 4 weeks: 2166 beneficiaries have been screened, 190 have undergone dedicated triage and consultation, no one responded to MOH suspected Covid19 case definition. Engagement with partners and stakeholders is ongoing at all sites, including MoH, traditional leaders and Health Advisory Committee.

    Prison Project continues to support prison authorities at Chichiri Prison in Blantyre through continued delivery of health promotion messages on a daily basis and screening activities by a counsellor and peers; monitoring of active utilization of handwashing points; weekly donations and monitoring of PPEs use and other logistic needs; on the job training of the clinical staff by the CO on COVID-19 management; providing technical support with IPC, among other activities.

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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

    There was an average of 12 new remandees daily and there were no released prisoners noted for the reporting period. The total numbers of prisoners in Chichiri as of 7th June was 1705. Screening activities outside the main gate is ongoing, two though the Health Promotion part has faced temporary challenges due to not having enough HR. Screening and consultation inside prison are also on-going, from April 20 to date, a total of 470 inmates have been screened for ARI and 54 were further linked for COVID consultation. There were still no reported cases of confirmed COVID-19. MSF is advocating for continuous implementation and adaptation of activities on COVID-19 preparedness, 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) among beneficiaries. MSF prison COVID SOPs are being replicated by other partners in other prisons.

    For 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 which 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.

    Up to the 30 of May, 422 people have been screened in the C-19 zone of which 22 were tested (8 samples still waiting for result), with 2 positive C-19 results (asymptomatic). The setting-up of the IPD case management isolation ward (19-bed capacity) has been finalized. The daily case management of possible COVID-19 patients in the isolation ward will be under the management of MoH. MSF will assist MoH with technical support and providing medical equipment with the full set of PPE.

    The general health promotion activities; training for HCW, orientation on HC screening set-up, the installation of hand-washing points in eight supported HC and in NDH have been concluded. HC visits of the 8 pilot sites have been re-launched to follow up on critical HIV/TB activities.

    Adaptations to MSF activities:

    The Advanced HIV disease (AHD) mentoring activities in the 8 pilot sites health centre and in the different wards of NDH have been put on hold during the COVID-19 intervention. The HC Human resources have been shifted towards the COVID-19 response in NDH. Community awareness related to COVID 19 and health access to health facilities (specifically NDH) is a focus. FSW Project is providing longer refills.

    In Dedza and Zalewa the comprehensive one-stop services at health facilities are available (HIV and SRH) all weekdays. 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 of beneficiaries by phone.

    We are observing critical situations among FSWs, who struggle ensuring basic needs (e.g. food and housing) are met. New HIV guidance during Covid-19 has been issued by DHA which will temporarily restrict activities such as VMMC and new initiation onto PREP. For the prison project, there are challenges concerning risk allowance policies, among other HR challenges.

     

  • Mozambique

    Context

    Mozambique has 1,557 confirmed cases of COVID-19 and 11 deaths (WHO 23/07)

    All provinces are affected, particularly Cabo Delgado, Nampula and Maputo City and Province. The country has switched from clusters of cases to community transmission in the province of Nampula and Cabo Delgado. There is still a very low proportion of severe/critical cases in Mozambique, no reports of community deaths and no cases among our patients or staff in Maputo.

    COVID-19 activities:

    We have worked on preventative measures like infection control, triage and surveillance. We have also adapted our models of care to reduce the risk of infection for vulnerable patients while ensuring access to healthcare.

    In Maputo, we have supported the main COVID-19 referral hospital Polana Caniço. An MSF team provided support and on the job training to the MoH staff with a focus on infection control, patient flows and triage protocols. Moreover, our harm reduction services in Maputo have been adapted to reduce the risk of exposure to COVID-19 for our patients, notably by providing Methadone take-home doses. Another example of a successful model of care adaptation is the fact that 88% of our DRTB cohort in Maputo is now under Self-Administered Treatment with 2-4 weeks refill. We participate in the Mozambican COVID-19 coordination meetings and technical groups providing advice for the shaping of the response in the country and facilitating access to updated evidence for protocols update and adaptation when necessary.

    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.

    The team is supporting MoH in order to have two isolation centres operation, 24 de Julho with 100 beds capacity and Marazul with 33 beds. These centres are still not operational, for the time being, serious cases are treated at Beira Central Hospital, supported by MSF for HIV patients follow up. MSF has re-designed and implemented the lay-out of the transit centre in BCH as temporally COVID centre.

    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 trainings, 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 Paquetiquete. Where it was created a waste zone, waiting area and Health Promotion activities. Medical activities will be focussed at Cariaco and Paquetiquete Health Centers through support on organizing patient flow, triage, training and case management support, as needed.

    After the attack on Macomia town, MSF is readapting its strategy and is assessing the needs in the Metuge where 17,000 IDPs are. There is an ongoing outbreak of cholera, but also measles and there is community transmission in the province.

    Adaptations to MSF activities:

    In Beira, we are reinforcing awareness campaigns on COVID-19 involving the communities leaders to avoid any kind of stigma with COVID-19 patients among the population as well as reinforcing the messages of 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 consultation space), and access to water and sanitation.

     

  • Zimbabwe

    Context

    Zimbabwe has 2,034 confirmed cases of COVID-19 and 26 deaths. (WHO 23/07)

    A total of 105 121 (62 589 RDT and 42 532 PCR) tests have been carried out as of 21 July. The sharp increase is attributed to a spike in local transmissions, and among returning residents and those in transit, mostly from South Africa, Mozambique, Malawi, Botswana Namibia and Lesotho.

    The country has swiftly tightened lockdown measured, with President Munangagwa imposing dusk-to-dawn curfew with immediate effect. 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.

    Reports of corruption involving prices of a huge consignment of PPE have been levelled against government officials and their relatives and this has affected the availability and price of PPE. There is political unrest following an announcement by civil society and opposition movements of a nationwide protest against corruption and the lack of the rule of law, which resulted in the arrest of a protest leader and a prominent journalist. It’s being questioned whether measures announced as COVID-19 measures are in fact not meant to stop the planned mass demonstration.

    The country continues to receive returning residents. While there are now more local transmissions mostly in Harare and Bulawayo, there are still concerns about high positive cases among 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). A number of strikes by health workers are taking place concurrently throughout the country over poor working conditions and remunerations, and lack of PPE. Some non-profit organisations and private companies are donating PPE, essential health equipment, medical supplies and money to ensure COVID-19 preparedness at designated health centres.

    COVID-19 activities:  

    The MSF Migration Project based in Beitbridge is working with the Ministry of Health and Child Care (MoHCC) and Ministry of Labour and Social Welfare (MoL&SW) along with 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. The MSF Clinic that was stationed in the middle of the Rainbow Hotel, now a quarantine and reception facility, has been relocated outside the facility due to the high risk of exposure to COVID-19. There are overall poor IPC, cleaning and disinfection standards.

    In the same district, we are providing support to Beitbridge District Hospital. A 30-bed facility to manage moderate to severe cases has been set up, with most structural adaptations completed. We have provided training, HP, risk communication, WASH, IPC and basic case management training for nurses, EHT’s, nurses from prison, CEZHA and others.

    MSF’s Regional Environmental Health Project completed 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 Infections 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.

     

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