SITREP 38


SITREP 38



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Ministry of Health and Social Services
Republic of Namibia
on
MAMIBIA
Outbreak Name
COVID-19
Country affected
Namibia
|
Date & Time of
25 April 2020 20:00
Investigation start date
13 March 2020
|
report
:
_
|
Prepared by
Surveillance Team
|
Date of outbreak declaration in Namibia: 14 March 2020.
1, SITUATION UPDATE / HIGHLIGHTS
No new confirmed case was reported in the last 21 days (5 — 25 April 2020).
Cumulatively, 16 confirmed cases have been reported in the country, to date.
To date, of the 16 confirmed cases, eight (8) have recovered and discharged.
o One (1) confirmed case recovered today
Supervised quarantine for all Namibians arriving from abroad for 14 days is
ongoing.
The lockdown has been extended until 4 May for entire country, as announced on
14 April 2020 by His Excellency, the President of the Republic of Namibia
o All borders will remain closed except for essential/critical services and
humanitarian support to the response.
o All other prevention measures are applicable to the entire country
2. BACKGROUND
Description of the cases
Index cases: Two confirmed cases of COVID-19 were reported in Windhoek
district on 13 March 2020. The married couple; a 35-year-old male and a 25-year-
old female, arrived from Madrid, Spain on 11 March 2020.
Total number of imported cases currently stands at 13 while 3 cases are local
transmissions.
There is no evidence of community transmission in the country at the moment.
Table 1: Confirmed cases by region as of 25 April 2020
Reporting
region
Total Cases | New cases | Active cases
| Khomas
1
0
4
| Recovered
7
| Death
0
| //Karas
|
0
1
Erongo
4
0
3
| Total
1
0
8
0
0
1
0
8
0
__|
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4
24
14
04
Date of symptoms onset
Figure 1. Epi-curve for COVID-19 confirmed cases in Namibia as of 25 April 2020
: il
@ Male
@ Female
0to4
5to14 15to34 35to59 60 to 79
80+
Age group (years)
Figure 2 Age and sex distribution for COVID-19 confirmed cases in Namibia as of 25
April 2020
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COVID-19 Cases-Namibia
Q— 100 — 200 300 400 500 km
Figure 3: Suspected and confirmed COVID-19 cases in Namibia per District, 25 April
2020
3. PUBLIC HEALTH ACTION / RESPONSE INTERVENTIONS
EPIDEMIOLOGY & SURVEILLANCE
Case definitions as of 20 March 2020:
Suspect 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 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 suspect case for whom testing for COVID-19 is inconclusive.
Inconclusive being the result of the test reported by the laboratory
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Confirmed case: A person with laboratory confirmation of COVID-19 infection,
irrespective of clinical signs and symptoms.
Active surveillance working case definition as of 20 April 2020
A patient diagnosed with Upper/Lower Respiratory Infection (Mild or Severe)
presenting any of the following signs and symptoms: cough, sore throat, fever,
chills, myalgia/body pains or shortness of breath in the past 7 days.
¢ Surveillance activities
* Daily pillar and intra-pillar discussions are held to deliberate daily progress,
gaps and way forward;
* Call centre continue operations for 24 hours per day
"Data entry is ongoing and real time data dashboard has been completed and
ready to be launched soon.
= Active case finding in all regions aimed at looking for possible community
transmission is ongoing.
= Contact tracing is ongoing (see table 2) and all contacts will be tested
= People under mandatory quarantine are being monitored daily (see table 3)
and will be tested on day 12 before release on day 15.
Contact tracing Summary
Table 2: National contacts tracing summary for Covid-19 as of 25.04.2020
Variables
Contact risk level
High
Medium | Low | Total
Total Number of contacts listed (potential)
68
48
118
234
Total Number of contacts identified
68
48
102
218
Total Number of active contacts (being
followed)
8
1
2
6
Number of contacts monitored/followed in the
| last 24hrs
3
1
2
6
| Total number of Contacts completed 14-days 62
44
95
201
follow up
Total Number of contacts that developed signs 25
7
7
39
& symptoms
Total Number of contacts tested positive
3
l
0
4
|*|| Tanodtals° ymNputmobmesr of contacts tested without signs 18
1
8
27
| © Total Number of contacts lost to follow up _| 0
2
5
7
| Total number of Contacts never reached
0
0
16
16
*Number of contacts without signs & symptoms tested. One tested positive.
© Seven contacts are lost to follow up, all are non-Namibians and have travelled back to their countries of origin.
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Table 3: Number of people in mandatory quarantine facilities as of 25.04.2020
| Region
Newly
quarantined
Cumulative
number of
Number of | Number of people |
people
in quarantine
24hrs
people
discharged | now
|
_OOsmhuasantai_ {i[oO
Ohangwena
6
28
0/
8/
35
Il
24
Hardap
0
40
40
0
|
|Otjozondjupa
0
100
61
39
Khomas
4
158
147
11
Zambezi
0
109
80
29
//Karas
0
97
15
82
|
Erongo
0
28
0
28
Total
11
577
355
222
LABORATORY INVESTIGATIONS
e As of 25 April 2020, a total of 704 COVID-19 specimens were tested in the two
laboratories (NIP and Path Care) as per table 4. below:
Table 4: COVID-19 specimens recorded at NIP and Path care Laboratories as of
25.04.2020
As of 25/04/2020
Laboratory
Total sample received by the Laboratory
NIP | Path care | South Africa
621 | 207
-
Total sample tested
Total results received
504 | 200
-
504 | 200
-
Total sample re-tested
76 | 1
-
Total results positive
9
6
*]
Total results negative
Total sample discarded
Total results pending
495 | 194
=
41 |2
-
0
4
=
Total results inconclusive/indeterminate
0
0
=
@Total new suspected cases in last 24
9 |3
-
hours
*] Patient specimen collected and tested in South Africa, he travelled back before results came out
@ Total new suspected cases laboratory results received within 24 hours
Total
828
704
704
77
16
689
43
4
0
32
COORDINATION AND LEADERSHIP:
e Daily feedback meetings between pillar leads, coordination team and Incident
manager ongoing, to share daily accomplishments and to address key challenges
e Efforts to increase isolation and quarantine facilities are ongoing.
¢ Integrated training on covid-19 concept note being revised to ensure the number
of participants and logistics arrangements are in alignment with the lock-down
directives and covid-19 social distancing.
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e Final inputs to the organogram, SOPs, TORs, M&E, Contingency Response Plan
and sentinel surveillance protocol are being incorporated, in order to submit them
for clearance to senior management by Monday, 27 April 2020.
CASE MANAGEMENT
¢ Out of the 16 cumulative confirmed cases, 8 recovered, and have been discharged,
after testing negative for COVID-19 at 48 hours’ interval.
e The other 8 confirmed cases are in stable condition and all are asymptomatic.
© Conversion of casualty department at Windhoek Central Hospital (WCH) into a
highly infectious referral ICU is nearing completion.
e A 12-bed Isolation Unit has been constructed at WCH, awaiting installation of
oxygen equipment
e Rhino Garments’ building renovation to be repurposed as an isolation facility.
o The memorandum of understanding between MoHSS and private hospitals
are being prepared on the renovation and operation of the facility.
e Katutura State Hospital (KSH) TB ward being re-purposed into a COVID-19
ward.
e Four Private hospitals in Windhoek (Mediclinic, Lady Pohamba, Rhino Park, and
Roman Catholic private hospital) have been designated as the private hospitals for
the response of COVID-19 with a combined total of 8 ICU beds and 32 beds for
moderate to severe cases.
o COVID-19 patients with health insurance cover are eligible to access care
in any of the 4 designated facilities
e Training of health care workers (from wards and from private facilities) on case
management and IPC is conducted daily at WCH, KSH, and Robert Mugabe
Clinic.
e Forty (40) medical graduates were trained on IPC, surveillance and specimen
collection.
o Were deployed on 24 April 2020 to Case Management and Surveillance
teams.
e Health Facility readiness visit to the regions being planned.
e Bi-weekly ZOOM training sessions for Health Care Workers is ongoing.
INFECTION PREVENTION AND CONTROL (IPC)
e Conducted a training on Overview of COVID-19 and IPC for HCWs in
Correctional facilities and from Ministry of Defence
e Finalised [PC materials as part integrated training package
¢ Reviewed and finalised the SOP for management of remains of people who dies
from COVID-19
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LOGISTICS:
Facilitation of the allocation of quarantine facilities in the country and
transportation for discharged people from quarantine facilities is ongoing.
Provision of commodities’ specifications and verification for procurement is being
done regularly
Received a consignment from Chinese government
o N95 Medical Mask x 20 000; General Medical Mask x10 000; Gown x
portable infrared thermometer x 500; googles x 2000; Examination
glovesx10 000 and shoe cover x 10 000
Received a second consignment from Jack Ma Foundation
o Swab & viral transport medium x 18 900; Extraction kits x18912; Medical
Protective Clothing x 3800; Faceshield x 3 800; Ventilation Machine-
CPAP x 10; Thermometer gun x 36 and Medical gloves x 9 500
POINTS OF ENTRY:
Inspection was done at 2 big markets in Windhoek to assess its readiness before
re-opening
Continuing to work on the training content of the planned integrated training for
COVID-19 response.
Provisional tippy taps are being installed at all the roadblocks around Khomas.
A concept note on establishing truck ports in major towns and along the borders
have been finalized.
RISK COMMUNICATION AND COMMUNITY ENGAGEMENT:
The communication hub continues to give updates on COVID-19 and also clarify
miscommunications on a daily basis this is done concurrently with the social
media updates.
The RCCE team worked with the City of Windhoek to develop messages for
traders and customers at the open markets.
The Media continue to communicate messages on COVID-19 and the extension of
the lockdown.
The RCCE continues to share messages on Covid-19 prevention measures
PSYCHOSOCIAL SUPPORT SERVICES:
Health education, psychosocial support and post counselling services to people
under quarantine, COVID-19 confirmed cases and their families are ongoing
Regional social workers provide counselling to 70 persons in quarantine in 7
regions.
A total of 463 persons in need of shelter housed at two sites.
Daily orientation of regional social workers on their role in the COVID-19
response continues in order to guide them in activities to be conducted.
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A total of 461 persons in need of shelter housed at two sites
Health education, psychosocial support services provided, as well as food and
other material distributed at places where persons in need of shelter are placed is
ongoing.
MTC continue to provide lunch for the persons without shelter at the two sites in
Windhoek
Negotiations underway with a total of 160 persons in need of shelter who are
refusing to still to be placed.
Finalize need assessment of persons in need of shelter and compile report with
recommendations for relevant authorities for planning and implementation.
4. CHALLENGES
Inadequate and at some places lack of isolation units at health facilities and at
points of entry in the regions.
Unavailability of probes and primers for NIP laboratory to start testing for
Seasonal Influenza (HIN1) from beginning May 2020.
Inadequate swabs for Covid-19 (despite receiving swabs from Jack Ma
Foundation which are not suitable for nasopharyngeal swabbing)
Regions need training addressing all pillars of the response team, but travelling to
the regions seems unfeasible to the travel restrictions and social distancing.
5. RECOMMENDATIONS
Establish fully equipped isolation units at health facilities and at points of entry in
the regions.
Fast track procurement process laboratory testing kits (probes and primers) for
Seasonal Influenza (H1N1) testing in the two selected sentinel sites (Katutura
Hospital, and Rehoboth Hospital). The number of sites can be extended later.
Finalise integrated training capacity package (addressing all pillars) and complete
assessment for readiness for regions and districts to undertake virtual training on
covid-19 soonest
Finalize need assessment of persons in need of shelter and compile report with
recommendations for relevant authorities for planning and implementation.
Approved:
wn Ls
Incident Manager
Date: 25.04.2020
o>
Se€retariat
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