SITREP 3


SITREP 3



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Ministry of Health and Social Services
Republic of Namibia
Ns sy Organization
NAMIBIA
ut reak ame -
Date & Time of
report
Prepared by
19 March 2020 21:00
Surveillance team
IStric
Region
Country affected
Investigation start date
Khomas Region,
Namibia
13 March 2020
e Two index confirmed cases of COVID-19 were reported in Windhoek on 13 March 2020. A 35-
years-old male and a 25 years-old female, both Romanians tested positive on 14/03/2020
e A third confirmed case was recorded on 19.03.2020; a 61 years old male, a Germany national with
travelling history via Amsterdam and Zimbabwe. He visited a private hospital on 17 March 2020
with complaints of fever (>38°C) and chills, the specimen was taken the same day by Path-Care and
sent to NICD in South Africa and tested positive on 19.03.2020
e Overview of numbers of cases: to date 129 suspected cases were reported
e Contacts: 43 people have been listed as contacts so far, with more to be identified.
e Key laboratory results: 3 confirmed cases RT-CRP for COVID-19 tested positive
e COVID-19 thematic area response meetings are held daily, started on 14/03/2020
e MOoHSS received a donation of POC/RDTs for COVID-19 ON 18 March 2020, but it is not known
if these are WHO accredited and we need guidance before we can use them.
e WHO consultant, Dr James Akpablie arrived in the country to support IMS, PHEO and coordination
of COVID-19 response
e Key Challenges include:
o Inadequate isolation facilities, human resources and material supplies including PPE, ICU
beds and ventilators.
o Insufficient budget for the response.
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Description of cases
= Index cases: Two confirmed cases of COVID-19 were reported from Windhoek district
to MoHSS National level on 13 March 2020. The patients are married couple; a 35year-
old, male and a 25 year-old female, both Romanians who have permanent residence in
Spain, with a travel history from Madrid, Spain, via Doha, Qatar. They arrived in Namibia
via Hosea Kutako International airport on 11 March 2020. The couple tested positive of
COVID-19 on 13 March 2020.The couple have been in Isolation facility since the 14
March 2020.
= A third confirmed case was recorded on 19.03.2020; a 61 years old male, a Germany
national with travelling history via Amsterdam on 26 February 2020 and Zimbabwe on
4" March 2020 and arrived in Namibia on 13 March 2020 by Air. The onset of symptoms
was on 10" March 2020 while in Zimbabwe. He visited lady Pohamba private hospital
on 17 March 2020 with complaints of fever (>38°C) and chills, the specimen was taken
the same day by Path-Care and sent to NICD in South Africa. The result came out
positive on 19.03.2020.
Description of disease burden globally:
e On 4th February 2020, the World Health Organization declared Coronavirus Disease
(COVID-19) outbreak a Public Health Emergency of International Concern(PHEIC)
and on 11th March 2020 was declared as a Pandemic.
e According to WHO, for the latest update of case burden and affected countries refer to
https://www.who.int/emergencies/diseases/novel-coronavirus-201.
Mode of transmission: The main driver of transmission, based on currently available data, is
symptomatic cases.
Source: Based on current information, an animal source seems the most likely primary source
of this outbreak. Detailed investigations are ongoing to determine it.
Severity: Current information suggests that the virus can cause mild, flu-like symptoms as well
as more severe disease. Patients infected with the disease are presenting with a wide range of
symptoms. Most seem to have mild disease, and about 20% appear to progress to severe
disease, including pneumonia, respiratory failure and in some cases death.
Incubation period: 1-14 days, based on current information
Description of disease burden in the country (Namibia): This is a new strain of coronavirus
and has never been reported in Namibia. These are first cases of COVID-19 in the country.
Date of outbreak declaration of the pandemic in Namibia: 14 March 2020
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o Descriptive Epidemiology
= Number of confirmed cases: 3
= Alive and dead: 0 death and 3 cases alive
= Case characteristics (age, sex, occupation): The persons affected are a married
Romanian couple (a 35 year-old male and 25 year-old female) from Madrid, Spain. The
new case is 60-year-old male from Germany.
= Time trends: The couple were tested on 11 March 2020 and confirmed on 13 March
2020. The new case was tested on 17 March 2020 and confirmed on 19 March 2020. All
specimens were tested at NICD in South Africa.
= Clinical description:
= The couple were taken to a local private doctor on 11 March 2020 with a history
cough and fever for the male and fever only for the female.
= The new case presented at private hospital on 17 March 2020 with complaints of
fever and chills
Contact Tracing Summary
Table 1: Contacts trancing summary as of 19.03.2020
Variables
Index cases (couple)
3"4 case
Category of risk
High | Medium |Low [Total | High | Medium | Low | Total
risk | risk
risk
risk
risk
Grand.
Total
Contacts listed in
1
3
last 24 hrs.
22
26
1
4
13
18
43
Number of contact | 1
3
trance in last 24hrs
21
25
1
4
13
18
40
Number of pending | 0
0
contacts
Health care
1
workers contacts
Number of
0
1
symptomatic
contacts
Contacts completed | 0
0
14 days
Total follow up for | 1
3
tomorrow
1
1
0
0
1
2
0
2
2
3
0
0
0
0
0
0
22
26
1
4
0
0
1
5
7
9
0
0
3
0
0
0
13
18
44
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= Index cases samples were taken on 11 March 2020 and tested positive on 13 March 2020. The
new case was tested on 17 March 2020 and confirmed on 19 March 2020. All specimens were
tested at NICD in South Africa.
= As of 19/03/2020 a total of 131 COVID-19 specimens were recorded in the two laboratories (NIP
and Pathcare) as per table below:
Table 2: COVID-19 specimens recorded in at NIP and Pathcare as of 19.03.2020
As of 19/03/2020
NIP
Total sample sent to the | 25
Laboratory
Total sample tested
20
Total results positive
0
Total results Negative | 20
Total results pending
5
Laboratory
Pathcare
106
37
3
34
70
Total
131
57
3
54
75
We have realized with concern that there is a degree of clinicians not following the case definition for
covid-19 to classify cases as suspects, particularly by the private clinicians and laboratories. The Case
Management and Surveillance teams are working on this.
o COORDINATION AND LEADERSHIP:
= National Health Emergency Management Committee special committee on COVID-19 response
was activated 14 March 2020 and chaired by the Hon. Minister of Health.
= Declaration of the outbreak was done through a press conference by Hon. Minister of Health on
14 March 2020.
= Incident Management System activated and Incident Manager for COVID-19 have been
appointed.
= Sub-committees, including coordination, logistics, laboratory, surveillance, points of entry,
community engagement, case management and infection prevention and control, have been
activated and hold regular meetings.
= A high-level meeting was held at the State House with President and precautionary measures
were taken.
= Namibia COVID-19 response plan being updated to include regions and newly identified needs
= President declared State of Emergency today, 17 March 2020
o SURVEILLANCE:
= Case contact tracing commenced on 14 March 2020 and is ongoing.
= A telephone hotline center has been activated and staffed with responders to address concerns
from the general public.
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Case definitions:
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 with no other aetiology that
fully explains the clinical presentation AND a history of travel to or residence in a
country/area or territory reporting local transmission (See situation report) 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 COVID19 case (see definition of contact) in the last 14 days prior to
onset of symptoms;
OR C. A patient with severe acute respiratory infection (fever and at least one sign/symptom
of respiratory disease (e.g., cough, shortness breath) AND requiring hospitalization AND
with no other etiology 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
Confirmed case: A person with laboratory confirmation of COVID-19 infection, irrespective
of clinical signs and symptoms.
o LABORATORY:
= Laboratory has been involved and sensitized about collecting and transporting this
extreme biohazard specimen from suspected patients
= There is a system in place for shipping specimen to NICD reference laboratory in South
Africa.
= NIP laboratory has capacity for local testing and has limited tests for COVID-19.
o CASE MANAGEMENT and Infection Prevention and Control:
All 3 cases are admitted in isolation wards and managed as per WHO recommendations.
Of the 2 index cases, 1 is asymptomatic and the other has mild symptoms but is clinically
improving. The 3" case is classified as mild-moderate and needed close monitoring
As of 19 March 2020, all patients are stable.
SOP on both case management and IPC is readily available on soft copy and has been
distributed to all sub-committees as well as on social media platforms but needs to
periodically be revised
Training on case management and IPC has already begun at WCH and KIH. The plan is to
tap into ZOOM platforms and have regular presentations nationwide. First ZOOM
presentation is 20/03/20 at SPM
Intergrated case management and IPC Plan is available for distribution.
o Points of Entry
= Port Health services (screening) has been intensified at major points of entry
o RISK COMMUNICATION,
MOBILISATION:
COMMUNITY
ENGAGEMENT
& SOCIAL
= Risk communication by Office of President and Executive director of Ministry of Health
has been conducted
= Risk communication SOPs in draft
= Risk Communication Strategy being developed
= RCCE sub-committee expanded to include other ministries, UN agencies and CSOs
* Social media plan under the leadership of the PROs MoHSS activated with support from
Ministry of Information, Communication and Technology
= NBC airing health education messages related to COVID-19 on TV and all 11 Radio
stations
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« Namibian placing COVID—19 health education messages daily in their paper
= Risk communication team have scheduled radio talks in 11 radio languages stations of
the national broadcaster.
= Media interviews with private and public media houses conducted daily
= Press Conferences and subsequent engagement with the media is frequent and facilitated
by the Minister’s office
= TEC materials developed and printed, translations is in process, plans to print more are in
place
= Namibia Airports Company is airing COVID-19 messages on all the screens at the
airports
= Rumour management system is being set-up through media monitoring, social media
posts and press conferences
Health Education sessions on COVID-19 in workplaces is ongoing
o LOGISTICS:
= List of supplementary needed items has been compiled and submitted for procurement;
PPE, Masks, gloves, etc.
= Modification of the entrance/exit of existing the designated isolation facility at Robert
Mugabe clinic is ongoing. It is expected this will be a screening facility.
o Coordination and communication related challenges for implementing IMS
o Lack of fully equipped isolation facilities in the Country
o Insufficient Personal Protective Equipment/clothing
o Insufficient trained personnel
o Insufficient funding for the response plan
o COORDINATION AND LEADERSHIP:
= Need for technical support in coordination, case management and IPC, surveillance and
POE, risk communication and community engagement
Involve all relevant stakeholders with commitment from top management
Finalization of all relevant SOPs per pillar
Activation of the IMS at the national level and in regions
MOHSS to accelerate to officiate requests of government Ministries who have indicated they
are having staff to support the outbreak response.
o SURVEILLANCE:
= Intensify contact tracing process to identify all contacts
= Strengthen surveillance and detection throughout all districts and regions to detect suspected
cases early
= Include regions and other stakeholders to support timely and effective contact tracing
o LABORATORY:
= Utilise Namibia Institute of Pathology for local testing
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= Improve communication and share SOPs of results for notifiable disease by private
laboratories (Pathcare) with MoHSS
o CASE MANAGEMENT:
= Ensure all health workers involved are well trained in COVID-19
= Have clear SOPs of case management readily available
= Procure and distribute relevant equipment and materials
= Determine screening facility and direct
o POINTS OF ENTRY
# Fully equip (Equipment & Human resources) all identified points of entry
o RISK COMMUNICATION, COMMUNITY ENGAGEMENT & SOCIAL
MOBILISATION
= Conduct regular risk communication and community engagement through IEC material,
electronic media and direct engagement.
o LOGISTICS
= Procurement of IPC and laboratory supplies for Emergency preparedness and response
= Strengthen participation of logistic/procurement/operations/financial experts from
MoHSS, WHO, CDC, UNICEF, etc in the coordination group that coordinates these.
Incident Manager
Date: 26| 2] 2920
Secretariat
7TlPaca