SITREP 5


SITREP 5



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Ministry of Health and Social Services
Republic of Namibia
X\\) World Health
Sv Organization
NAMIBIA
Date & Time of
report
Prepared by
21 March 2020 21:00
Surveillance team
Region
Country affected
Investigation start date
Khomas Region,
Namibia
13 March 2020
e No new suspected or confirmed case reported today
e Overview of numbers of cases: to date 148 suspected cases were reported with samples collected
e Contacts: 56 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
e Thematic group meetings continue to be held daily, since the 14/03/2020
e Treasury approval and validation of donated COVID-19 POC/RDT testing kits under way.
e A test result of high risk contact of the third confirmed covid-19 case came out inconclusive and it
was repeated today (21 March 2020).
e 35 returning Namibians from covid-19 affected countries mainly Europe, USA and Canada arrived
in the country this morning (21 March 2020) with KLM airline from the Netherlands and they were
put on supervised quarantine at Greiters hotel and Conference center for the next 14 days.
e Key Challenges include:
o Inadequate isolation and quarantine facilities, human resources and material supplies
including PPE, ICU units and ventilators.
o POE: inadequate infrastructure at some key points of entry (working space for port health
staff, equipment and supplies):
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 a 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.They have been in Isolation facility since the 14 March
2020 in stable condition.
= 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 from Cape Town. 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. He was admitted at Lady Pohamba Private
Hospital on the 18.03.2020 and was transferred to Windhoek Central Hospital on
19",03.2020 where he is currently receiving care in an isolation unit.
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 Laboratory confirmed cases: 3
= Alive and dead: 0 death and 3 cases alive
* Case characteristics (age, sex, and 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 61-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 , chills and body pains
Contact Tracing Summary
Table 1: Contacts trancing summary as of 21.03.2020
Variables
Index cases (couple)
34 case
Category of risk
High | Medium | Low | Total} High | Medium | Low | Total
risk | risk
risk
risk
risk
Contacts listed in
1
3
last 24 hrs.
22
26
5
10
25
40
Number of contact | 0
2
trance in last 24hrs
16
18
1
8
10
14
Number of pending | 1
1
contacts
Health care
1
0
workers contacts
Number of
symptomatic
0
1
contacts
Contacts completed | 0
0
14 days
Total follow up for | 1
3
tomorrow
6
8
4
7
1
2
0
2
5
6
0
0
0
0
0
0
22
26
5
10
1S
26
5
a
0
0
0
0
25
40
Grand
Total
66
32
34
9
6
0
66
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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 20/03/2020 a total of 148 COVID-19 specimens were recorded in the two laboratories (NIP
and Path care) as per table below:
Table 2: COVID-19 specimens recorded in at NIP and Path care as of 21.03.2020
As of 20/03/2020
NIP
Total sample sent to the | 31
Laboratory
Total sample tested
26
Total results positive
0
Total results Negative
25
Total results inconclusive | 1
Total results pending
5
Laboratory
Path care
le
88
3
34
0
28
Total
148
104
3
59
1
33
The high risk contact of the third positive case was tested and the results is inconclusive , hence the
samples were repeated today 21 March 2020, awaiting results.
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. The last meeting was
held on the 20 March 2020 chaired by the Incident Manager.
* Declaration of the outbreak was done through a press conference by Hon. Minister of Health on
14 March 2020 and planned to conduct weekly. Last press briefing conducted on 19 March 2020
= Incident Management System activated and Incident Manager for COVID-19 have been
appointed and on board.
= Sub-committees, including coordination, logistics, laboratory, surveillance, points of entry,
community engagement, case management and infection prevention and control, have been
activated and hold daily 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 and additional measures have been
identified and communicated for implementation.
= Costed response plan is being finalized.
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o SURVEILLANCE:
Case contact tracing commenced on 14 March 2020 and is ongoing on a daily basis.
A telephone hotline centre has been activated and staffed with responders to address concerns
from the general public operating 24 hours.
Daily meetings are held to discuss daily progress, gaps and way forward, last meeting held
on 21 March 2020.
SOPs were finalized and shared with coordination for approval.
An orientation meeting is planned for 22 March 2020,for additional hotline responders
35 Namibians who arrived in the country on 21 March 2020 have been placed under
supervised self-quarantine and daily monitoring will be done for 14 days.
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 continue to test the collected samples and provide daily updates on the results
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 21 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 was on 20/03/20 at SPM
Integrated 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
= 35 returning Namibians arrived at Hosea Kutako Inter’ airport and were screened and
cleared off to the quarantine facilities.
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o RISK COMMUNICATION, COMMUNITY ENGAGEMENT & SOCIAL
MOBILISATION:
= 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
= 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
= IEC 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 Country coordination and communication related challenges (beyond MoHSS) for
implementing IMS and multi-sectoral coordination
o Lack of fully equipped isolation facilities in the regions at health facilities and points of entry in
the regions
o Insufficient Personal Protective Equipment/clothing
o Insufficient trained personnel
o Insufficient funding for the response plan
o COORDINATION AND LEADERSHIP:
= Need for improving country coordination, planning and monitoring,
= Need for 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
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= MOoHSS to accelerate sending of requests to government Ministries who have indicated they
are having staff to support the outbreak response esp. MOD and Police
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
= Advocate and request for more staff to support contact tracing and hotline
= Submit the final budget for additional resources needed to enhance response
o LABORATORY:
= Utilise Namibia Institute of Pathology for local testing
= Improve communication and share SOPs of results for notifiable disease by private
laboratories (Path care) 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,
MOBILISATION
COMMUNITY
ENGAGEMENT
& SOCIAL
= 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.
arf et :
Incident Manager
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