IN FULL: Zweli Mkhize outlines how SA is dealing with coronavirus

Here are the opening remarks by health minster Dr Zweli Mkhize at a briefing at the National Institute for Communicable Diseases (NICD) in Johannesburg on Wednesday:

The department of health wishes to assure the public that South Africa is adequately prepared for active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of coronavirus infection, and to share full data with the World Health Organisation (WHO). South Africa has no reported or suspected cases to date.

Research into the epidemiology and natural history of the virus is ongoing. Although the origin of the disease in Wuhan City, China, is suspected to be zoonotic (that is of animal origin), evidence suggests that current spread is from human to human. According to the WHO the incubation period is about two to10 days, though some literature has cited up to 14 days. More evidence is needed to determine if asymptomatic patients are contagious, although the preliminary evidence suggests that, like SARS (severe acute respiratory syndrome) and Ebola, all the contacts reported were patients who had symptoms.

Typically, patients present with flu-like symptoms and cough. The disease can be complicated by shortness of breath, multi-organ failure and death. Most fatalities reported were elderly people or persons with pre-existing co-morbidities, suggesting that these are the population groups that are most at risk. Contrary to some media reports there is no evidence that the genotype of the organism is mutating — the virus still looks the same now as the first one isolated in December.

The department is aware of the cases that have emerged in countries outside China and is closely tracking the movements of the virus. The numbers change rapidly and so I may quote something now only to find that the numbers have changed as we speak. Closer to our shores we are aware that there is a suspected case under investigation in Zambia — the NICD is closely monitoring that situation. We will shortly invite Prof Cheryl Cohen from this institute to elaborate in more detail how the institute is tracking the numbers and how it keeps the public and stakeholders informed. You will also have an opportunity to walk through the Emergency Operating Centre straight after this briefing, where you will be able to see for yourselves the hard work and expertise that goes into responding to a disease outbreak that could be potentially pandemic.

On January 27 we published travel advice based on the WHO recommendations: these take into consideration all factors which determine the level of threat to a particular territory. The guidelines have not recommended any restriction on travel and trade, but it is recommended that non-essential travel to Wuhan City or Hubei province should be avoided or postponed. Prospective travellers can monitor the situation and plan their travel accordingly. Our understanding is that, currently, Wuhan City is essentially quarantined and 5-million citizens have been evacuated. Chinese authorities have closed all public transport entering and leaving Wuhan and other areas in Hubei province.

South Africa has responded rapidly to ensure that the coronavirus does not become a national threat. As a department it is standard procedure to monitor emergent outbreaks and we are currently tracking a plethora of pathogens, including those viruses of pandemic potential, like H5N1. We wish to reassure that coronavirus is no exception. In the recent past we have effectively responded to public health issues such as the Ebola virus outbreak that is currently ongoing in the Democratic Republic of Congo.

In regard to coronavirus, due to the rapidly evolving situation in China, the multi-sectoral national outbreak response team (MNORT) was reconvened on 24 January 2020. MNORT comprises the WHO, national departments such as home affairs, agriculture, international relations, tourism and representatives of the private health sector. At the meeting an incidence management system (IMS) was set up, with the key roles and responsibilities identified, and named responsible officials attached to each key functional area.

The current activities already undertaken by the national department of health and NICD include:

• An alert that was developed and disseminated to all provinces and stakeholders.

• MNORT and provincial outbreak response teams have been activated.

• Press releases have been circulated and various officials from departments of health and international relations have been interacting with the media and the public. Our media analytics have revealed 284 media citations of coronavirus, with an estimated reach of over 125-million people between January 20 and 26 2020.

• A hotline has been set up at the NICD to field questions from clinicians.

• South Africa has developed and distributed clinical guidelines and case definitions to doctors and nurses in both the public and the private sectors, which include information on how to diagnose and respond to a possible 2019-nCoV case.

• Provinces have activated outbreak response teams and are on high alert to detect and manage inadvertent cases that may arrive in the country.

• Screening of returning travellers from China at major airports has been intensified. I will go into detail in this regard as this is, of course, of paramount concern.

Our port health officials routinely conduct temperature screening for all international travellers. However, due to the current risk of importation of inadvertent cases of 2019-nCoV from Wuhan City in China, our port health authorities have intensified surveillance of all travellers from Asia, especially China.

Port Health Services is responsible for preventing, protecting and providing a public health response to the international spread of diseases through the points of entry (POE).

Port Health Services are provided in 36 points of entry, with a staff compliment of 300.

The service is provided on an ad hoc basis in the remaining smaller points of entry.  Screening is conducted in the POE to early detect an ill traveller by the following means:

1. Temperature screening is conducted in 12 POE utilising non-invasive thermometers, where all travellers arriving through these POE are channelled to the temperature screening. If travellers are found to have an elevated temperature, they are assessed by a nurse and if determined to be suspect are transported to a health facility for further management. The NICD is immediately notified.

2. Arriving conveyances (transport vehicle): Health officials go on board each arriving international aircraft and ship to determine if there is any sick traveller. If a traveller falls ill while on board, port health officials are informed by the crew members in line with World Health Organisation (WHO) and International Civil Aviation Organisation (ICAO) requirements and an assessment of the traveller is conducted upon arrival. If the traveller is found to exhibit symptoms consistent with novel coronavirus, the traveller would be transported to a medical facility for further management. Contact information of travellers who may have been in contact with the ill travellers are collected and used to follow up if necessary.

3. As the busiest airport in Africa, special measures have been introduced in OR Tambo International Airport, where travellers on direct aircraft from China in the past 14 days are required to complete a questionnaire for possible contact tracing.

The National Institute of Communicable Disease remains vigilant in monitoring the movement of this virus as reported by World Health Organisation and the team will take you through their emergency operations centre to show you how they do this.

We are working closely with the international community and particularly with Chinese officials through the WHO.

An emergency committee meeting was convened on Wednesday 22 January 2020 by the WHO director-general under the International Health Regulations (IHR) (2005). They concluded that although developments in China were concerning, it is still too early to declare a PHEIC (public health emergency of international concern). There is wide consensus internationally that there is no cause for panic, with experts pointing out that the common flu still remains an important disease burden: WHO estimates that seasonal influenza may result in 290,000 to 650,000 deaths each year due to respiratory diseases alone. This perspective is important to maintain, lest we get distracted and lose sight of ongoing priorities.

We have received a number of queries regarding the safety and health security of our citizens living in China, particularly those in Wuhan City or Hubei province. A meeting was convened by the Chinese foreign ministry with diplomatic missions on January 27 2020. In summary, the government of the People’s Republic of China has reassured us that there is no evidence to support the necessity to evacuate foreign nationals living in Wuhan City and they have called for calm in this respect. All persons entering or leaving Wuhan are subjected to a 14-day quarantine to ensure they do not develop symptoms. Foreign nationals who need medical assistance for whatever reason will be treated like Chinese citizens and be afforded all the medical care necessary. Embassies are enabled to support those locked out and locked inside Wuhan.

I have asked the ministry of international relations to be here with us today so they can share the developments at Dirco (department of international relations and co-operation) in responding to the outbreak. Dirco has been closely collaborating with all relevant stakeholders to respond appropriately to the needs of our citizens who either may want to go to, exit or remain in China. It is important to understand that how we respond as a country must represent the best interest of the people whom we intend to aid.

In conclusion, I wish to reiterate the basic principles to reduce the general risk of transmission of acute respiratory infections, which include the following:

• Avoiding close contact with people suffering from acute respiratory infections.

• Frequent handwashing, especially after direct contact with ill people or their environment.

• Avoiding unprotected contact with farm or wild animals if travelling in China.

• When sneezing or coughing it is better to cover your nose and mouth with a tissue or arm and not your hands.

• In case of symptoms suggestive of respiratory illness before, during or after travel, the traveller must seek medical attention and share travel history with their health-care provider.

For more information on 2019-nCoV or other diseases, please visit http://www.nicd.ac.za/diseases-a-z-index/.

For medical/clinical-related queries contact the NICD Hotline +27 82 883 9920.

Guidelines and other useful resources are available on the NICD website: www.nicd.ac.za.

The department of health will issue daily updates by voice notes and through radio stations to keep the public informed and abreast of developments until the situation abates.