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MINISTER ON COVID-19 PLAN, HEALTH PERSONNEL, OPENING OF SCHOOLS

27/07/2020 06:16:00 BY TIMES REPORTER

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Thank you for affording us an opportunity to engage you on your efforts to curb the spread of coronavirus in Eswatini.
Firstly we wish to commend you and your government for allowing the economy to operate despite the rise of COVID-19 infections. This has surely placed a great burden upon the health system even before the country experiences a peak of infections. Recently you announced the development of a six-point plan to manage the crisis, which could possibly help us realise the target of flattening the curve sooner rather than later.

1. Kindly give us an overview of this plan and how it will address each of the elements that contribute to the rapid rise of new cases.
a.    Manzini Region is the epicentre of the COVID-19 pandemic, accounting for 55 per cent of the cumulative confirmed cases. This is evident of a continued increase in transmission of the coronavirus in specific areas (hot spots) of the region despite measures put in place to slow down the pandemic.
b.    As a response and based on recent WHO technical advice, the Ministry of Health (MoH) developed a plan to identify all persons who will be found to be having symptoms related to COVID-19 (fever, cough, shortness of breath, headache/dizziness, runny nose, poor appetite, loss of taste, loss of smell, diarrhoea, vomiting) and test them – in order to reduce the transmission of the virus to others.
c.    The launched approach is a six-point plan to intensify screening clients and finding symptomatic cases, testing, treating, isolating them and tracing their contacts, which will include testing symptomatic cases.
Nine localities in Manzini hot spot areas will be targeted for a period of one month with a 2-week evaluation period set. Ten teams for Manzini localities have been deployed including one team just to focus on schools.

2. The success of any plan largely depends on financial resources. Have you acquired the required funding to execute the six-point plan and from who or where? Kindly give us a breakdown of how such funds will be used.
a.    The campaign strategy has been costed to the value of 924 606 SZL which includes costs for lodging for the teams, transportation, tools kits for swabbing, which encompasses personal protective equipment and waste disposal.
b.    Financial support has been secured from the government and other sources including the United Nations and the Red Cross and discussions are ongoing with these donors and new donors for the scale-up of the strategy to other hot spot areas.

3. Would you say the plan has obtained the necessary buy-in from all the affected stakeholders?
a.    The strategy is currently being implemented and received approval from government and will be modified following the two-week evaluation phase where the ministry will take time to incorporate lessons learned and findings from its implementation on the ground.

4. Have you been able to get the desired number of health personnel, equipment and vehicles in order to consider your strategy well equipped to deliver on its targets? If not, where are the shortfalls?
a.    With the financial support we have received from government, donors and partners, we are able to implement the strategy in Manzini but will require additional funding to continue implementing in Manzini and scale up to hotspots in other regions.

5. A recent survey by a group of public health specialists and toxicologists by UNESWA’s Dr Fortunate Shabalala, found only a 37 per cent compliance with COVID-19 regulations by businesses. How will the plan address this to achieve 100 per cent compliance?
a.    The six-point plan has not been developed to address compliance. The launched approach is to intensify finding symptomatic cases, testing, treating, isolating them and tracing their contacts, which will include testing symptomatic cases to reduce onward transmission of the coronavirus disease.
b.    Compliance adherence will require a different strategy from the Ministry of Commerce, Industry and Trade.

6. The shortage of fuel has become the latest challenge to the COVID-19 response. How are you addressing this issue, which seems to have more to do with administrative challenges rather than a reported fuel shortage from source of supply?
a.    Government has provided special provision for fuel through NDMA to support the COVID-19 response. The vehicles are able to refuel at filling stations around the country utilising funds that government has made available to ensure minimal interruption to service delivery.

7. The country now has 21 deaths (as at Tuesday, July 21, 2020). When the first two deaths occurred, we were informed that diabetes was the underlying condition. Could you help break down the underlying conditions of the 19 subsequent deaths.
a.     Well, 78 per cent of the deaths have had pre-existing conditions which include diabetes, hypertension, HIV, epilepsy and Parkinson’s disease.

8. Could you also give us a breakdown on the stages at which they occurred; i.e. ventilation, in-facility or pre-admission and what you make of each circumstance. Could they have been avoided and how?
a.    There is no normal progression of this disease; some people at infection can be asymptomatic and go through the incubation period without showing any signs and symptoms. Other people become severely ill from infection and pre-existing conditions make some of them more susceptible.
b.    People can be initially asymptomatic and rapidly progress to severe, others progress from being asymptomatic to mild and recover and others eventually progress to severe. The timing for this differs across different individuals.
c.    Most of the deaths have been in moderate and severely ill patients at admission, however, disease progress varies from person to person.
d.    Some of these deaths could have been avoided as follows:
a. People need to know their health status, particularly men. Other people only know of other pre-existing conditions when admitted for COVID-19 yet they need to know of them prior, so they are put on a treatment to stablilise their immune system.
b. Additionally, some people have started treating themselves at home for ‘normal flu’ and only come to hospital when severely ill. It is imperative that when not feeling well, people come immediately to the hospital and not attempt to treat themselves with home remedies, especially for flu.

9. How much pressure has the opening of schools placed on your ministry’s response strategy and how do you hope to address the challenges that this group presents?
a.    We have had to provide additional human resource capacity to ensure that adequate support is being provided to the Ministry of Education for reopening of the schools.
b.    With regard to the effect of that on the overall, we are yet to evaluate that as there is a 14-day lag between reopening of a sector and effect of that on the health system when taking into consideration the incubation period and testing turnaround time.

10. You have recorded an impressive recovery rate of COVID-19 patients. What do you attribute this to?
a.    It is difficult to attribute to any specific thing; in the beginning the infection rates were low and thus contact-tracing worked well to identify the cases early. This early in identification is bearing fruits in the recovery rates.
b.    We have seen a majority of our cases in the 0 – 39 age range who are mostly asymptomatic with no comorbidities, which may be attributed to their agile recovery.
c.    The recovery rate compares well to the global picture, which is around 50 per cent.

11. Based on your models or projections, what are the timelines. When can we expect to start seeing a change in the infection curve?
a.    The main intervention for cutting COVID-19 transmission is social distancing; ensuring that people stay away from each other. As the economy gradually reopens including other sectors, we expect cases to increase for the month of July and August with a second increase later in the year depending on how quickly the sector open (schools, churches and sports) completely.

12. Much focus is on COVID-19. This has overshadowed other critical challenges facing the ministry. To what extent has the coronavirus pandemic affected delivery of services or attention to other ailments requiring equal if not more attention?
a.    In the beginning, there were a lot of services that were affected caused by various factors including:
i. Repurposing of existing staff members to be able to rapidly respond to the pandemic as structures were being strengthened.
ii. We went into lockdown, which limited the movement of people.
    This resulted in some members not being able to easily access health services as they could previously.
iii. The global lockdown and trade embargos caused a shortage of health commodities which had not been planned for, forcing government to make alternative plans to ensure that supplies were made available.
iv. The pandemic has obviously caused a strain on the health system in terms of the budget and the PPE needs, which are unprecedented.
b.    To mitigate this, our COVID-19 response strategy includes a pillar on maintaining essential health services and systems with key strategies including:
i. Review and/or adapt guidelines on continuation of essential services delivery.
ii. Redesign of service delivery models for both facility-based and community-based services.
iii. Maximising human resources (HR).
iv. Strengthening occupational health and safety measures.
v. Ensuring availability of adequate quality commodities and supplies for service delivery through effective logistics forecasting and prepositioning, and distribution at all levels.
vi. Instituting monitoring and evaluation by developing a framework comprising a set of indicators for continuity of essential services, performance assessment as well as assessing the impact of and disruptions caused by COVID-19 to routine health services.

13. What daily diet could to every liSwati afford?
a.    A normal well-balanced diet.

14. What feasible lifestyle habits would you encourage for every liSwati?
a.    Wash your hands frequently.
b.    Eating a normal well-balanced diet
c.    Physical exercise.
d.    Avoid crowds especially in closed spaces.
e.    Avoid alcohol or practise moderate use of alcohol.
f.    Avoid or quit smoking.

15. Post COVID-19, what lesson would you and your ministry have learnt order to be ready for a similar, if not worse, pandemic?
a.    We have learnt to be agile and flexible to respond appropriately to the pandemic e.g. we were able to repurpose existing staff members to mount the COVID-19 response as we worked to get posts approved and recruitment underway.
b.    It is important to have a strong health system to build response from; this has provided us with a platform to start from and strengthen our emergency response systems for future pandemics including establishment of in-country laboratory capacity for COVID-19 testing, contact-tracing etc.
c.    Working as a multi-sector for the response.

16. On a personal level, how is this pandemic affecting you? Kindly give us an insight into the day in the life of our Health minister amid the coronavirus pandemic.
a.    I spend a lot of time thinking, planning and researching about COVID-19, eating up the time on the things I would normally do such as gardening.

17. What would you like to emphasise to emaSwati going forward?
a.    We continue to emphasise on the core measures.
i.   Washing of hands with soap and water or use of alcohol-based sanitiser when soap and water are not available.
ii. Social distancing; keep 1-2 metre distance between each other.
iii. Respiratory etiquette including the appropriate use of masks.
iv. Self-isolation when exposed to COVID-19.
b.    Know your health status.

18. Any additional information would be highly appreciated.
a.    The next few weeks are going to be very tough on the nation as the numbers soar both in case numbers and fatalities. Citizens are encouraged to adhere to infection control and prevention measures.