SARS Interventions in South Africa

The World Health Organisation (WHO) released the Global Health Alert on SARS on 12 March 2003. The National Outbreak Response Team (NORT) within the Department has embarked on implementing the following interventions:

Communication

• The first press statement was released on 18 March 2003, and this was followed up by a series of press statements
• The Presidency, Minister of Health and all the Ministers were informed of the Global Health Alert, and the National Assembly is informed in terms of replies to the parliamentary questions
• The World Health Organisation, Pretoria Country Office, AFRO, and Headquarters were informed of the possible SARS case and were updates on a weekly basis
• Weekly updates on the status of SARS globally and in the country are sent out to the Provincial Outbreak Response Teams (PORT) and Port Health officials
• Weekly updates on the status of SARS are sent to the Minister and members of the National Outbreak Response Team
• A press conference was held at the National Institute for Communicable Diseases, Johannesburg on 9 April 2003
• A meeting was held with the Ambassador from the Chinese High Commission in South Africa
• Radio, television, newspapers and magazine interviews are ongoing on a daily basis
• A report on the status of SARS worldwide and epidemic preparedness was prepared for the MINMEC meeting,
• There is a hotline for the Department, which is useful in answering queries from the public on a daily basis

Guidelines

• SARS Clinical Guidelines for Health Workers
• Port Health Guidelines for Port Health Officials
• Flow Chart for Port Health Officials
• Laboratory Guidelines [NICD]
• Health Alert Notices for Passengers and Physicians
• SARS Fact Sheet for the Public
• lease note that guidelines are updated, as new information is made available.

Information Dissemination

• SARS Clinical Guidelines were distributed to all provinces, for provincial outbreak teams to disseminate to all hospitals within the provinces
• Port Health Guidelines and Flow Charts were distributed to all Port Health Officials in the Provinces
• Health Alert Notices have been distributed to all Port Health Officials responsible for International Airport, harbours and borders
• Laboratory Guidelines have been distributed to all Provincial Outbreak Response Teams
• All the guidelines were published in the Departmental website, www.health.gov.za

Coordination

• Coordination by the National Outbreak Response Team and the Integrated Disease Surveillance and Response Network within NDOH
• The main collaborators are the National Institute for Communicable Diseases (NICD), PORT and Port Health Authorities
• Daily communication with the NICD, PORT, Johannesburg International Airport Port Health Officials, Communication Cluster Manager is ongoing
• Communication with Private Hospital with suspected cases of SARS is ongoing, e.g. Netcare
• Weekly Teleconferences are held with PORT, NICD and Port Health Officials
• Participate in SADC Epidemic Preparedness and Response

Fieldwork

• A visit was made to JIA in order to ascertain the preparedness measures as implemented by Port Health Officials
• A meeting was held with SA Tourism to discuss preparedness strategies, particularly for the “SA Tourism Indaba” to take place on 3-6 May 2003
• A meeting was held with the Gauteng Outbreak Response Team
• A meeting was held with the Limpopo Outbreak Response Team just before Easter as part of preparedness for over 4 000 000 Zion Christian Church pilgrims
• A meeting was held with KwaZulu-Natal Superintendent General for Health, CDC Coordinator, Port Health Manager and Respiratory Infectious Diseases from Nkosi Albert Luthuli Hospital
• The WHO-AFRO was updated on the status of preparedness in South Africa, at the Joint EPI and Integrated Disease Surveillance and Response meeting on 1-2 May 2003 in Johannesburg
• A presentation on epidemic preparedness and response was made in Umtata, Eastern Cape

Collaborating Partners

• NICD
• Provincial Departments of Health
• SA Tourism
• Department of Foreign Affairs
• Netcare
• Afrox
• Hospital Association of Southern Africa [HASA]
• Media

Hospitals\Private and Public

• PORT identified hospitals that will be used for isolation of SARS cases in order to minimise the spread of the outbreak
• Clinical guidelines with an emphasis on infection control and strict barrier nursing had been distributed to all designated hospitals and other hospitals within the provinces
• The probable case died on 29 April and all the 17 contact cases were followed up for two incubation periods, and none had signs and symptoms of SARS
• Infection Control power point presentation have been made available for clinicians

Public Awareness

• Information or fact sheet have been developed and sent out with media releases for public consumption. The fact sheet is available on the Departmental website
• Media (print and electronic) is still the most important tool to reach the public and concerned citizens
• There is no policy, even from WHO restricting passengers from the affected areas into South Africa

PLANNED ACTIVITIES

• Explore availability of other efficient and cost effective screening equipment for use at ports of entry, e.g. temperature strips
• Development of a assessment questionnaire to assist in rapid screening of passengers on incoming flights particularly from countries where local transmission has been reported
• Discuss with provincial health departments on support for Port Health Officials with additional staff to conduct screening
• Explore means for second additional staff to Directorate: Communicable Disease Control to assist with epidemic preparedness and response
• Update the available guidelines and develop new ones focussed on groups, e.g. schools, or institutions
• Improve on community\public awareness
• Encourage PORT to routinely report on status of infection control, particularly in designated hospitals
• PORT should be the focal and lining structure for collaboration between public and private hospital
• The DOH should buy space in the major newspapers in order to enhance public education and provide updates on intervention government is implementing to combat SARS
• Communication with Chinese Health Department to learn from their experiences
• Explore public and private partnership, particularly between hospitals within the provinces
• Approach South African Airways in order to explore the possibility of developing more materials for passengers and advertisements on billboards
• Explore the possibility of implementing SADC outbreak preparedness and epidemic response strategies
• Involve the WHO-AFRO in the implementation of Integrated Disease Surveillance and Response as a long-term solution in the region
• NEPAD
• Request National Treasury to be involved and offer advice with regard to financing some of the preparedness strategies