NEWS & ANALYSIS

On the evacuation of citizens from Wuhan – Zweli Mkhize

Minister says it is most important to protect safety and dignity of those returning, as well as safety of public

Minister Zweli Mkhize: Evacuation of citizens from Wuhan

1 March 2020

Background:

In December 2019 Chinese authorities announced the emergence of a novel coronavirus that was the causative agent for an outbreak of respiratory disease. It is believed the outbreak originated in a food market in Wuhan City, China. This virus has now come to be known as COVID-19. The symptoms are largely respiratory which can range from mild upper respiratory tract manifestations to respiratory failure, multi-organ failure and death. The mortality rate is around 3% and evidence shows that the vast majority of fatalities are patients who are immunocompromised either due to extremes of age or pre-existing conditions. Whilst there are ongoing studies, there is no proven cure and there is no vaccine.

On 30 January 2020, due to the emerging worldwide spread of the Virus, the World Health Organisation declared Coronavirus a Public Health Emergency of International Concern. This set in motion pre-determined global policy implementation that enables the co-operation of governments, the private sector and multi-lateral organizations to optimize the response to the spread of the virus and ensure its early detection and containment in any territory around the world. This includes the ability to strengthen public health systems in territories that are under-resourced. I would like to take this opportunity to thank the World Health Organisation for the critical leadership provided.

We have been very fortunate that, to date, there is has been no case of COVID-19 in South Africa.

However, as you have now heard, 2 South Africans who were crew members of the Princess Diamond ship tested positive for Coronavirus.

We are in constant contact with our embassy in Japan and the Diamond Princess parked off the coast of Yokohama

Those citizens from the cruise liner are receiving direct contact with our team to monitor their progress. We have been assured that they are recovering. When they test negative they will be free to return except those going through quarantine. Thereafter they will return without restrictions

South Africa’s State of Readiness

The South African Government has worked hard to optimize our state of readiness with the resources and capability we have in the event that we should have a case of COVID-19.

The Multisector National Outbreak Response team (MNORT) is responsible for tracking and tracing outbreaks around the world, monitoring and analysis of developments, advising all relevant authorities on the country response to the outbreak and ensuring our state of preparedness.

The NICD had very early on picked up on the COVID-19 outbreak and MNORT had convened twice by the time the WHO announcement was made to ensure that there was a standard operating procedure in place for the early detection, containment and management of a possible outbreak in South Africa. This included up-capacitation of our ports of entry to be able to screen incoming passengers, especially those from China and other affected countries and preparing tertiary institutions to be referral centres for the isolation and management of COVID-19 patients as well as to take advantage of their research capabilities

On the eve of the WHO announcement I held a press briefing detailing these measures, which included the activation of the Emergency Operation Centre in the event of a WHO public health emergency announcement. When that announcement was made the EOC was immediately activated- many of the media had an opportunity to see the EOC and learn of its inner workings.

A 24 hour clinician hotline was set up as well as a working hours hotline set up for the public. The Public Hotline number is 0800 029 999 and operates from 8.00 to 16.00. If South Africa were to confirm a case of Coronavirus the public hotline will convert to a 24 hour hotline. These hotlines have been extremely busy fielding calls from clinicians and the public and a second line has been linked to the clinicians hotline.

An Inter- Ministerial Committee was formed by the following Ministers:

Health

Defense

Home Affairs

International Relations and Co-operation

Justice

Social Development

Police

This ensures there is co-ordinated collaboration across different departments and each is able to directly respond to specific needs that may be required from it.

Since the outbreak our government has issued daily statements with situational updates for South Africa. As at 26 February 121 people have been tested for Coronavirus and all the results were negative

On the first week of the outbreak the number of citizens wishing to return was negligibly low and contact was a challenge as many SA citizens do not report their whereabouts to the embassy or DIRCO

We must commend DIRCO and the embassy staff as well as Chinese authorities for assisting to locate our citizens in China

We gave a directive that every citizen must be frequently contacted directly personally and their concerns recorded This has enabled government to properly evaluate their needs hence the well informed decision  taken

Earlier government intervened to assist with advices and instances where there were special requirements for medical supplies and concerns of low food supplies

In all instances the Chinese authorities have been helpful and supportive hence we were happy with the condition of our citizens

Many reported challenges in personal resources and anxiety to return home and requests started to increase and government now has identities and precise location of our citizens

Government has prioritized the needs of our citizens

Accusations that the government prioritised diplomatic relations with China and accusations that government is sending mixed messages are ill informed, mischievous and are attempt to create sensation and controversy on a matter that requires single minded focus of all to ensure the safety of all South African citizens.

Decision to Evacuate Citizens From Wuhan/ Hubei

Following the President’s directive for the repatriation of asymptomatic South African citizens in Wuhan City, where the epicenter of the outbreak is, such contingency plans are now being effected as a matter of extreme urgency. We have noted that other areas of China do not represent a high risk for exposure to COVID-19 and so the citizens under lockdown in Wuhan have been prioritised.

We have been able to ascertain that there are approximately 199 South Africans living in Wuhan and, of those, 147 have indicated a wish to be repatriated. Amongst these are students who have completed studies and students whose studies were interrupted by the lockdown.

16 Citizens indicated they do not wish to return. There was also a South African citizen who elected to be repatriated with Indian citizens who were recently evacuated by the government of India.

In response to the plea by our citizens to return home, Cabinet instructed the inter ministerial committee to effect plans to evacuate and repatriate the citizens.

At this stage, through the DIRCO, we are making an effort to locate the remaining thirty-six (36) South Africans in Wuhan.  We are making a special appeal to the families who may have relatives in Wuhan to contact DIRCO at 012 351 1754 and 012 351 1756, [email protected] and [email protected].

The Repatriation Process is implemented in three phases namely Evacuation, Quarantine ad Re-unification. We are guided by the WHO guidelines and the relevant South African laws and policy framework.

I will now go into each phase in a bit more detail:

Evacuation:

This will be an exercise undertaken by the Military in co-operation with DIRCO and Chinese authorities.

All South African citizens from Wuhan City that wish to be repatriated will be accommodated and brought back in a chartered aircraft under strict quarantine protocols that will be enforced.

There will be a Multi-Disciplinary Medical Team on-board the aircraft that will be responsible for pre- and inflight screening and medical care. All nationals that do not meet the Medical Screening Requirements during pre-screening will be referred to the Chinese Health System. A Port of Entry has been prepared for the receipt of RSA Nationals, flight crew and medical team.

All support staff coming into direct contact with the repatriates will also fall into the quarantine protocol

Quarantine:

The very nature of the quarantine exercise is to isolate a group of COVID negative people who have been exposed to a high risk environment, remove them from that high risk environment, and then allow the determined incubation period to lapse before being integrated into virgin society. Human contact and mixing of groups will be limited in the entire process.

A quarantine facility that meets all the requirements has been identified

There will be a perimeter line that will be guarded by the military. Within that perimeter the area will be declared a no entry zone and a no flight zone

Those under quarantine will not be allowed to exit the perimeter but will be allowed to move freely within the perimeter

No-one will be allowed to enter the Zone. There will be a “no mans land” strip to accommodate the collection of goods whereby there is zero contact between the deliverers and the collectors.

I must reiterate that no family members, friends or associates of those under quarantine may visit the Zone.

We plead with the media to respect the boundaries and not make attempts to enter the quarantine zone

Support staff in the facility will also be subject to quarantine protocols

the entire quarantine period will be 21 days duration to allow for arrival and phased exit.

Legal action will be taken against any individual that goes against the stipulated regulations in relation to quarantine.

There will be a medical facility installed as per standard military procedures and the quarantine facility will be collaborating closely with the designated facilities for Coronavirus in the country.

On arrival all quarantine members will be briefed and tested and there will be screening done at predetermined intervals.

Should someone develop symptoms they would be immediately isolated for further testing

Should the patient test positive for Coronavirus they would immediately be transferred to a designated referral facility

Should there be multiple cases of Coronavirus the project would be escalated to a multi-isolation system whereby quarantine members would then be confined to their rooms for the entire duration

For every incident of confirmed Coronavirus, the quarantine period starts again at D- Day ( or day one).
Reunification

Assuming the quarantine period is incident free:

The final day of quarantine is denoted by all members testing negative for Coronavirus

The members would then be given the final counseling and then granted leave to depart

There will be continued contact with the citizens thereafter.

All affected equipment, venues, facilities etc will be subjected to decontamination protocols

Reflection on the State of the Coronavirus Outbreak Worldwide and what the future holds

Whilst it can never be possible to predict what will happen in South Africa if the virus were to be introduced to our territory, it is a useful exercise to survey the current global status and start to formulate projections that can help us guide public policy.

We continue to monitor the development in other countries and are in touch with our embassies

We are concerned that when we first reported this matter  there were 4500 cases reported largely in China. Today the coronavirus has spread to 50 countries world wide with devastating consequences.

We are in touch with and receive twice daily updates from our embassies and authorities in several countries where the infections are rising rapidly.

South Korea has rapidly rising COVID-19 cases-  They have over 2000 cases and 13 deaths. The City of Daegu, 300km from Seoul, is the epicenter.

Iran is an area of concern seeing that they have 141 cases and high mortality of 19

We understand that both Algeria and Nigeria have infections that have no history of travel to China- they seem to have originated from Italy. 

Reports of a death in USA and infection on individuals that cannot record any contact with a known COVID-19 case mean that we are seeing COVID-19 as a disease prevailing in communities with no direct link with China.

We have to get ready as there is no country that has a formula to prevent the coronavirus from infecting its people.

In the long term We have to prepare for readiness for resident coronavirus that may arise in any part of the country- that is the advice from WHO.

Research has to be done to ascertain how soon after the patient is tested negative of COVID-19 does it stop being infectious.

Common experience suggests that once the test is negative there should be no possibility of transmitting the virus.

This point is important as we monitor those who return home after they have contracted and were treated and recovered from COVID-19.

However there are positive developments.

The manner China has managed the outbreak has many lessons for the global community on what works and mistakes to avoid, as they have treated around 80000 patients with proven COVID-19. 

Approximately 32000 have recovered and around 46000 still on treatment and there have been 2900 deaths. Relatively speaking this mortality is relatively low at around 3%.

Furthermore in China the number of recoveries is exceeding the number of new infections day to day and the rate of infection is declining. This points to a very positive picture of a virus that can be managed at both clinical and public policy level.

Conclusion

To conclude, it is important to bear in mind the highly dynamic nature of the global Coronavirus phenomenon. There is no start or end to the work that must be done. There are more robust studies needed and medical precision needs to be sharpened. Our level of vigilance continues to be at the highest level in the wake of the WHO announcement of a Public Health Emergency of International Concern.

We will issue constant situational updates in the form of media statements. We wish to advise that there will be some measure of control as to what information the quarantine members can communicate to the media and on social media platforms as a matter of security and to that end we appeal for co-operation in this regard.

Ultimately we must remember that we are dealing with a group of healthy people who had built lives in Wuhan but found themselves disrupted by an extraordinary situation. As this operation unfolds it is most important to protect their safety and dignity and also public safety. Our citizens have been through a lot already in Wuhan, but they have conducted themselves with incredible stoicism and solidarity with the Chinese, co-operating with Chinese regulation and authority. Their dignified manner of partnering with China and also ourselves through the embassies should set an example and tone for the rest of us to follow as we engage in this process in the interest of public safety.

We have taken note of Countries that have reported increased numbers of Coronavirus cases. We therefore call on all travellers to immediately seek medical attention should you develop symptoms consistent with Coronavirus.

Issued by Department of Health, 1 March 2020