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Covid-19 measures: Mnangagwa bans ‘inessential’ foreign travel, beerhall drinking

By Idah Mhetu

https://www.newzimbabwe.com/covid-19-measures-mnangagwa-bans-inessential-foreign-travel-beerhall-drinking/


PRESIDENT Emmerson Mnangagwa has issued a ban on “inessential travel” outside the country by locals and further banned the taking of alcohol inside bars in his government’s latest attempts to arrest the further spread of the deadly coronavirus in the country.

Zimbabwe has recorded two positive cases of the virus which claimed its first victim on Monday in Zororo Makamba, son to top businessman and politician James Makamba.

Addressing the media at State House Monday evening, Mnangagwa also reduced the number of people allowed to gather in one place at the same time from the initial 100 limit to 50.

The President also moved to issue a blanket ban on “gatherings around night clubs, bars, beerhalls, movie houses, swimming pools, gymnasiums and sporting activities, until further notice”.


“I am aware that this curtailment of social activities will be hard on all of us,” Mnangagwa said.

“However, such tough measures have become necessary and unavoidable for our collective safety as a nation.”

Hospital visits have also been reduced to one visit per day and one relative per person.

In his latest tightening of anti-coronavirus measures, Mnangagwa seemed to be in unison with his opposition rival Nelson Chamisa who told the media earlier the President should start effecting a systematic lockdown of the country in what should include the banning of all incoming international flights with immediate effect.

“It is my humble submission that the country starts implementing a systematic lockdown, a process which is time marked to make sure that we as a leadership take the necessary precautionary measures to also boost up our capacity, our preparedness and of course attend to infrastructural deficiencies that we have to attend to,” Chamisa told journalists.

“We must stop all overseas flights into Zimbabwe with immediate effect. We need all visitors from high risk countries to be put in some kind of mandatory quarantine for a particular period subject to testing and also make sure mechanisms are put in place if there is need for treatment.”




Updated WHO recommendations for international traffic in relation to COVID-19 outbreak


This document provides updated recommendations for international traffic in relation to the COVID-19 outbreak, in light of the rapidly evolving situation. It supersedes the advice published on 27 January 2020.

On 30 January 2020, the Director-General of the World Health Organization, following the advice of the Emergency Committee convened under the International Health Regulations (2005), declared the current outbreak of COVID-19 a public health emergency of international concern and issued Temporary Recommendations. The Committee asked the Director-General to provide further advice on these matters and, if necessary, to make new case-by-case recommendations, in view of this rapidly evolving situation.

Affected areas

“Affected areas” are considered those countries, provinces, territories or cities experiencing ongoing transmission of COVID-19, in contrast to areas reporting only imported cases. As of 27 February 2020, although China, particularly the Province of Hubei, has experienced sustained local transmission and has reported by far the largest number of confirmed cases since the beginning of the outbreak, lately the situation in China showed a significant decrease in cases. At the same time, an increasing number of countries, other than China, have reported cases, including through local transmission of COVID-19. As the epidemic evolves, it will be expected that many areas may detect imported cases and local transmission of COVID-19. WHO is publishing daily situation reports on the evolution of the outbreak.

The outbreaks reported so far have occurred primarily within clusters of cases exposed through close-contacts, within families or special gathering events. COVID-19 is primarily transmitted through droplets from, and close contact with, infected individuals. Control measures that focus on prevention, particularly through regular hand washing and cough hygiene, and on active surveillance for the early detection and isolation of cases, the rapid identification and close monitoring of persons in contacts with cases, and the rapid access to clinical care, particularly for severe cases, are effective to contain most outbreaks of COVID-19.

Recommendations for international trafic

WHO continues to advise against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks.

In general, evidence shows that restricting the movement of people and goods during public health emergencies is ineffective in most situations and may divert resources from other interventions. Furthermore, restrictions may interrupt needed aid and technical support, may disrupt businesses, and may have negative social and economic effects on the affected countries. However, in certain circumstances, measures that restrict the movement of people may prove temporarily useful, such as in settings with few international connections and limited response capacities.

Travel measures that significantly interfere with international traffic may only be justified at the beginning of an outbreak, as they may allow countries to gain time, even if only a few days, to rapidly implement effective preparedness measures. Such restrictions must be based on a careful risk assessment, be proportionate to the public health risk, be short in duration, and be reconsidered regularly as the situation evolves.

Travel bans to affected areas or denial of entry to passengers coming from affected areas are usually not effective in preventing the importation of cases but may have a significant economic and social impact. Since WHO declaration of a public health emergency of international concern in relation to COVID-19, and as of 27 February, 38 countries have reported to WHO additional health measures that significantly interfere with international traffic in relation to travel to and from China or other countries, ranging from denial of entry of passengers, visa restrictions or quarantine for returning travellers. Several countries that denied entry of travellers or who have suspended the flights to and from China or other affected countries, are now reporting cases of COVID-19.

Temperature screening alone, at exit or entry, is not an effective way to stop international spread, since infected individuals may be in incubation period, may not express apparent symptoms early on in the course of the disease, or may dissimulate fever through the use of antipyretics; in addition, such measures require substantial investments for what may bear little benefits. It is more effective to provide prevention recommendation messages to travellers and to collect health declarations at arrival, with travellers’ contact details, to allow for a proper risk assessment and a possible contact tracing of incoming travellers.

Recommendations for international travellers

It is prudent for travellers who are sick to delay or avoid travel to affected areas, in particular for elderly travellers and people with chronic diseases or underlying health conditions.

General recommendations for personal hygiene, cough etiquette and keeping a distance of at least one metre from persons showing symptoms remain particularly important for all travellers. These include:


  • Perform hand hygiene frequently, particularly after contact with respiratory secretions. Hand hygiene includes either cleaning hands with soap and water or with an alcohol-based hand rub. Alcohol-based hand rubs are preferred if hands are not visibly soiled; wash hands with soap and water when they are visibly soiled;
  • Cover your nose and mouth with a flexed elbow or paper tissue when coughing or sneezing and disposing immediately of the tissue and performing hand hygiene;
  • Refrain from touching mouth and nose;
  • A medical mask is not required if exhibiting no symptoms, as there is no evidence that wearing a mask – of any type – protects non-sick persons. However, in some cultures, masks may be commonly worn. If masks are to be worn, it is critical to follow best practices on how to wear, remove and dispose of them and on hand hygiene after removal (see Advice on the use of masks)

As for any travel, travellers are also advised to follow proper food hygiene practices, including the five keys for food safety, as well as recommendations to reduce the risk of transmission of emerging pathogens from animals to human in live markets.

Travellers returning from affected areas should self-monitor for symptoms for 14 days and follow national protocols of receiving countries. Some countries may require returning travellers to enter quarantine. If symptoms occur, such as fever, or cough or difficulty breathing, travellers are advised to contact local health care providers, preferably by phone, and inform them of their symptoms and their travel history. For travellers identified at points of entry, it is recommended to follow WHO advice for the management of travellers at points of entry. Guidance on treatment of sick passengers on board of airplanes is available on ICAO and IATA websites. Key considerations for planning of large mass gathering events are also available on WHO’s website. Operational considerations for managing COVID-19 cases on board of ships has also been published.

For countries which decide to repatriate nationals from affected areas, they should consider the following to avoid further spread of COVID-19: exit screening shortly before flight; risk communication to travellers and crew; infection control supplies for voyage; crew preparedness for possibility of sick passenger in flight; entry screening on arrival and close follow-up for 14 days after arrival. (WHO recommendations to reduce risk of transmission of emerging pathogens from animals to humans in live animal markets)

General recommendations to all countries

Countries should intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia and monitor carefully the evolution of COVID-19 outbreaks, reinforcing epidemiological surveillance. Countries should continue to enhance awareness through effective risk communication concerning COVID-19 to the general public, health professionals, and policy makers, and to avoid actions that promote stigma or discrimination. Countries should share with WHO all relevant information needed to assess and manage COVID-19 in a timely manner, as required by the International Health Regulations (2005).

Countries are reminded of the purpose of the International Health Regulations to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. Countries implementing additional health measures which significantly interfere with international traffic are required to provide to WHO, within 48 hours of implementation, the public health rationale and relevant scientific information for the measures implemented. WHO shall share this information with other States Parties. Significant interference generally means refusal of entry or departure of international travellers, baggage, cargo, containers, conveyances, goods, and the like, or their delay, for more than 24 hours.

WHO continues to engage with its Member States, as well as with international organizations and industries, to enable implementation of travel-related health measures that are commensurate with the public health risks, are effective and are implemented in ways which avoid unnecessary restrictions of international traffic during the COVID-19 outbreak.



Key considerations for repatriation and quarantine of travellers in relation to the outbreak of novel coronavirus 2019-nCoV


On 30th January 2020, the WHO Director General has declared the outbreak of novel coronavirus 2019- nCoV as a Public Health Emergency of International Concern (PHEIC), based on the advice of the Emergency Committee under the International Health Regulations (2005).1 Following that determination, WHO did not recommend any travel or trade restrictions, based on the current information available.

Evidence on travel measures that significantly interfere with international traffic for more than 24 hours shows that such measures may have a public health rationale at the beginning of the containment phase of an outbreak, as they may allow affected countries to implement sustained response measures, and non-affected countries to gain time to initiate and implement effective preparedness measures. Such restrictions, however, need to be short in duration, proportionate to the public health risks, and be reconsidered regularly as the situation evolves.

Countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO. In accordance with their obligations under the Article 43 of the International Health Regulations (2005), States Parties must inform WHO about additional health measures that significantly interfere with international traffic.

For countries that have decided to repatriate their nationals from Wuhan City, Hubei province, the following key considerations need to be made, in order to ensure the health and wellbeing of those involved in the repatriation. In addition, measures aimed at bolstering national preparedness capacities to prevent the further spread or importation of 2019-nCoV before, during, and after repatriation need to be considered.


Measures to be adopted before embarkation


  • Advanced bilateral communication, coordination, and planning with the responsible authorities before departure.
  • The aircraft should be properly staffed with sufficient medical personnel to accommodate the number of nationals anticipated, and that they are outfitted with appropriate PPE and equipment/supplies to respond to illness en route.
  • The non-medical crew of the aircraft should be properly briefed and outfitted, as well as aware of the signs and symptoms to detect symptomatic passengers for nCoV.
  • Exit screening, for example temperature measurement and a questionnaire, should be conducted before departure for the early detection of symptoms. Screening results should be shared with the receiving country.
  • It is advised to delay the travel of the suspected ill travellers detected through exit screening to be referred for further evaluation and treatment.
  • On 30th January 2020, the WHO Director General has declared the outbreak of novel coronavirus 2019- nCoV as a Public Health Emergency of International Concern (PHEIC), based on the advice of the Emergency Committee under the International Health Regulations (2005).1 Following that determination, WHO did not recommend any travel or trade restrictions, based on the current information available.

Evidence on travel measures that significantly interfere with international traffic for more than 24 hours shows that such measures may have a public health rationale at the beginning of the containment phase of an outbreak, as they may allow affected countries to implement sustained response measures, and non-affected countries to gain time to initiate and implement effective preparedness measures. Such restrictions, however, need to be short in duration, proportionate to the public health risks, and be reconsidered regularly as the situation evolves.

Countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO. In accordance with their obligations under the Article 43 of the International Health Regulations (2005), States Parties must inform WHO about additional health measures that significantly interfere with international traffic.

For countries that have decided to repatriate their nationals from Wuhan City, Hubei province, the following key considerations need to be made, in order to ensure the health and wellbeing of those involved in the repatriation. In addition, measures aimed at bolstering national preparedness capacities to prevent the further spread or importation of 2019-nCoV before, during, and after repatriation need to be considered.

Measures to be adopted before embarkation

  • Advanced bilateral communication, coordination, and planning with the responsible authorities before departure.
  • The aircraft should be properly staffed with sufficient medical personnel to accommodate the number of nationals anticipated, and that they are outfitted with appropriate PPE and equipment/supplies to respond to illness en route.
  • The non-medical crew of the aircraft should be properly briefed and outfitted, as well as aware of the signs and symptoms to detect symptomatic passengers for nCoV.
  • Exit screening, for example temperature measurement and a questionnaire, should be conducted before departure for the early detection of symptoms. Screening results should be shared with the receiving country.
  • It is advised to delay the travel of the suspected ill travellers detected through exit screening to be referred for further evaluation and treatment.

Onboard the Aircraft

  • The seating location of passengers inside the aircraft should be duly noted/mapped in case a passenger begins to display symptoms, so they can be isolated, and to furthermore take note of those in the immediate vicinity (ex: those within same row, and two rows in front and two rows behind) for the needed follow up upon arrival.
  • In case suspected cases are detected on the aircraft, the cabin crew should inform and seek advice from a ground-based medical service provider at the point of entry of arrival through the control tower. In cases of severe illness, the pilot in command may consider diversion for the unwell passenger to the nearest point of entry receive the required treatment.

In the event of a respiratory illness en route, the following immediate steps may be taken to reduce exposure and limit transmission to other passengers or aircraft crew2:

  • Designate one dedicated cabin crew member to look after the ill traveller, preferably one who has previously interacted with the passenger;
  • Use appropriate personal protective equipment (PPE) when dealing with symptomatic patients (medical or surgical mask, hand hygiene, gloves);
  • In all cases, the adjacent seat(s) of the patient should be left unoccupied, if feasible;
  • Passengers seated in the close vicinity should have their information on itinerary and contact details recorded for further follow up, as potential contacts, using a Passenger Locator Form3. This information may be collected on a voluntary basis for the remaining passengers;
  • The patient on the aircraft should adhere to respiratory/cough etiquette either by wearing a medical or surgical mask (if available and tolerated) or the patient could contain his cough or sneeze by using disposable tissue. If the patient cannot tolerate a mask, healthy travellers adjacent to the ill traveller may be offered masks;
  • Practice hand hygiene (hand washing or hand rub);
  • Handle any blankets, trays or other personal products used by the patient with respiratory symptoms carefully;
  • In case of presence of spills (vomits, blood spills, secretions or others), practice environmental cleaning and spills-management;
  • Handle all waste in accordance with regulatory requirements or guidelines;
  • Notify the health authority at the point of arrival. The health part of the aircraft general declaration (Annex 9 of IHR) can be used to register the health information onboard and submit to point of entry health authorities, when requested by the country;
  • Ensure the flight crew maintain continuous operation of the aircraft’s air recirculation system (HEPA filters are fitted to most large aircraft and will remove some airborne pathogens, depending on the size of the particulate or microorganism).

Upon arrival at the Point of Entry

  • Entry screening: temperature screening alone may not be very effective as it may miss travellers incubating the disease or travellers concealing fever during travel, or it may yield false positive (fever of a different cause). If temperature screening is implemented, it should be accompanied with:
    • Health messages: Dissemination of health messages and travel notices informing persons on signs, symptoms and where to seek medical support if needed.
    • Primary questionnaire: Development and use of forms to collect information on symptoms, history of exposure and contact information.
    • Data collection and analysis: Establishment of proper mechanisms for collection and analysis of data generated from the entry screening for the rapid evaluation and response.

Suspected cases detected at arrival

  • Personnel and supplies: Trained personnel should be available for the early detection and initial evaluation of cases and equipped with the needed supplies.
  • Interview and initial management: A separate space should be designated for the initial assessment of suspected cases and the interview of contacts.
  • Fast track pathway and transport: A separate pathway should be delineated to rapidly refer suspected cases to the designated hospital/facility for further evaluation to avoid contact with the other passengers. Arrangement for safe transportation of suspected cases to the designated hospital/facility should also be in place.
  • Contingency plan: A functional public health emergency contingency plan at point of entry should be in place to respond to public health events.
  • Disinfection of the Aircraft: In accordance with the aircraft make and model, usage of preferred cleaning chemicals and methods should be consulted to properly disinfect the aircraft. A segregated space at the PoE and trained personnel should be available to clean the aircraft after disembarking passengers.

Non-suspected passengers’ arrival into the country

  • Risk communication: Prepare countries to communicate rapidly and transparently with the population and ensure the involvement of media to support the spread of the right messages and avoid rumours4. Countries should communicate with their public early and effectively to mitigate stigma or discrimination and avoid panic, in line with the principles of Article 3 of the IHR.
  • Health measures: If there is evidence of an imminent public health risk from the arriving passengers, the country may, in accordance with Article 31 of the IHR and in alignment with its national law, deeming the extent necessary to control such a risk, compel the traveller to undergo additional health measures that prevent or control the spread of disease, including isolation, quarantine or placing the traveller under public health observation. In the absence of an established quarantine law, countries should ensure emergency contingency protocols to support quarantine.

Quarantine

If the country decides to put arriving passengers, those not displaying symptoms, in a quarantine facility, the following needs to be considered, in accordance with Article 32 of the IHR:

  • Infrastructure: there is no universal guidance regarding the infrastructure for a quarantine facility, but space should be respected not to further enhance potential transmission and the living placement of those quarantined should be recorded for potential follow up in case of illness.
  • Accommodation and supplies: travellers should be provided with adequate food and water, appropriate accommodation including sleeping arrangements and clothing, protection for baggage and other possessions, appropriate medical treatment, means of necessary communication if possible, in a language that they can understand and other appropriate assistance. A medical mask is not required for those who are quarantined. If masks are used, best practices should be followed5.
  • Communication: establish appropriate communication channels to avoid panic and to provide appropriate health messaging so those quarantined can timely seek appropriate care when developing symptoms.
  • Respect and Dignity: travellers should be treated, with respect for their dignity, human rights and fundamental freedoms and minimize any discomfort or distress associated with such measures, including by treating all travellers with courtesy and respect; taking into consideration the gender, sociocultural, ethnic or religious concerns of travellers.
  • Duration: up to 14 days (corresponding with the known incubation period of the virus, according to existing information), may be extended due to a delayed exposure.

Personnel

Health Care Workers: trained personnel should be assigned for the observation and follow up of these passengers in the quarantine facility. These health care workers should be equipped with the basic PPEs and commodities needed to deal with the suspected cases (medical/surgical masks, gowns, gloves, face shields or goggles, hand sanitizers and disinfectants). Additional commodities are needed for surveillance, lab and clinical management of the 2019-nCoV6. Additionally, they should be trained on case definitions, infection prevention and control measures, and the initial management of suspected cases to perform the following interventions7:

  • Active surveillance: to identify suspected cases;
  • Isolate suspected cases and ensure safe transport: strictly adhere to infection prevention and control (IPC) measures and social distancing procedure to prevent potential spread of the infection to others;
  • Collect laboratory samples: to test for the 2019-nCoV in the national reference laboratory or international laboratories in the absence of the lab testing capacity;
  • Manage cases clinically: Identify ambulances and designated health facilities to refer cases to for the necessary isolation, treatment and follow up. Adhere to strict IPC measures to prevent the spread of the infection among health care workers or other patients;
  • Trace contacts: to identify other potential cases within the quarantine facility, test, isolate and treat as necessary. Extend and adapt quarantine period to correspond to the incubation period of the delayed exposure;
  • Share data: on the number and description of cases with WHO using the WHO reporting forms and in accordance to Article 6 of the IHR.

Other Support Staff: personnel responsible for administrative work and cleaning service should also be trained and properly briefed on signs and symptoms of the disease and provided with appropriate PPEs, as needed.