Reduction in the isolation period for patients with confirmed covid-19 infection
Media statement by Dr Zwelini Mkhize
Tonight we wish to inform South Africans that the recommended isolation period for patients with confirmed Covid-19 infection is reduced from 14 to 10 days.
This recommendation is based on evidence that most patients with a mild Covid-19 infection continue to shed the virus from their upper airways for approximately 7-12 days. Furthermore, the presence of detectable virus when testing does not necessarily imply infectiousness. It has been proven that in mild cases, virus cultures are generally only positive for 8-9 days after symptom onset.
The duration of infectiousness in patients with severe disease (i.e. requiring admission due to clinical instability) is less well established. In general, patients with severe disease may continue to shed virus at higher levels for
longer periods than patients with mild disease. To provide a buffer, it is recommended that such patients be de-isolated 10 days after clinical stability has been achieved, rather than 10 days after symptom onset. To illustrate this in simple terms, if a patient was admitted and placed on oxygen, we advise that when they oxygen supplementation is discontinued, the patient must remain in isolation for another 10 days. This continued isolation provides clinical comfort that the patient is no longer infectious.
Asymptomatic patients represent a conceptual challenge, since it is not possible to estimate where in the course of viral shedding they are at the timepoint at which they test positive. We therefore advise that an asymptomatic patients must remain in isolation for a period of 10 days following the date of their positive results.
I must mention that these guidelines have been provided by the World Health organisation. The Ministerial Advisory Committee has also submitted an advisory in this regard. Their advisory proposed that the isolation period should be reduced to 8 days. After considering this advice and the guidelines by the WHO, the National Coronavirus Command Council, on recommendation by Health, resolved to adopt the WHO guidelines.
After consulting WHO and the chairperson of our Clinician Subcmmitte of the Ministerial Advisory Committee Professor Marc Mendelson with due regard to the hard they have put into this recommendation, whilst we understand the basis of the recommendation we will initiate engagements with our experts and those of the World Health Organisation to take this discussion forward.
The Ministerial Advisory Committee has also done further work that relates to supporting health workers who are have been exposed to an infection. This matter is being processed.
The figure below therefore provides a summary of the revised recommendations:
The recommended isolation time is the period during which a patient is still considered infectious. This should be distinguished from the point at which a patient is medically well enough to return to work. Some patients, especially those who have had severe disease, may require to be booked off sick for longer than the above isolation periods.
For a guide to the management of staff in healthcare and laboratory settings with Covid-19 exposure, please consult the document at the following link: https://sacoronavirus.co.za/wp-content/uploads/2020/07/9_2020-V4-14-4-2020-Guidance-for-symptom-monitoringand-management-of-essential-staff-with-COVID-19-related-illnessfinal-for-approval.pdf
Presentation of the National Department of Health Track and Trace System
In the past few weeks some members of the public may have received SMS’s from the Department of Health giving them vital information, which may have included receiving their test results or an alert that they have been identified as a contact of a COVID-19 positive patient. These message also prompt the user to provide further information on their condition in order to determine what clinical assistance and attention they require.
One of the critical aspects of combatting COVID-19 is the ability to detect positive cases early, track and trace their contacts, and refer them for appropriate management, whether it is immediate testing, isolation or
The digital system that the department of Health is currently using, called COVIDConnect, brings an easy-to-use self-service portal to your cellular phone. It is freely accessible through WhatsApp and SMS. What also makes it more accessible is that it does not require for a user to have a smart phone but it works on any mobile phone.
This system enhances the physical effort of contact tracking and tracing which is done by our community health workers and volunteers. It automates this traditional process and continuously engages with the affected user.
To explain the process further the system works as follows:
When a patient tests for Coronavirus, the information is picked up from the lab form and informs the patients of the test result, whether positive or negative, by SMS. If the result is positive, the system prompts the patient for further information in order to identify their contacts. The system then immediately dispatches alerts via SMS to those contacts without disclosing the index patient’s details and prompts them on the next steps to take. The nondisclosure of the patient’s name is to ensure that their privacy is protected and also to make sure that after a contact details are made available that person’s privacy is also protected.
In addition, the system can geo-locate the nearest quarantine and isolation facility for the user and the nearest health care facility for patients or their contacts who are experiencing symptoms requiring medical attention.
Users can also get the latest COVID-19 news and information, prevention tips and wellness advice at the touch of a button. There is also a simple riskassessment tool which will screen users for COVID-19 symptoms and give them advice on whether they should self-isolate or seek professional clinical assistance.
We are pleased to announce that since the system went live in June it has yielded some positive results. Between June 28 and July 15, it has dispatched 674 380 SMSes to users nationwide and relayed 326 522 test results. 39,463 users have engaged with the service- BUT THIS IS NOT ENOUGH. The surge of this pandemic requires all citizens to participate in such innovations. As an individual, at home or at work, once you receive this SMS we urge that you take it upon yourself to appropriately respond as prompted. We believe that this method will significantly enhance contact tracing and allow for us to quickly identify cases that we would not easily trace.
We also want to inform the public that this track and trace service will not infringe people’s privacy or data. In fact, one of the reasons we delayed to implement the system was to ensure that that it passes the legal muster and adheres to legal prescripts relating to personal information, confidentiality and individual and data privacy. In this regard the National Department of Health held a productive consultation with Madame Justice Kate O’Reagan, who is the COVID-19 designate judge. Her guidance assisted the Government to
establish regulation on how to implement the track and trace system.
We take this opportunity to acknowledge the entities that the department of health has partnered with, namely Telkom/ BCX, GovChat, Praekilt and BlueBird.
To access COVIDConnect, just add ‘0600123456’ to your phonebook and say ‘hello’ to us on WhatsApp. If you do not have a smartphone, just dial *134*832# and follow the prompts.
When you test for COVID-19, supply your healthcare worker with your correct date of birth, physical address and cellphone number. You can then use COVIDConnect to retrieve your test results via your cellphone or you will receive an SMS once your test results are ready.
To receive your results on WhatsApp, just add ‘LetsTalk’ to your phonebook on ‘0820468553’. Type in ‘Results’ on WhatsApp and follow the prompts. We look forward to many of our people taking part in this track and trace system.