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Coronavirus disease 2019 (COVID-19) Preparedness in Africa: The Role of African Field Epidemiology and Laboratory Training Programs (FELTPs)

On 7 January 2020, Chinese authorities confirmed that they had identified a new virus known as a novel coronavirus (nCoV) which has since been renamed Coronavirus disease 2019 (COVID-19).  The virus is a new strain of the coronaviruses that has not been previously identified in humans. The outbreak that started in Wuhan city, Hubei province in China has spread to 24 other countries across the world.  According to the WHO Situation report of 16 February 2020, globally 51 857 laboratory-confirmed, China 51 174 laboratory-confirmed, 1666 deaths. Outside of China 683 laboratory-confirmed in 25 countries and 3 deaths. 

On 30 January 2020, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, declared the COVID-19 outbreak a public health emergency of international concern (PHEIC), making it the 6th event for which WHO has declared a PHEIC since the International Health Regulations (IHR) came into force in 2005. Africa has registered a case of COVID-19 in Egypt. 

Field Epidemiology and Laboratory Trainings (FE(L)TPs  play a critical role in  public health emergency preparedness and response in Africa & globally. Since the declaration of the COVID -19 outbreak as a PHEIC by WHO, FE(L)TPs in Africa have stepped up their support and involvement in Preparedness and Response activities within the host Ministries of Health. The African Field Epidemiology Network (AFENET), a networking and Service Alliance of FELTPs in Africa has documented some of the activities undertaken by member programs across sub-Saharan Africa.   

Ethiopia Field Epidemiology and Laboratory Training Program: The graduates and residents are playing a key role in preparedness effort by leading the national Public Health Emergency Operation Center (PHEOC) and as a member of incident management structure for COVID-19. More than six residents are currently placed in the national public health emergency management (PHEM) center PHEOC to support preparedness efforts. In addition, nine of the full time staff in the PHEM center Emergency Operation Center are graduates of the Ethiopia FETP. The graduates are leading the following activities: 1) Overall coordination of the preparedness effort as incident manager 2) country preparedness assessment and regular risk assessment 3) developing emergency preparedness and response plan 4) developing protocols/guidelines for surveillance, points of entry, case management and investigation 5) points of entry surveillance/screening and other related activities 6) case management and infection prevention 7) risk communication and community engagement 8) developing and sharing SITREP to all stakeholders 9) rumor collection, verification and investigation as member of rapid response team 10) epidemiological surveillance and laboratory 11) data management and visualization for informed decision making 12) PHEOC management 13) follow up and 14) capacity building at national and subnational level.

Zewdu Assefa graduate of the EFELTP and Planning Section Chief at the National PHEM COVID - 19 EOC Preparedness and Readiness Unit.

Democratic Republic of the Congo (DRC) FELTP: The FETP has been involved in: 1) development of the national preparedness and  response plan; 2) development of a roadmap for the implementation of planned activities; 3) adoption WHO COVID-19  case definition to the DRC context; 4) investigation of the first suspected COVID -19  case in Kinshasa; 5) setting a daily newsletter for dissemination to ports of entry (PoE); 6) following up alerts and travelers coming from China and 7) orientation of PoE teams on COVID-19  . Three FELTP graduates who are staff of the DRC ministry of health are leading preparedness and response efforts  at national level and these; the Manager Emergency Operations Centre (EOC), the In-Charge of surveillance at the national directorate of surveillance and the Deputy Director for the National Program for Border Hygiene. 

Kenya FELTP: Currently, 10 residents of the K-FELTP have been deployed at Jomo Kenyatta International Airport and Mombasa International Airport to support screening of travelers. The K-FELTP is also involved in evaluation of preparedness at PoEs and supporting coordination at the national EOC.

Mozambique FELTP: The Mozambique FELTP has participated following activities: 1) development of contact tracing forms and flowcharts, 2) FETP graduates have been mobilised to orient rapid response teams targeting provinces with main PoEs, 3) residents developed a research protocol to strengthen surveillance of acute respiratory infections in public and private health services in Maputo City, 4) participating in the ministry of health (MoH) weekly technical meetings, 5). All current residents and most graduates have been mobilised and are available to respond in case the epidemic spreads to Mozambique.

South Africa FELTP: Five residents of the South African Field Epidemiology Training Programme (SAFETP) have been deployed to the EOC to support the following activities: 1) to ensure that health facilities COVID-19   outbreak standard operating procedures, guidelines, and data collection tools have been received and are in use, 2) event-based surveillance (EBS) to monitor the number of cases, number of deaths, and number of countries affected (this information is included in the daily situational report), 3) supporting data capture and data cleaning from persons under investigation (PUIs), 4) capturing and analysis of screening information from the South African Port Health Services, 5) liaising with the national institute of communicable diseases (NICD) communications team to inform them of any necessary changes to the NICD website and social media accounts and 2) participating in weekly operational and data management meetings. In addition to the activities of the SAFETP residents, four recent SAFETP graduates have joined the coronavirus response to support ongoing incident management activities. 

Uganda FETP: The FETP program in Uganda is currently providing technical support at national and local levels. One resident was attached to the EOC to support coordination of preparedness and response activities. The FETP has played a key role in supporting MoH to develop a national response plan for COVID-19. One FETP graduate who is currently employed as Station Manager at the National Aviation Services, based at Entebbe International Airport, provides technical support (on operational strategies) to the screening teams at the airport. Two FETP residents are currently deployed at Entebbe International Airport to support screening of travelers and supervise infection prevention and control. A seminar on COVID-19   has been organized to orient all the residents and the faculty.

Zambia FETP: The Zambia FETP has mobilised all the residents and most of its graduates and they will be available to respond. The FETP residents have been assigned to participate in the following activities at national level: 1) investigation of suspected cases, 2) following up suspected exposed persons for 14 days, 3) providing technical support during the weekly coronavirus meetings 4) reviewing and organising subject expert materials on COVID-19   and coronaviruses in general. Two graduates of the Zambia FETP are currently employed by the Zambia national public health institute (ZNPHI) in the epidemic preparedness and response (EPR) cluster and are leading coordination and planning of COVID-19   response in Zambia. Two residents are placed in ZNPHI (one in EPR cluster and another in the surveillance cluster) and they are actively engaged in preparedness and response activities including development of SOPs/ guidelines and training. 

Zimbabwe FETP: Zimbabwe is one the countries in Africa which receives several travelers from China for reasons such as tourism, business among others. In addition, Zimbabwe citizens also visit China for various reasons including trade. This puts Zimbabwe at a high risk of importation of the ongoing COVID-19   outbreak in China. The Zimbabwe FETP (ZIMFETP) is working closely with the ministry of health and childcare of Zimbabwe to respond the COVID-19 outbreak in the country. On 2 February 2020, the health authorities in Matebeleland North Province received information of 2 employees from a power company who had been isolated with the suspicion that they were infected by the novel coronavirus. A team comprising of Provincial Epidemiology and Disease Control Officer, Provincial Environmental Health Officer, Provincial Health Promotion Officer and a second year resident with the ZIMFETP was sent to Hwange to investigate this rumour and ascertain the existence of a threat of the virus. The team ascertained that the COVID-19   suspected cases were a 27-year-old Chinese national and 30-year-old Zimbabwean (a driver) travelled to Harare on 23 January for a meeting. While in Harare, they met colleagues who had travelled from China. However, it was not established whether these individual who had travelled from china were symptomatic or had visited the epicentre of the COVID - 19 outbreak. On assessment, the two isolated workers were asymptomatic with a normal temperature and had no travel history to an epidemic area nor contact with a confirmed case of corona virus-infected patient. The team concluded that the two individuals are highly unlikely to be infected by the novel coronavirus.

 The building where the suspected cases were isolated