Bulawayo City Council declared a diarrhoea outbreak with more than 1,700 cases and 9 deaths reported as of 22 June. Facing a malaria outbreak with a surge in malaria cases from the beginning of March until the middle of May, this new outbreak creates an additional burden to an already fragile health system.
From 1 January to 7 June 2020, 335,872 malaria cases and 316 deaths were reported (vs 320,606 cases and 307 deaths two weeks ago). According to the latest Weekly Disease Surveillance Report covering the week ending 7 June, a total of 6,600 malaria cases and 6 deaths were reported, in comparison with 12,824 malaria cases and ﬁve deaths reported two weeks earlier, 17,294 malaria cases and 14 deaths the previous week, and 21,072 cases and 19 deaths a week earlier, indicating a signiﬁcant decrease in reported malaria cases during the last six weeks.
In addition, 10 (vs 4 two weeks earlier, and 13 the previous week) new suspected typhoid cases and no deaths were reported during the week ending 7 June from West South West District (9) in Harare Province and Mpilo Hospital in Bulawayo Province. So far in 2020, 642 (vs 624 two weeks earlier) typhoid cases and two deaths have been recorded.
For vaccine preventable diseases, evidence shows a declining routine immunization coverage due to decreased demand/health seeking behaviour; reduced delivery of vaccines and number of outreach services; and lack of conﬁdence of health workers and fear of infection.
As of 24 June, Zimbabwe had reported 530 conﬁrmed COVID-19 cases (vs 287 two weeks earlier), including six deaths since the onset of the outbreak. The national incidence risk as of 20 June was 3.2 per 100,000. Provinces with the highest incidence risk were Bulawayo (6.8), Harare (8.3) and Matabele South (6.3). In the last two epidemiological weeks (from 6 to 20 June), 207 confirmed COVI9-19 cases reported including 175 (84.5 per cent) amongst recent returnees and 32 (15.5 per cent) as a result of local transmission, with 21 of the 32 local cases (65.6 per cent) being known contacts of confirmed cases. A cumulative total of 4,430 contacts were identified, with 1,264 having completed 14 days of daily monitoring while 1,585 were still being monitored daily as of 20 June.
There are close to 2 million patients with chronic non-communicable diseases while 1.2 million people are living with HIV/AIDS in Zimbabwe. This group of people are more susceptible to more severe COVID-19 illness requiring hospitalization and intensive medical care. People with pre-existing chronic illness (including people living with HIV), older persons, women, people with disabilities, older persons, migrants, IDPs and refugees all face risks related to COVID-19, requiring immediate gender-sensitive and age-sensitive action. In addition, people living in urban informal settlements are at increased risk of contracting COVID-19 due to inadequate access to essential health care, clean water and sanitation services and crowded living conditions.
The focus on provision of COVID-19 services has led to a reduction in provision of sexual and reproductive health services. Women cannot access family planning services, and, in some settings, there are shortages of family planning pills, which will have a negative impact on SRHR of women and girls resulting in unwanted pregnancies. Six maternal deaths were reported during the last week from Sally Mugabe Hospital in Harare Province, Mwenezi District in Masvingo Province, Makonde District in Mashonaland West Province, Mutare District in Manicaland Province, Mt Darwin in Mashonaland Central Province and Goromonzi District in Mashonaland East Province.
Delivery of essential health services is being continued in the areas of: 1) Outbreaks: A national Rapid Response Team was deployed to support outbreak response activities following the diarrhoea outbreak in Bulawayo with laboratory tests isolating Shigella and Salmonella pathogens; 2) Integrated campaigns including COVID-19 awareness; Gender Based Violence community dialogue; Menstrual Hygiene Campaign (Bulawayo); COVID-19 and malaria training of Village Health Workers (Mash Central); and patients with chronic Non-Communicable Diseases (NCD) conducting integrated COVID-19 and NCD campaigns (Manicaland); 3) HIV/AIDS: Updated programme guidance with alternative ARV regimens in view of global and national stock-outs of 2nd line ARVs.
Highlights of the recent COVID-19 response in Zimbabwe included: (1) Laboratory testing with improvement in laboratory turnaround time including in quarantine facilities; insufficient supply of GeneXpert cartridges; new guidance on use of RDT use from Africa Centres for Disease Control and Prevention ( Africa CDC); (2) Quarantine Facilities with Inter-ministerial Training of Trainers in management of quarantine centres on 17-18 June 2020; Transition to non-educational facilities; (3) Case management with renovation of identified isolation facilities ongoing in most provinces; (4) Infection Prevention and Control with Training of over 5,000 health workers in 52 districts completed and additional training supported by MSF, FHI360, Africa CDC; and (5) Risk Communication and community engagement including media campaigns and street awareness campaigns.
Conditions associated with the lockdown, extended indeﬁnitely with review every 2 weeks, include: use of screening test (rapid diagnostic tests) for employees resuming work; compulsory use of face masks by all public place; mandatory quarantine for all travellers arriving in Zimbabwe for seven days followed by polymerase chain reaction (PCR) testing and then an additional seven days voluntary quarantine.
Intensiﬁed active surveillance is ongoing with 556 health facilities in six provinces assessed since 28 April 2020; 208 communities identiﬁed with reports of clusters of acute respiratory illness/Inﬂuenza like illness; and Rapid Response Teams (RTTs) assessing identiﬁes clusters and collecting samples from laboratory testing.
Surveillance was intensiﬁed with emphasis in areas with reported border jumpers and escapees from quarantine centres.
Following the recent increase in conﬁrmed cases straining response capacity at provincial/district level, ongoing efforts to strengthen response capacity at provincial, district and community level need to be accelerated, including isolation and quarantine capacity; surveillance, data management and contact tracing capacity; laboratory testing capacity; health worker surge for direct COVID-19 response as well as continued delivery of essential health services.
It is critical that the capacity of the health system to test, isolate and treat all cases of suspect, conﬁrmed and probable COVID-19 cases is enhanced. To this end, there is an urgent need to: increase the number of beds in the health facilities nation-wide for isolation of suspect, conﬁrmed and probable cases; increase availability of medical equipment including ventilators, patient monitors as well as medical supplies and consumables required for the management of cases; increase the availability of laboratory supplies and consumables; increase the availability of personal protective equipment for all health workers involved in the management of cases; increase the capacity to safely refer patients by ambulance.