As of 3 September 2020, Zimbabwe reported 6,678 conﬁrmed COVID-19 cases (vs 4,339 on 5 August; 926 on 9 July; and 287 on 10 June), including 206 deaths (vs 84 deaths on 5 August; 12 deaths on 9 July and 4 deaths on 10 June) since the onset of the outbreak. Of confirmed cases, 75 per cent are adults within the age range 21-50 years, with 45 per cent being female and 55 per cent male. After a decline in weekly incidence risk from 7.6 in week 31 (26 July-1 Augustus 2020) to 3.7 in week 33 (9-15 Augustus 2020), the weekly incidence risk increased to 4.4. in week 34 (16-22 Aug 2020). As of end of August 2020, the five provinces Harare, Bulawayo, Matabeleland South, Midlands and Manicaland account for 85 per cent of all confirmed COVID-19 cases in Zimbabwe.
The main challenges relate to (1) health-care workers, including persistent industrial action by nurses, notice to strike by additional health worker cadres, and increasing number of health workers infected with COVID-19; (2) COVID-19 response, including delayed implementation of national decisions aimed at scaling up community surveillance, contact tracing and community-level isolation facilities, insuﬃcient capacity for hospitalization of moderate-severe ill COVID-19 patients, and delayed placement of orders of essential supplies (lab kits, PPE) including where funding is already available; and (3) delivery of essential health services, with declining coverage of essential services as of end June 2020, and 26 districts out of 63 districts reporting routine immunization coverage with Penta 3 < 80 per cent.
There has been a continued declining access and utilization of essential services including preventive, curative and rehabilitation services, with several provinces reporting decreased access to health services a result of insufficient health workers-industrial action, health workers in isolation/quarantine as a result of COVID-19 infection; insufficient PPE; and the recent institution of user fees in facilities. Several health facilities particularly in urban areas request COVID-19 test results before they can attend to patients.
A HIV update of 26 August indicated a 60 per cent reduction in the number of clients tested for HIV and received their results in Zimbabwe for March-April 2020 compared to the same period in 2019; The number of HIV ST kits distributed declined by 41 per cent during the COVID-19 lockdown era (March-April) compared to the similar period in 2019; 76 per cent reduction in number of VMMCs performed in the visited sites during the COVID-19 era due to closure of VMMCs services in some provinces; 55 per cent reduction in STI clients tested for Syphilis during the COVID-19 lockdown era (Feb-April); The number of pregnant women booked for ANC visits declined by 37 per cent during the COVID-19 era compared to similar period in 2019; Number of newly diagnosed HIV patients declined by 51 per cent during the COVID-19 period (April-June 2020).
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.
Efforts to institute integrated outreach services are in a final stage to address some of the challenges related to the declining access and utilization of essential services, with MOHCC and the case management pillar finalizing plan for a rapid assessment to document the situation in the provinces.
COVID-19 response capacities were scaled up including: (1) National COVID-19 Chief Coordinator overseeing the finalization of multi-sectoral response plan and efforts to strengthen the national COVID-19 response coordination platforms; (2) Laboratory testing: Average daily laboratory tests in week 34 (16-22 August) of 1,337 compared to previous week 33 which was 1,575; Proportion of PCR positive in week 34 was 8 per cent indicating an increase from week 33 which was 5 per cent; (3) Surveillance Performance: At least 80 per cent of alerts investigated in 24 hours were reported in 3 provinces (Bulawayo, Mashonaland East, Masvingo), with at least 80 per cent of all contacts monitored daily reported in the 3 provinces.
As for case management, with insufficient health workers continuing to be a major challenge in terms of making the available renovated infrastructure and clinical equipment in designated HDU/ICU wards fully functional, 96 per cent of confirmed cases were isolated at home, with bed occupancy in isolation wards designated for mild-moderate cases (data as of 23 Aug 2020) including Matabeleland North 2 per cent; Bulawayo 13 per cent; Mashonaland East 10 per cent; and Mashonaland Central 60 per cent. Efforts to consolidate data from the private sector supported COVID-19 centres are ongoing, with inventory of all clinical equipment recently procured/donated including from private sector to support COVID-19 case management. In addition, IPC guidelines are being reviewed/updated to take into account updated global guidance and country-level context, with partners supporting integrated IPC/Case Management training at district level.
National COVID-19 response continues to be strengthened: (1) Public Health priorities including enhancement of surveillance and testing in hotspot districts with highest infection, strengthening the isolation of conﬁrmed cases, reinforcement of lock-down in areas with highest transmission (Bulawayo, Harare); (2) Multisectoral priorities with support for the most vulnerable (food, cash transfers, WASH); (3) COVID-19 resources tracking with GoZ COVID-19 response resources to be posted on a World Bank supported tracking platform/dashboard; (4) Support to health workers with ongoing negotiations to resolve ongoing nurses industrial action.
The increase in local transmission is contributed by: delayed case detection due to gaps in surveillance, contact tracing and quarantine of contacts; gaps in isolation of conﬁrmed cases; and sub-optimal implementation of infection prevention and control practices in health facilities, crowded institutions such as prisons, education facilities.
Priorities include: (1) New MOHCC leadership/GOZ leadership: Advocacy efforts regarding health workers, logistics, PPE, transparency and accountability, remove to barriers to access to care including requirement for COVID-19 testing; (2) Consistency quality of COVID-19 response: Support to pillars and front line responders to document factors contributing to performance of COVID-19 priority activities; Documentation and dissemination of best practices; (3) Laboratory testing: In-depth reviews to address the long delays in release of results; ensure continued attention on regular and reliable inventories and close follow up with supplies ordered but not yet received; (4) Essential health services: Support to timely implementation of proposed rapid assessment to get most updated data; support efforts to address health worker concerns on occupational safety and health