16/07/2020

Country Presentation - COVID-19 Information Session

Ministry of Health

Dr. Daniel NGAMIJEMinister of Health

Republic of Rwanda

Republic of Rwanda

Rwanda: The Land of a Thousand Hills• East/Central Africa – Great Lakes Region

▪ 11.9 million inhabitants▪ Almost 50% population under 18

years▪ ~1.8 million children under 5

▪ 26,338 km²▪ GDP per capita - $826 (2018)▪ Population density – 483 people/km2

▪ Landlocked▪ Majority of export earnings and labor

force attributed to agriculture

Epidemiological situational analysis

COVID-19 response structure (National)

Decentralization of COVID-19 response (Sub-national)

Laboratory capacity

Surveillance and non-pharmaceutical public health interventions

Lessons learnt and health system resilience

Overview

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Date ReportedNew Local Cases New Imported Cases Total Cases

*Total Cases=1,416 (daily median=6)Local=1,021(2)Imported=395 (2)

COVID-19 Local and Imported Cases by Date of Report — Rwanda, July 14, 2020 (N=1,416)

Previous Prevention Measures TakenJan 21 COVID Public Notice (-53 days before 1st case reported)Feb 10 CDC COVID kit arrival/training/validation (-33 d)Feb 12 GOR created COVID Scientific Advisory Group (-31 d)Feb 14 Robert Koch validation/training on German Tib Molbiol kit (-29 d)Mar 6 GOR created official COVID Task Force (-8 d)Mar 8 POE COVID Screening; Public gatherings prohibited (-6 d)

Day 123

Phase 1 lockdown extended until 1 June (13d); quarantine duration shortened; curfew shortened (5am-9pm) by 1hr (day 16P1)

Large gatherings including church prohibited

Schools closed

Airports closed (30d) Masks required when

social distancing difficult (day 28)

Truck driver isolation and testing (day 32)

Phase 1 lockdown lift 4 May-18 May (14d): businesses and buses reopen for essential staff; 5am-8pm movement within provincesallowed (day 1P1)

Phase 2 lockdown lift 3-30 June (14d+15d); national movement and moto taxis allowed; home quarantine of contacts (day 1P2)

District Lockdownin Rusizi/Rubavu/

Nkombo Island (14d+15d)

National lockdown(day 1) until 6

April (14d)

Detention Center A Outbreak(day 27P2)

6 Village Lockdown (day 23P2) inKigali(14d)

Local and Charter Tourism Resumed (day 15P2)

Detention Center B Outbreak(day 38P2)

Transit Center Outbreak(day 34P2)

COVID-19 Case Demographics — Rwanda, July 13, 2020 (N=1,378)

79%

21%

Sex Distribution of COVID-19 Cases

Male Female

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Age Distribution* of COVID-19 Cases

*Age Distribution Summary92% cases <50 years78% cases <40 years49% cases <30 years

Day 122

Estimates of Time Varying R (Rt) — Rwanda, March 14–July 13, 2020 (N=1,378)

*Rt (July 13)=0.99 (0.90-1.10); Rt=time varying reproductive number, expected number of secondary cases arising from a primary case; Rt>1, sustained outbreak likely; Rt<1, outbreak likely to die out

Day 122

Epidemiological situational analysis

COVID-19 response structure (National)

Decentralization of COVID-19 response (Sub-national)

Laboratory capacity

Surveillance and non-pharmaceutical public health interventions

Lessons learnt and health system resilience

Overview

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COVID-19 Task Force Coordination

Command Post

Epidemiology Operations cell

Administration & Logistics cell Communication cell Plans cell

Expert Advisory Team

National Epidemic Preparedness & Response Coordination Committee

(NEPRCC)

COVID-19 National Steering Committee COVID-19 Response Coordination structure

Surveillance Case

Management & Infection Control

Laboratory

Point of Entry Screening

Health Facility & Community Surveillance

Contact tracing & Quarantine

follow up

Data Management

Rapid Response

Team

Infection Prevention

Control

Isolation & treatment

Transport

Equipment & Materials

Infrastructure

Awareness & Community Engagement

Media Management

Rumors Management ( call center)

Current planning

Future plans

Documentation & training

Finance administration

Epidemiological situational analysis

COVID-19 response structure (National)

Decentralization of COVID-19 response (Sub-national)

Laboratory capacity

Surveillance and non-pharmaceutical public health interventions

Lessons learnt and health system resilience

Overview

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Epidemiology & response

Expert Advisory Team

National Epidemic Preparedness & Response Coordination Committee

(NEPRCC)

COVID-19 Coordination Structure : Decentralized | Integrated | Sustainable

Epi surveillance

Case Management &

Infection Control

Point of Entry

Screening

Surveillance & response

Rapid Response

Team

Infection Prevention

Control

Isolation & treatment

Transport

Equipment & Materials

Infrastructure

Awareness & Community Engagement

Security organs

Finance administration

Provincial Command Post (PCP)

District Command Post (DCP)

Epi surveillance

Case managementProvincial Technical Coordinator

Data Science

Partners coordination

National Command Post (NCP)

Laboratory

Sample collection

& transport

Data management

IT solutionsTesting

Administration, logistics & planning

Communication and public health enforcement

District Technical Coordination

Disease detectives

Local government

Laboratory Data science

Epidemiological situational analysis

COVID-19 response structure (National)

Decentralization of COVID-19 response (Sub-national)

Laboratory capacity

Surveillance and non-pharmaceutical public health interventions

Lessons learnt and health system resilience

Overview

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• National Reference Laboratory capacity = > 2500 Samples Tested/Day • Current results turnaround time at National Reference Laboratory = 24-48-hrs • Pooled sample testing is used for large-scale testing events; Pool sizes = 20 samples • Satellite laboratories currently operational (n=8) serving all provinces, with > 1000 Samples Tested/Day • A cohort of discharged patients are tested at 2 weeks, 1 Month, and 3 Months post-discharge to monitor relapse concerns

COVID-19 National Laboratory Capacity & Testing Algorithm

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Percentage Positive Tests Conducted 7 per. Mov. Avg. (Percentage Positive) 7 per. Mov. Avg. (Tests Conducted)

COVID-19 Laboratory Diagnostic Testing — Rwanda, April 7–July 14, 2020 (N=192,379)

Median Daily Tests Conducted = 1,368 Median Tests Conducted per Case = 142Median Percentage Positive = 0.5%

*Tests conducted per million population (tests conducted per positive case) =14,890 (136); Selected African Countries: South Africa: 37,706 (7); Surrounding Countries: Uganda=5,065 (222); Kenya=4,126 (21)

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Day 123

Epidemiological situational analysis

COVID-19 response structure (National)

Decentralization of COVID-19 response (Sub-national)

Laboratory capacity

Surveillance and non-pharmaceutical public health interventions

Lessons learnt and health system resilience

Overview

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COVID-19 Surveillance Strategies

COVID-19 Mass Screening • High-risk occupations (markets, shops,

hotels, bank, coffee shops, etc..)• Drive-throughs and walk-throughs

Active surveillance• Contact tracing • Testing cross-border travelers and

traders

Sentinel surveillance (health facilities)• Influenza like illness (ILI)• Severe Acute Respiratory Infections

(SARI)

Non-Pharmaceutical Public Health measures

Epidemiological situational analysis

COVID-19 response structure (National)

Decentralization of COVID-19 response (Sub-national)

Laboratory capacity

Surveillance and non-pharmaceutical public health interventions

Lessons learnt and health system resilience

Overview

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Lessons from COVID-19 and health system resilience Leadership/governance and Partnership :

• Community trust (Compliance in Lock-down)• Enforcing non-pharmaceutical public health

measures• Multisectoral collaboration ( Police , Loc Gov ..)• Coordination of Partners in response

Access to essential medicines & financing:• Government commitment to provide free services

for COVID-19 testing, quarantine and treatmentHealth information systems:

• Data management tools and innovations duringcase identification, testing, contact tracing, casemanagement (EMR, GIS, RapidSMS)

• Health Workforce : Protection of MoH staff, Use ofRobbots , CHW and Youth Volunteer

Rwanda's health system 1994 - 2019

16/07/2020 18

Main economic activities were affected: Economic recovery strat

Cross-border travel and trade (Clusters of cases -Truck-drivers )

Shortage on market lab reagents for some diagnostic platforms

Lack of effective rapid diagnostic tests ( Antigen based)

Schools re-opening : Constraint in term of accommodation

Quid Covid 19 Home based management of asymptomatic

and mild cases ???

Immediate and long-term challenges

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THANK YOUMURAKOZE CYANE!!