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 Range (years)
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!!