FREQUENTLY ASKED QUESTIONS

Surveillance definition:

For epidemiological/ surveillance purposes and to standardize reporting, the following simple definition of recovered should be used:

A person with probable/confirmed COVID-19 is known to be alive and 14 days have elapsed since diagnosis (for asymptomatic), onset of symptoms (for mild cases) or clinical stability/ supplementary oxygen stopped (for moderate-severe cases in hospital)

Note – For practical purposes, this surveillance definition does not specify resolution of fever and improvement of symptoms at the time of de-isolation or return to work. Repeat PCR testing is not required as a surveillance criterion for recovery.

For purposes of comparison:

Clinical definition:

“Recovered” is not specifically mentioned or defined in the Guideline for clinical management of suspected or confirmed COVID-19 disease (version 4).

However, the following criteria are specified for de-isolation of a person with RT-PCR-confirmed COVID-19:

  1. Asymptomatic patients: 14 days after initial positive test
  2. 14 days after the onset of their symptoms for cases of mild disease (this is defined as SpO2≥95% and respiratory rate <25 and heart rate <120 and temperature 36-39°C and mental status normal)
  1. 14 days after achieving clinical stability (e.g. after supplemental oxygen was discontinued) for cases with moderate-severe disease
  2. Patients who are still symptomatic at the end of their isolation period can be de-isolated provided that their fever has resolved and their symptoms have shown
  3. It is not necessary to repeat PCR testing in order to de-isolate a

Occupational health definition:

Similar criteria are applied to employees who are confirmed as COVID-19 cases before they can return to work. This is outlined in the DOH guideline for symptom monitoring and management of essential workers for COVID-19 (version 1).

Employees can return to work:

  1. 14 days after symptom onset for cases of mild disease
  2. 14 days after clinical stability (e.g. after oxygen stopped) for cases of severe disease
  3. Note: PCR testing is not required for return to work (exception: if a person remains asymptomatic in quarantine after a high-risk exposure to a confirmed COVID-19 case, a PCR test should be done when assessing the employee for early return to work on day 8 post- exposure).

Human coronaviruses are common throughout the world. The name corona refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43 and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognized in China in 2002. On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19). The majority of the case-patients initially identified were dealers and vendors at a seafood, poultry and live wildlife market (Huanan Seafood Wholesale Market) in Jianghan District of Hubei Province. This suggests that the novel coronavirus has a possible zoonotic origin. The specific source of the virus is not yet known.

As there is community transmission of SARS-CoV-2 in South Africa, all South Africans are at risk of infection with SARS-CoV-2 (illness called COVID-19). There are areas of the country where local transmission of the virus may be occurring at higher rates than other areas. Daily updates are available on www.nicd.ac.za and www.health.gov.za. People who have been in contact with a confirmed case of COVID-19 are at an increased risk of infection and disease.  In addition, healthcare workers have an increased risk of acquiring infection in the workplace. The elderly and individuals with co-morbidities, such as heart disease (including high blood pressure), chronic respiratory diseases, cancer patients, endocrine diseases (such as diabetes), have been found to be at a higher risk of severe illness and mortality associated with COVID-19. Information can be accessed at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.

Transmission of the virus is via respiratory droplets, similar to how influenza and other respiratory pathogens spread. When a person infected with COVID coughs or sneezes, they release droplets of infected fluid. Larger droplets fall on nearby surfaces for example tables, counters in shops, seats in cars/taxi etc. If you touch these surfaces the virus may transfer to your hands, then to mouth, nose or eyes when you touch your face.  People may also be infected by breathing in droplets if standing with 1m of infected person.  You cannot become infected through your skin. 

People who develop symptoms of respiratory illness including cough, sore throat, fever and shortness of breath should seek medical care early. Additional groups who are at risk include contacts of a confirmed case as well as healthcare workers in facilities where COVID-19 patients are being treated or where people are admitted to hospital with pneumonia of unknown cause. The guidelines for who is at risk and should be tested for SARS-CoV-2 are frequently updated as the global and local situation change. The latest guidelines for who should be tested can be found at this link https://www.nicd.ac.za/wp-content/uploads/2020/04/COVID-19-Quick-reference-v12-09.04.2020_final-1.pdf

Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with any or all of the following:  fever, cough, fatigue, shortness of breath, myalgia (muscle pain), arthralgia (sore joints), headache, chills or sore throat. Gastrointestinal symptoms such as nausea and vomiting are less common. Anosmia (loss of sense of smell) and dysgeusia (alteration of the sense of taste) have also emerged as relatively common and early symptoms. The severity of illness can range from people who are infected without any illness (asymptomatic infection) to mild respiratory illness, to severe illness requiring admission to hospital or death. The majority of patients (approximately 80%) will have mild respiratory illness.

COVID-19 is diagnosed by a laboratory test, polymerase chain reaction (PCR) molecular test, on a respiratory tract sample (e.g. sample from nose, throat or chest). This test detects the SARS-CoV-2 genetic material.  For specific guidance on who should be tested as well as sample collection and transport please visit the NICD’s website https://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-resources/

Treatment is supportive (e.g. provide oxygen for patients with shortness of breath or treatment for fever). There is no specific antiviral treatment available. Antibiotics do not treat viral infections. However, antibiotics may be required if a bacterial secondary infection develops. There are some studies in progress using different medications that may have some effectiveness against the virus. Updates on the progress of available treatment is available on the NICD webpage https://www.nicd.ac.za/wp-content/uploads/2020/03/Clinical-Management-of-COVID-19-disease_Version-3_27March2020.pdf

Currently there is no vaccine for COVID-19. There are no specific measures currently recommended to prevent COVID-19 but the following can provide protection against infection with coronaviruses and many other viruses that are more common in South Africa:

·  Practice physical distancing, this means keeping a physical distance of at least 2 metres from all people you interact with, specifically when out in public. This keeps you safe from respiratory droplets.

·  Practice social distancing, this means not interacting with people outside of your household unless necessary.

·  The use of a cloth mask (not medical mask as these are need for health care workers) may help protect you and people around you. Please look at the recommendation for these masks.

·  Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer (at least 70% alcohol).

·  Avoid touching your eyes, nose, and mouth with unwashed hands.

·  Cover your cough or sneeze with a flexed elbow or a tissue, then throw the tissue in the bin.

·  Avoid close contact with people who are sick.

·  Stay at home when you are sick and try and keep distance from others at home.

·  Clean and disinfect frequently touched objects and surfaces.

A countrywide lockdown started on 26 March for 21 days and extended to 35 days, the aim of this lock down is to flatten the infection rate curve. This means spreading infection rate over a longer period of time rather than a large number in a shorter period of time. This is to give healthcare facilities a chance to treat people needing treatment.

Other strategies to minimise the impact of COVID-19 on South Africa includes actively testing as many people with symptoms as possible. The Department of Health is also doing community based screening in certain areas where there are potentially large number of infected people. Both these strategies help to identify and isolate infected people, protecting their families and the community. 

There are guidelines how the patients should be isolated while awaiting test results and after they test positive. This can be found on https://www.nicd.ac.za/diseases-a-z-index/covid-19/advice-for-the-public/what-to-do-if-i-test-positive-for-coronavirus-disease-and-i-am-asked-to-home-isolate%e2%80%8b/.  Please keep in contact with your health care provider telephonically to monitor your progress. 

The main test used to diagnose COVID-19 is a polymerase chain reaction (PCR) test, which detects the genetic material (RNA) of SARS-CoV-2, the virus which causes COVID-19.

If you test positive then it means that genetic material of the virus was detected in your sample, which is normally a sample collected from your nose or throat and confirms a diagnosis of SARS-CoV-2 infection. A negative test does not exclude an infection with SARS-CoV-2, as your test result depends on when your sample was collected and the quality of the sample that was collected.

The amount of virus in your body (called the viral load) changes during the course of an infection, starting from low levels which increase over a few days and then start to decrease towards the later stages of infection. How long you have the virus for (called viral shedding) depends on many factors such as your age, whether you have an underlying condition and how severe your disease is. Viral shedding is generally detectable around 2-3 days before the onset of symptoms and tends to decrease after about 7 days from the onset of symptoms.

Although the PCR test is a very sensitive test, there is no test that is 100% sensitive and so if you are tested very early in your infection, and the viral loads in your body are low then the test may not detect the virus. However, if tested later in infection, when viral loads are higher, your test may change to positive. Similarly, if you are tested towards the end of the infection, your test result may change to negative.

The test result is also affected by the type and quality of the sample that is collected. If a poorly collected sample is tested, then it is possible that not enough clinical material was collected from you and your test result will be negative when you are infected. If your clinician suspects a false-negative result, they will request that a repeat sample is collected to be re-tested.

If your COVID-19 test result changes on repeat samples, it does not mean that a laboratory error was made but could reflect that the viral load has gone down or could be due to poor sample collection.

At present the country is on lockdown; one of the conditions of lockdown is no internal or international travel.

Visit the NICD website at www.nicd.ac.za for further information. For medical/clinical related queries by health care professionals only, contact the NICD hotline at 0800 111131. The NICD General Public Hotline number is 0800 029 999. All lines operate 24 hours a day.

Guidelines and case definitions are available on the NICD website https://www.nicd.ac.za/wp-content/uploads/2020/04/COVID-19-Quick-reference-v12-09.04.2020_final-1.pdf https://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-guidelines/

The government has a number of helplines and call centres through which you can get information about services and programmes. These are available at https://www.gov.za/about-government/government-call-centres-and-help-lines

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