Emergency Medical Services Festive season contingency plans 

The Department has been inundated with media and public enquiries in the past few days about the emergency medical services and capacity especially as the country enters the festive season, which is associated with high rates of accidents and trauma. 
 
The Emergency Medical System in all provinces have festive season contingency plans which are aligned to Arrive Alive Campaign, Road Safety Awareness led by the Department of Transport. Although, the deployment periods vary within provinces but heightened focus for the 2022/23 Festive Period will be from 14 December 2022 to 20 January 2023.  
 
The associate risks during festive season include Vehicles accidents; Pedestrian vehicle accidents; Domestic accidents; Domestic violence, GBV and femicide; Increased crime; Alcohol poisoning; Risks related to recreational/sporting activities; Drownings; Gang violence and Mass casualty incidents. 
 
We have deployed strategic resources according to the needs and demands of each and every area across the country. These include ambulances; rapid response units; aeromedical services and disaster buses. We have roped in the Private sector EMS in order to augment our current capacity through existing Service Level Agreements. 
 
We will be deploying 1350 ambulances across the country`s major high traffic volume routes  which include N1; N2; N3; N4; N4; N5; N6; N7; N10; N12; N14. The breakdown or allocation of ambulances per province is as follows: Eastern Cape (209); Free State (118); Gauteng (384); KwaZulu-Natal (222); Limpopo (120); Mpumalanga (72); North West (84) Northern Cape (67) and Weston Cape (74).  
 
Measles Outbreak 2022 
 
In terms of the update on the outbreak of measles diseases, a total of 137 cases of laboratory-confirmed measles have been reported from four provinces, as of 11th of October in Limpopo Province up until the 6th of December 2022. 
 
Limpopo and Mpumalanga have reported 89 and 40 cases, respectively. Another outbreak was declared in North West province on the 2nd of December 2022 after three cases were reported. On the 6th of December three cases were reported by Gauteng. The WHO defines a measles outbreak as 3 cases reported in a single district in one month.  

The age of cases or patients across the country range from 2 months to 42 years, the dominant age category of laboratory-confirmed cases is 5-9 year age group which accounts to 56 cases, followed by 1-4 years which accounts to 40 cases and the least affected age group is 0-1 year which suggests that parents do take their babies for vaccination. Of the 137 cases, 98 had an unknown vaccination status, 17 had a history of vaccinated, while 22 were unvaccinated. 
 
The number of measles cases in the country are rising, and so far four out of nine provinces have outbreaks. It is imperative to know the signs and symptoms. Measles patients present with fever, rash, and one or more of these symptoms, cough, red eyes, and runny nose. Complications of measles include pneumonia, diarrhoea, dehydration, encephalitis, blindness and death. 
 
Measles complications are severe in malnourished children and young infants under 2 years of age. Persons of any age who are not vaccinated can be infected and develop the disease. Clinicians and caregivers should be on alert for anyone presenting with the aforementioned signs and symptoms. Road-to-health booklets should be checked to ensure measles vaccinations are up-to-date.  

Provincial and District outbreak teams have been mobilised in line with outbreak response guidelines and have implemented the necessary response measures. Contact tracing and active case search at health care facilities is ongoing, and blood samples from suspected measles cases are being forwarded to NICD for testing. Province-wide measles immunisation campaign have started, Limpopo began on 23 Nov – 15 Dec, targeting children of 6 to 59 months, and Mpumalanga is following suit. The National Mass Measles Immunisation Campaign, supported by the World Health Organisation (WHO) is planned for 06 – 17 February 2023. 

COVID-19  

The country has this week crossed the 38 million mark with vaccine doses administered.  Although the number of COVID-19 cases remains very low around the country, but sub-variants of Omicron continue to be detected at low levels across the country. We continue to record deaths on a weekly basis. COVID-19 vaccination is now integrated into our primary health care services, and we have closed majority of our special vaccination sites. The target remains reaching 70% of adult population with a particular focus on reaching the older persons and the vulnerable groups.  
 
The Department has been receiving enquiries on whether additional COVID-19 vaccine booster doses will be made available to provide ongoing protection against the pandemic, especially for older persons and those who are immunocompromised because they at the highest risk of severe COVID complications. 
 
At the current moment, adults between the ages of 18 – 49 years are eligible to receive a total of three doses, whilst those 50 years and older are eligible to receive four doses. Consideration is being given to an additional booster dose to be offered to both age groups. This will mean that adults aged 18 – 49 years will be eligible to receive a total of four doses, while those 50 years and older will be eligible to receive five doses.  
 
There is little experience of ideal booster intervals and there is a high level of immunity in the community. At this stage the intention is to provide another booster at an interval between the previous and the additional booster dose of a minimum of 180 days (six months). Although, this next booster will be a voluntary dose and not part of a wide community campaign, but the department reminds South Africans that the lifting of restrictions didn’t imply that the pandemic is over. 
 
From early in 2023, all children aged 5 – 11 years living with conditions that place them at risk of severe COVID disease, will be offered vaccination with two doses of the paediatric Comirnaty vaccine, otherwise known as Pfizer vaccine, with an interval of 21 days between the two doses. This will include children with chronic respiratory, heart, neurological, kidney, liver and gastrointestinal conditions as well as those with certain endocrine disorders, conditions associated with immunosuppression and serious genetic abnormalities. 

Progress on Loadshedding exemption of Hospitals

Short-term Interventions
There is work in progress with the exemption of priority hospitals, with 77 hospitals directly supplied by Eskom already exempted. The Department continues to engage with COGTA to assist by facilitating municipalities to fast track their efforts to implement exemption of health facilities receiving electricity directly from municipalities. 

Medium-term Interventions
The preliminary network analysis exercise conducted by Eskom on the exemption of 46 hospitals around the country reveals that additional hospitals can be exempted through building a new infrastructure at the cos of R356 million. While CSIR (Council for Scientific & Industrial Research) is still busy conducting a due diligent exercise for the installation of solar panels at all our health facilities.

Issued by Department of Health, 8 December 2022