The South African government will launch an unprecedented and major military-style operation to safely evacuate at least 151 South Africans who have been stranded in Wuhan, the Chinese city at the epicentre of the coronavirus disease (Covid-19), which may become a global pandemic. The number of those seeking evacuation is rising rapidly.

Strict measures are being taken to ensure evacuees from Wuhan, China do not infect each other, or anyone else, Health Minister Zweli Mkhize, and other ministers and officials emphasised at a media briefing on Sunday, 1 March 2020.

He told Daily Maverick the operation about to be undertaken was “unprecedented” for South Africa. The coronavirus disease (Covid-19) evacuation mission would start within seven to 10 days of the directive which Cabinet gave the government on 26 February 2020 to start preparing to repatriate the South Africans.

The operation is to be led by the South African National Defence Force in cooperation with the Department of International Relations and Cooperation.

A multi-disciplinary medical team will fly to Wuhan to ensure pre- and inflight screening and medical care, Mkhize said. If any of the South Africans did not meet the medical screening requirements, or if they did not wish to go into quarantine for 21 days on arrival in South Africa, they would not be allowed to embark and would be referred back to Chinese health authorities.

There would also be facilities on board the aircraft to isolate any of the evacuees who showed symptoms or tested positive for Covid-19. Other official sources said the aircraft – likely to be a South African Airways passenger jet – would include an isolation area for the evacuees from Wuhan as well as two other specially equipped high-isolation wards to deal with anyone who showed signs of infection in flight.

Once in quarantine – in a so-far secret location – back home, the South Africans from Wuhan would be held under military-like security in a facility guarded by soldiers who would keep others out and prevent the evacuees from leaving.

Mkhize said the South Africans would be flown to an unnamed airport in South Africa and moved into quarantine for 21 days. He said a port of entry had been prepared for their arrival, but would not divulge where it would be. However, he hinted it would be a military base as he said the evacuees would not disembark anywhere they might be able to mingle with civilians.

Mkhize would also not divulge where the South Africans would be quarantined, though there has been speculation it could be in a remote Free State resort. Mkhize underscored that everyone involved in the evacuation operation, including the crew of the aircraft and the government officials involved, would also have to remain in quarantine for 21 days.

He added the government had been able to ascertain that there were approximately 199 South Africans living in Wuhan. Of those, 151 had indicated a wish to be repatriated. These included students who had completed studies and students whose studies were interrupted by the lockdown in Wuhan where the Chinese authorities have imposed severe restrictions on the movements of all residents, to try to contain the spread of Covid-19.

Mkhize said 16 South African citizens in Wuhan had indicated they did not wish to return. Another South African citizen had elected to be repatriated with Indian citizens who were recently evacuated by the government of India.

He added that the government was still trying to locate the remaining South Africans to establish if they also wished to be repatriated. So the number to be evacuated could rise – also because those who had chosen to remain in Wuhan might change their minds. Between the issuing of a statement by the health ministry on Sunday, 1 March about the evacuation and Mkhize’s press conference, the number requesting evacuation rose from 147 to 151. And, during the press conference, one official indicated several more calls had come in from those asking to be repatriated.

Mkhize noted that Pretoria had originally decided not to evacuate the South Africans and had now decided to do so not because of any concerns about their conditions in Wuhan, but because growing numbers of them had requested repatriation.

Pretoria had not changed its mind, he insisted, but had merely responded to the requests of its nationals. He also denied as “mischievous” suggestions that Pretoria had originally decided not to evacuate the South Africans out of diplomatic considerations rather than considerations of the welfare of its citizens. Both the Chinese government and the World Health Organisation (WHO) have advised against evacuation. The Chinese ambassador in South Africa, Lin Songtian has warned that evacuation risks spreading the disease outside China.

Mkize said the government had identified a quarantine facility that met all its requirements. It would have a perimeter line to be strictly guarded by the military to ensure no one either entered or exited the facility, which would be declared a no-entry zone and a no-flight zone.

“No-one will be allowed to enter the zone. There will be a “no-man’s land” strip to accommodate the collection of goods whereby there is zero contact between the deliverers and the collectors,” said Mkhize. “I must reiterate that no family members, friends or associates of those under quarantine may visit the zone.”

Although the government was working on an incubation period for Covid-19 – of 14 days, it had chosen a 21-day quarantine period to allow for arrival and phased exit. Home Affairs Minister Aaron Motsoaledi – a former minister of health – said that although the exact incubation period of the virus was not yet known with scientific certainty, 14 days was the average period of the estimates so far. Mkhize stressed that much was still not known about the virus.

He stressed that, “Legal action will be taken against any individual that goes against the stipulated regulations in relation to quarantine. There will be a medical facility installed as per standard military procedures and the quarantine facility will be collaborating closely with the designated facilities for Covid-19 in the country.

“On arrival, all quarantine members will be briefed and tested and there will be screening done at predetermined intervals. Should someone develop symptoms, they would be immediately isolated for further testing.

“Should the patient test positive for Covid-19, they would immediately be transferred to a designated referral facility.” Several of these have been established around the country, officials said. Mkhize – responding to a journalist who said she had found that two of these facilities seemed to be unmanned – gave the assurance these would be adequately staffed and equipped in time to deal with any needs which arose.

“Should there be multiple cases of coronavirus, the project would be escalated to a multi-isolation system whereby quarantine members would then be confined to their rooms for the entire duration,” Mkhize added.

“For every incident of confirmed coronavirus, the quarantine period starts again at D-Day (or day one).”

He said that if the quarantine period was incident-free, the quarantine would end when all members in quarantine tested negative.

“The members would then be given the final counselling and then granted leave to depart,” though contact would be maintained with them for some time thereafter.

“All affected equipment, venues, facilities et cetera will be subjected to decontamination protocols,” he added. This would include the aircraft, an official underscored.

Mkhize said at this stage, South Africa was only evacuating its nationals from Wuhan and its surrounds in Hubei province though he was aware China had also locked down residents of neighbouring provinces. And the virus had also spread quite far in other countries like South Korea and Iran.

Mkhize also provided an update on the two South African crew members of the Japanese cruise ship Princess Diamond, who had tested positive for Covid-19. The South African government was in direct contact with the two South Africans to monitor their progress as well as with the South African embassy in Tokyo and the Diamond Princess, which was berthed off the coast of Yokohama.

“We have been assured that they are recovering. When they test negative, they will be free to return except those going through quarantine. Thereafter they will return without restrictions.” These are the only two South Africans known to have acquired Covid-19, though Mkhize made it clear that the government was on standby for a possible outbreak, noting that since the virus has already spread to 50 countries, the possibility of it reaching South Africa had to be considered.

He gave the assurance that South Africa was ready to deal with an outbreak. “The South African government has worked hard to optimise our state of readiness with the resources and capability we have in the event that we should have a case of Covid-19.

“The Multisector National Outbreak Response team (MNORT), is responsible for tracking and tracing outbreaks around the world, monitoring and analysis of developments, advising all relevant authorities on the country response to the outbreak and ensuring our state of preparedness.”

He said the National Institute for Communicable Diseases (NICD), had very early on picked up on the Covid-19 outbreak and MNORT had convened twice by the time the WHO announcement was made to ensure that there was a standard operating procedure in place for the early detection, containment and management of a possible outbreak in South Africa.

“This included up-capacitation of our ports of entry to be able to screen incoming passengers, especially those from China and other affected countries and preparing tertiary institutions to be referral centres for the isolation and management of Covid-19 patients as well as to take advantage of their research capabilities.”

Mkhize took strong exception to a question from a journalist who asked whether the fact that so far only three cases had been reported in Africa – in Egypt, Nigeria and Algeria – meant that the incidence of coronavirus on the continent had been “underreported”. That suggestion “cast aspersions” on the capability of African countries to detect the virus, he said. He insisted that the WHO had reported only three cases in Africa and that was the official figure, which should be accepted.

He also responded to a media report that the WHO’s technical officer in Africa, Dr Mary Stephens, had said South Africa and other African countries faced major challenges with regards to preparedness for Covid-19 in the areas of infection prevention, and control and case management.

Mkhize said that Stephens was referring to South Africa’s long-term capacity to deal with the coronavirus. She was not referring to its ability to deal with an emergency in the short term, which he insisted was adequate.

He said a 24-hour clinician hotline had been set up as well as a working hours hotline set up for the public. The Public Hotline number is 0800 029 999 and operates from 8am to 4pm. If South Africa were to confirm a case of Covid-19, the public hotline will convert to a 24-hour hotline. These hotlines have been extremely busy fielding calls from clinicians and the public and a second line has been linked to the clinicians hotline.

Mkhize also appealed to those who might have information about the remaining South Africans in Wuhan – estimated now to be about 34 – to contact the Department of International Relations and Cooperation (DIRCO) at 012 351 1754 and 012 351 1756, [email protected] and [email protected]. DM