AFRICA CDC GUIDANCE FOR ASSESSMENT,

MONITORING, AND MOVEMENT RESTRICTIONS

OF PEOPLE AT RISK FOR COVID-19
Dr. Djoudalbaye Benjamin
Head of Policy and Health Diplomacy at Africa CDC
22 February 2020
We need to be absolutely clear about definitions

Quarantine usually involves 3 different

issues
Quarantine
means separating a ▪ Movement restriction: Do we tell the
HEALTHY person who is at person to stay in their home, in a
NO
risk of infection quarantine facility, or somewhere else?
symptoms
▪ Monitoring: When the person is in their
home or in a quarantine facility, how do
we monitor them for symptoms that may
with indicate infection?
SYMPTOMS
Isolation ▪ Enforcement: Do we use legal orders to
means separating an ILL restrict person’s movement and monitor
person who may be infected them? What do we do if they violate
these legal orders?

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Africa CDC has drafted guidance for how to manage people at risk for contracting
COVID-19

Why we need this guidance Goal for today’s discussion:

▪ Discuss and agree on Africa

▪ People are returning to Africa from areas with CDC guidance for quarantine
COVID-19 outbreaks e.g., China related to COVID-19
▪ More cases are likely to occur in Africa, and we need
to know how to manage contacts of infected persons
▪ Quarantining contacts MAY help reduce transmission
in communities
▪ Member States are asking for detailed guidance about
how to manage these situations

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Africa CDC’s guidance is for people who have been exposed to other people who have
been diagnosed with COVID-19

Persons can be divided into three risk levels Consider for

quarantine

A
A person with no COVID-19 symptoms*, but is a
known contact of a COVID-19 confirmed case or
“High Risk” has spent time in a healthcare facility with a COVID-
19 case in the previous 14 days.

B
A person with no COVID-19 symptoms*, but has a
“Some Risk” history of being in China or another COVID-19
outbreak area

C
“No Known A person that is neither “High Risk” nor “Some Risk”
Risk”

*Persons who classify as High Risk / Some Risk who are also experiencing COVID-19 symptoms should be considered a “Person Under Investigation”
and immediately lab tested and treated in a healthcare facility under proper clinical care and infection prevention and control protocols 4
Ask people about their contact with a confirmed case, exposure to a health facility, and
their travel history to outbreak areas

Person Under
Investigation
Does the Yes (PUI)
person have Immediately place
COVID-19 mask on person,
Is the person: symptoms? No isolate in a private
Does the
A Person Under room in a health
person develop
▪ A known Investigation facility, perform
COVID-19
contact of a Yes “High Risk” (PUI) laboratory test for
symptoms Yes
COVID-19 COVID-19
within 14 days
confirmed case
of quarantine? ▪+ If person tests
positive, treat and
OR No
C
manage person
under IPC and
▪ Someone who “No Known clinical
has spent time Person Under Risk” management
in health facility Investigation guidelines
No Does the (PUI)
with a COVID-19 Yes ▪- If person tests
case in the last person have
Does the COVID-19 negative, treat
14 days? person have No B
Yes symptoms? symptoms, monitor
history of and continue
being in China “Some Risk”
quarantine until 14
or another days are over
COVID-19 No
outbreak area?
C
“No Known
Risk”

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Quarantine procedures should vary depending on the person’s risk of developing
COVID-19
Risk exposure Movement restriction Monitoring Enforcement

A
▪ Home. Do not leave home for any ▪ Health officer checks at least ▪ Ask the person to restrict
reason other than medical one time per day via phone or in movement voluntarily.
High Risk
necessity or safety. person. ▪ Consider legal order if concerned
▪ Person also monitors their own about compliance.
health and reports any symptoms
of COVID-19.
B
▪ Home. Do not leave home for any ▪ Person monitors their own ▪ Ask the person to restrict
reason other than medical health and reports any symptoms movement voluntarily.
necessity or safety of COVID-19.

OR
Some Risk ▪ Permitted to leave home. Must
avoid congregate settings, public
transportation, and any other
situation where a person could
likely infect others

C
No Known
▪ None ▪ None ▪ None
Risk
Above guidance lays out the minimum requirements. Member states may choose to
implement more stringent measures for perceived higher risk cases or if country has
sufficient resources to do so without infringing on human rights and human dignity
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Scenario #1: Repatriation of an African student without any symptoms from China
SYMPTOMS
+
CONTACT OF HEALTH
#
FACILITIES

An African student lands in Student undergoes airport
Addis Ababa from China on screening and shows no
March 1. symptoms of COVID-19.
Student doesn’t develop any
COVID-19 symptoms and is
released from quarantine.
Public health officer at airport informs
student about:
▪ COVID-19 symptoms
▪ How to contact a healthcare
facility or medical officer if
symptoms occur
Public health officer obtains
contact details of person and at
least 2 relatives or close
contacts
X

Student develops fever at home

and calls public health officer.
Public health officer asks
student to remain at home and
sends an ambulance to pick
her up for isolation and testing
Student quarantines at home. Student is asked to restrict
at a health facility.
movement to home until March 15.

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Scenario #2: Close contact of a confirmed case
On March 5, a confirmed case lists
Person A as a close contact (last
contact on March 1) and shares
Person A’s contact details.
SYMPTOMS + Public health officer
CONTACT OF HEALTH
FACILITIES ▪ Informs Person A about COVID-19
symptoms and how to contact a
health facility or medical officer if
# symptoms occur
▪ Obtains contact details of Person
A and at least 2 relatives or close
contacts
X ▪ Asks Person A to restrict
Public health officer contacts Person A movement to home until March
▪ Asks about nature of contact with 15 (14 days from last contact with
confirmed case confirmed case)
▪ Confirms that person meets
definition of a “contact”

?
X

[POSSIBLE OUTCOME]: Person A is

Officer informs his superior of the
then taken to a state run quarantine
situation. Superior reviews and
facility and released after 5 days
evaluates country’s quarantine laws
upon showing no symptoms.
and legal enforcement approaches.
On March 10, officer visits but
Person A quarantines at home.
Person A is nowhere to be
Once every day, officer visits Person A to
found. Officer calls Person A, but
check on adherence to quarantine and any
he is unreachable.
symptoms.
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This guidance provides the minimum quarantine procedures
for people at risk of COVID-19.

We developed this guidance by considering the need to

effectively manage outbreak risk, the need to treat people
with respect and dignity, our experience with quarantine
related to Ebola, and the capacity of the public health
systems in most African countries.

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Frequently Asked Questions

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Should people have a laboratory test for COVID-19 before being permitted to enter my
country?

No. Laboratory testing should only be performed on people who meet the case definition for a
suspect case, including symptoms of COVID-19 and a history of exposure to COVID-19.

Testing people without symptoms creates several problems:

1. Wastes precious resources (diagnostic kits, health worker time etc.)
2. Can overwhelm laboratory capacity very quickly (as is happening in some countries).
3. May also provide false reassurance the person has no risk of COVID-19 (i.e., if the patient is
in the incubation phase, the test could be negative if the virus is not present in the airway yet)

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What do we do with people who are “some risk” or “high risk” that refuse to stay at
home or are known to have left their home for a non-emergency situation?

Countries and sub-national jurisdictions have different laws regarding quarantine and personal
liberties. Africa CDC recommends that countries:
1. Review laws regarding quarantine of healthy (uninfected) people
2. Consider what legal authority exists to enforce movement restriction and mandate
monitoring
3. Develop alternative settings for people who do not have a safe and stable home and for
people who do not comply with their movement restriction

Based on above, health officials will need to decide whether to restrict

movement to a place other than home, i.e., a quarantine facility,
taking into account several considerations including availability of
individual rooms, sufficient quality of facilities, funding and
personal requirements e.g., religious rituals, allergies

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Should health officials decide to restrict movement to a place other than home – a
dedicated quarantine facility?

Past experience from Ebola teaches us that this reduces willingness of people to tell the truth
and comply, and becomes very difficult to manage when the number of contacts grows.

However, countries can choose more restrictive measures based on their resources and
perceived risks. If this route is chosen, countries need to consider the following questions:

1. Group quarantines: Are there individual rooms for each person? People have different levels
of risk. Mixing people together can increase the likelihood of secondary transmission. If no
individual rooms are available, then people need to be kept >1m apart at all times.

2. Facility availability: Are there facilities to ensure health, hygiene, sleep, and safety?
3. Facility quality: Is there funding and personnel to supply food, water, toiletries, and other
social and cultural necessities?

4. Facility accommodations: Are the facilities able to accommodate individual-specific

requirements, such as religious rituals, physical disabilities, and/or allergies?

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What are the costs of quarantine on persons and health systems?
▪ Loss of personal income and/or job
▪ Inability to obtain food, medicine, or essential household supplies
Impact on the
▪ Psychological stress from social isolation and stigma
person being
quarantined ▪ Transmission of infection to other household members given more
prolonged time spent indoors
▪ Worsening of other medical conditions that require attention
▪ Decreased willingness of people to report their travel and contacts
▪ Decreased willingness of those named as contacts to truthfully verify
Impact on the
▪ Decreased willingness of people named as contacts to report symptoms
health
system ▪ Cost of monitoring persons
▪ Cost of paying for food, medicine, household supplies, and/or income for
people restricted to their homes

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Will COVID-19 spread if people violate quarantine?

Not necessarily. For disease to spread, you need several events to happen at the same time:

1.
1 Person has a high likelihood of acquiring COVID-19

AND

2.
2 Person develops symptoms or is infectious while violating the quarantine

AND

3.
3 Person has close contact with others while infectious

AND
4.
4 Others are infected and cannot be isolated

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