Foreword: Preparedness and response to SARS-CoV-2 in South Africa Foreword

The World Health Organization's (WHO) China Country Office was informed of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China on the 31st of December 2019. On 7 January 2020, the causative pathogen was identified as the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and on 11th of March 2020, the WHO declared a global pandemic. This paper serves as an introduction to a series of research articles which consider South Africa's preparedness and response to SARS-CoV-2.

Risk communication and community engagement-unlocking the key to South Africa?s response to SARS-CoV-2

Background. COVID-19 has changed the way that governments communicate and engage with citizens. In emergencies, effective communication must be immediate, grounded in science, transparent, easy to understand and in language-appropriate messaging delivered through multiple and varied platforms. For the South African (SA) COVID-19 response, the intent was to design an agile, locally relevant Risk Communication and Community Engagement (RCCE) strategy as the pandemic was unfolding and to constantly evaluate its implementation. Early involvement of communities in the formulation and direction of a risk communication plan is essential to its success. Objective. To outline the significance of the RCCE???s robust communication strategy during the COVID-19 response and the lessons learnt in executing the strategy. Methods. This is a qualitative review of documents and reports generated and utilised by the RCCE Technical Working Group (TWG) and reflects the lessons learnt from discussions and multiple engagements at district, provincial and national levels. The review incorporates lessons learnt from international practice, resource documents from the World Health Organization (WHO), RCCE readiness and response to coronavirus disease, feedback from the Behavioural Science Ministerial Advisory Committee, input from the call centre, website and various established social media platforms. Results. Communication and building trust with multiple stakeholders begin before an outbreak and is a prerequisite to facilitate the timeous flow of information, particularly in the context of a rapidly evolving outbreak of a new disease, where the scientific community does not immediately have all the answers. Initial COVID-19 messages were therefore filled with challenges that ranged from the lack of scientific and epidemiological information to rumours, conspiracy theories and misinformation. The findings validate that empowering communities to act, strengthening public trust and community participation using multiple channels as well as timely responses to rumours and misinformation are important drivers of COVID-19 communication efforts in SA. Communication efforts must be accelerated to translate science into locally relevant languages and the impact of interventions must be measured to appropriately direct limited resources. Conclusion. The risk communication strategy incorporated several key lessons that could be used to improve communication and inform future emergency response communication that is immediate, science-based, transparent, inclusive and encourages community participation.

Governing a pandemic: A case study of South Africa?s coordination and management structures used to respond to the COVID-19 pandemic

During a public health emergency, coordination and management are essential for ensuring timeous, decisive, and harmonised leadership. In this paper, the governance structures utilised in South Africa (SA) during the COVID-19 pandemic are recorded and the key strengths and weaknesses of response in the country are discussed. A qualitative methodology is used for the case study and comprises insights from stakeholders who were at the forefront of SA???s response as well as from documentation that was used to guide the response. Structured, transparent, science-based and agile coordination and management systems are necessary to gain the public???s trust during a public health emergency. This case study contributes to the literature on governing a pandemic and shares lessons learned from the COVID-19 response. The lessons learned by the stakeholders within the SA governance structures can be leveraged in future public health emergencies within SA and other low-and middle-income countries.

Parental access to hospitalised children during infectious disease pandemics such as COVID-19.

The COVID-19 pandemic has resulted in many hospitals severely limiting or denying parents access to their hospitalised children. This article provides guidance for hospital managers, healthcare staff, district-level managers and provincial managers on parental access to hospitalised children during a pandemic such as COVID-19. It: (i) summarises legal and ethical issues around parental visitation rights; (ii) highlights four guiding principles; (iii) provides 10 practical recommendations to facilitate safe parental access to hospitalised children; (iv) highlights additional considerations if the mother is COVID-19-positive; and (v) provides considerations for fathers. In summary, it is a child's right to have access to his or her parents during hospitalisation, and parents should have access to their hospitalised children; during an infectious disease pandemic such as COVID-19, there is a responsibility to ensure that parental visitation is implemented in a reasonable and safe manner. Separation should only occur in exceptional circumstances, e.g. if adequate in-hospital facilities do not exist to jointly accommodate the parent/caregiver and the newborn/infant/child. Both parents should be allowed access to hospitalised children, under strict infection prevention and control (IPC) measures and with implementation of non-pharmaceutical interventions (NPIs), including handwashing/sanitisation, face masks and physical distancing. Newborns/infants and their parents/caregivers have a reasonably high likelihood of having similar COVID-19 status, and should be managed as a dyad rather than as individuals. Every hospital should provide lodger/boarder facilities for mothers who are COVID-19-positive, COVID-19-negative or persons under investigation (PUI), separately, with stringent IPC measures and NPIs. If facilities are limited, breastfeeding mothers should be prioritised, in the following order: (i) COVID-19-negative; (ii) COVID-19 PUI; and (iii) COVID-19-positive. Breastfeeding, or breastmilk feeding, should be promoted, supported and protected, and skin-to-skin care of newborns with the mother/caregiver (with IPC measures) should be discussed and practised as far as possible. Surgical masks should be provided to all parents/caregivers and replaced daily throughout the hospital stay. Parents should be referred to social services and local community resources to ensure that multidisciplinary support is provided. Hospitals should develop individual-level policies and share these with staff and parents. Additionally, hospitals should ideally track the effect of parental visitation rights on hospital-based COVID-19 outbreaks, the mental health of hospitalised children, and their rate of recovery.