Recent amendments to Department of Health directions reduce the isolation period for Covid-19, provide new definitions and set out the criteria government will use to determine different alert levels
On 17 July 2020, the Minister of Health announced changes to the isolation and quarantine periods. The minister recommended that the isolation period should be reduced from 14 days to 10. However, at the time of the announcement, these changes were not gazetted into law. Almost one month later the changes have finally been gazetted into law together with a number of other noteworthy provisions. These changes are reflected in new amendments to existing directions issued by the Department of Health. Notably, the Directive on Occupational Health and Safety
has not yet been amended and employers remain bound by the time periods set out in that directive relating to employees returning to the workplace. We expect that this Directive will be updated in due course to align with these amendments.
New definitions added
The following definitions have been inserted into the directions:
|"Asymptomatic person" means a person who is Covid-19 positive but is not showing any symptoms associated with Covid-19 || ||"Symptomatic person" means a person who is Covid-19 positive and shows or experiences symptoms of Covid-19 || ||"De-isolate" means to release a person from isolation or to no longer require a person to be isolated from others || ||"Fever" means a temperature of above 38 degrees celsius |
A symptomatic person who tests positive for Covid-19 with mild disease (ie the person does not require hospitalisation) must isolate for a period of 10 days from symptom onset.
Such a person may de-isolate 10 days after symptom onset provided that -
- The person no longer has a fever.
- All other symptoms have improved.
A person with moderate or severe disease may de-isolate 10 days after recovery (ie when the person no longer requires additional oxygen and is clinically stable). The directions do not indicate who must make the determination on clinical stability. We presume that this would be the treating medical practitioner.
An asymptomatic person who tests positive for Covid-19 may de-isolate 10 days after the day of the positive test result. It is important to note that the person may de-isolate 10 days after the day of the positive test result and not 10 days after the day the test was actually undertaken.
The directions are silent on whether an individual should self-quarantine between the day of the test and receiving the test result. We presume that an individual should self-quarantine during that period.
The directions confirm that repeat testing is not a requirement in order for a person to de-isolate.
Separate directions on area-specific alert levels
The Minister of Health recently published separate directions on the criteria that will be used by government to determine alert levels.
As we have seen already, alert levels determine the level (or extent) of restrictions to be applied during the national state of disaster.
Alert Level 1 |
- Low Covid-19 spread with high health system readiness
Alert Level 2|
- Moderate Covid-19 spread with high health system readiness
Alert Level 3|
- Moderate Covid-19 spread with moderate health system readiness
Alert Level 4|
- High Covid-19 spread with low to moderate health system readiness
Alert Level 5|
- High Covid-19 spread with low health system readiness
The Ministerial Advisory Committee (MAC) appointed by the Minister of Health is responsible for advising the Minister on which alert level should be declared nationally and provincially as well as in a specific metropolitan areas or districts.
The directions provide that the MAC must take into account the following factors in determining which alert level should apply -
- epidemiological trends of Covid-19 infections (which includes a consideration of the trends in number of tests conducted, persons screened, positive cases, recoveries and the demographic profile of positive cases)
- the health system's capacity in a specified area to respond to the disease burden (this will include a consideration of the number of facilities available to support Covid-19, bed-occupancy levels, human resource capacity, equipment and related resources)
- any other factor that would influence level of infection, hospitalisation and mortality
Given the changing epidemiological trends of Covid-19 across the different provinces in South Africa, we may see area-specific alert levels being introduced by government in the coming weeks.