I, Dr Zwelini Lawrence Mkhize, the Minister of Health hereby, in terms of regulation 10(1)(a) of the Regulations issued in terms section 27(2) of the Disaster Management Act, 2002 (Act No. 57 of 2002), published in Government Gazette No. 43107, Government Notice No. R318 of 18 March 2020 ("the Regulations"), issue directions to address, prevent and combat the spread of COVID-19 in South Africa.
In these Directions, a word or expression bears the same meaning assigned to it in the Disaster Management Act, 2002 and the Regulations.“Human Remains Regulations” means the regulations made under section 68(1)(b) read with section 90((4)(c) of the National Health Act, 2003 (Act No. 61 of 2003) and published in Government Notice No. R. 363 of 22 May 2013;“PPE” means personal protective equipment.
2. Recruitment and training of human resources
(1)Additional health personnel should be recruited or seconded and deployed in strategic areas (points of entry, surveillance, case investigation, laboratory service, mortuaries, quarantine sites, etc.) for the purposes of addressing, preventing and combating the spread of COVID-19.(2)The recruitment process in relation to critical COVID-19 related posts should be shortened by advertising a post and effecting appointments within a period of a week, on condition that an appointment may be set aside depending on the outcome of personnel suitability checks and verification processes. Special technical skills required to support the Department and enhance capacity on short term basis can be recruited in line with COVID emergency acquisitions processes.(3)Enable urgent secondment of officials as may be required within a week.(4)All health personnel (in the three spheres of government both public and private) must be trained on COVID-19 for the effective and efficient management of this pandemic including management of mortal remains.
3. Deployment of human resources
(1)All health authorities should identify where there is a need for deployment of health personnel to respond to this pandemic irrespective of their areas of jurisdiction or area of responsibility.(2)All health personnel should be available for deployment to identified sites such as quarantine facilities and any other areas that require health services for rendering these health services.
4. Sourcing of human resources from the expanded public works programme, retired health professionals, community based organisation and non-governmental organisations to render services in identified sites
(1)All retired health personnel, community services personnel, extended public works programme workers, community based organisations and non-governmental organisations may be requested to fill in positions on a temporary basis to assist in responding to the pandemic.(2)All authorities should engage with non-Governmental organisations and individual retired health professionals to consider assisting government in rendering services in identified sites.(3)All health authorities in the three spheres of government should liaise with the Department of Public Works and Infrastructure or relevant agencies for the purposes of sourcing expanded public works programme workers to support the fight against COVID-19.
5. Provision of health equipment, sanitation materials and medical supplies
(1)All health authorities should endeavour to source and provide health equipment, sanitation material and medical supplies to various sites as may be required to respond to the COVID-19 outbreak.(3)Personnel should be trained on the use of the above items including personal protective clothing.
6. Disposal waste and sanitation of equipment from quarantine or treatment facility
(1)All waste from a quarantine facility must be isolated and classified as high risk medical waste and must be incinerated at the approved waste site.(2)All waste inside the quarantine facility must be isolated prior to being disposed of and handled.(3)All equipment used in the quarantine facility must be sterilised first before it can be used again.
7. Identification and establishment of mortuaries that will accommodate all COVID-19 mortal remains
(1)All Metropolitan and District Municipalities must identify suitably authorised mortuaries with valid certificates of competence for the accommodation of all COVID-19 mortal remains and further management.(2)All Provincial Departments of Health must identify suitable government mortuaries that will accommodate COVID-19 mortal remains and determine their capacity.(3)All the above information should be submitted to the National Department of Health within 48 hours of the date of the publication of these directions for the attention of the Chief Director: Environmental Health and Port Health Services.(4)All government mortuaries and designated private funeral undertakers should, when handling COVID-19 mortal remains, adhere to the Regulations relating to the Management of Human Remains promulgated under section 68(1)(b) read with section 90((4)(c) of the National Health Act, 2003, (Act No.61 of 2003) and published in Government Notice No. R363 of 22 May 2013 ("Human Remains Regulations").(5)All persons handling COVID-19 human remains should wear suitable personal protective clothing at all times and should practice good personal hygiene such as washing hands with soap and water and using personal protective clothing.(6)No person should at any given time handle the human remains with bare hands including kissing.
8. Disposal of COVID-19 mortal remains
(1)The handling, transportation and final disposal of COVID-19 human remains should be conducted in adherence only to chapters 5 and 6 of the Human Remains Regulations.(2)All persons handling COVID-19 human remains should wear suitable personal protective clothing at all times.(3)All persons handling COVID-19 human remains should practice good personal hygiene such as washing hands with soap and water and using personal protective clothing.(4)No person may at any given time handle the human remains with bare hands including kissing.(5)Metropolitan and Local Municipalities should ensure that the burial or cremation of COVID-19 mortal remains takes place in suitably approved cemeteries and crematoria, respectively.
8A. Handling of mortal remains¹ : general
(1)The handling, transportation, importation, exportation and final disposal of COVID-19 mortal remains should be conducted only in accordance with chapters 4, 5 and 6 of the Human Remains Regulations.(2)All persons handling COVID -19 mortal remains should wear suitable personal protective clothing at all times.(3)All persons handling COVID-19 mortal remains should practice good personal hygiene such as washing hands with soap and water and using personal protective clothing.(4)No person may at any given time make contact with, or touch, the mortal remains without wearing the appropriate PPE.(5)Metropolitan and Local Municipalities should ensure that the burial or cremation of COVID-19 mortal remains takes place in suitably approved cemeteries or crematoria, respectively.(6)Metropolitan and District Municipalities should ensure that they identify areas that may be utilised for mass burial should the need for same arise.¹ Mortal remains has similar meaning as "human remains".
8B. Handling of mortal remains in mortuaries or at funeral undertakers
(1)The act of moving a recently deceased patient onto a hospital trolley for transportation to the mortuary might be sufficient to expel small amounts of air from the lungs and thereby present a minor risk.(2)A body bag should be used for transferring the body to the mortuary and those handling the body at this point should use full PPE.(3)The outer surface of the body bag should be decontaminated immediately before the body bag leaves the ward or anteroom area and may require at least two individuals wearing such protective clothing, in order to manage this process.(4)The trolley carrying the body must be disinfected prior to leaving the ward or anteroom.(5)Prior to leaving the ward or anteroom, the staff members must remove their PPE.(6)Once in the hospital or private mortuary, it would be acceptable to open the body bag for family viewing by family members (one at a time) only (mortuary attendant must wear full PPE) at the mortuary. Family must be provided with masks and gloves for the viewing and should not touch the body with bare hands.(7)Washing or preparing of the mortal remains is allowed provided those carrying out the task wear PPE such as gloves, masks and waterproof coverall and all PPEs used must be disposed of immediately. However, the washing and preparing of the mortal remains by family members is not encouraged due to the health risks.(8)Mortuary staff and funeral directors must be advised by the Environmental Health Practitioner of the biohazard risk.(9)No washing is allowed out of the mortuary or funeral undertaker’s premises.(10)If the family wishes to dress the body, they may do so at the funeral undertaker's premises prior to the body being placed in the body bag and those carrying out the task should wear PPE such as gloves, masks and waterproof coverall apron and all PPEs used must be disposed of immediately.(11)If a post mortem is required, safe working techniques should be used and full PPE should be worn.(12)In order to avoid excessive manipulation of the body, embalming is not recommended, however, if embalming is undertaken, the embalmer should wear full PPE.(13)After use, empty body bags should be cut and disposed of as health care risk waste.(14)After use, the reusable empty heavy duty body bags must be treated in terms of existing procedures.
8C. Measures when a person passes on at home
(1)In the event that a person infected with COVID-19 dies at home, family members must not, at any stage, handle the body. An EMS must be called immediately to confirm death before removal by an undertaker.(2)The belongings of the deceased person should be handled with gloves and cleaned with a detergent followed by disinfection with a solution of at least 70% ethanol or 0.1% (1000 ppm) bleach.(3)Clothing and other fabric belongings of the deceased should be machine washed with warm water at 60-90°C (140-194°F) and laundry detergent.(4)If machine washing is not possible, linens can be soaked in hot water and soap in a large drum using a stick to stir and being careful to avoid splashing.(5)The drum should then be emptied, and the linens soaked in 0.05% chlorine for approximately 30 minutes. Finally, the laundry should be rinsed with clean water and the linens should be allowed to dry in full sunlight.
8D. Conveyance of infectious mortal remains
(1)The mortal remains of a COVID-19 patient may not be conveyed in public in any way unless-(a)such remains are placed in a polythene bag, sealed in an airtight container, placed in a sturdy non-transparent sealed coffin, embalmed and the total surface of the body is covered with a 5 cm layer of wood sawdust or other absorbent material which is treated with a disinfectant;(b)a medical practitioner declares, in writing, that in his or her opinion the conveyance of such mortal remains will not constitute a health hazard; and(c)the body is transported in an authorised vehicle designated and certified to transport mortal remains.(2)No person other than an attending medical practitioner, an attending forensic pathologist or a medical practitioner who can prove that he or she has treated the deceased during illness, may certify that the person did not die of an infectious disease, a certificate or declaration that a person did not die of an infectious disease must-(a)accompany the mortal remains at all times during the conveyance and up to the burial; and(b)be shown to an Environmental Health Practitioner on demand, by the person responsible for the conveyance of the mortal remains.(3)No person may-(a)damage a polythene bag or a sturdy non-transparent sealed coffin;(b)open such bag or coffin;(c)remove the mortal remains from the bag or coffin; or(d)come into direct contact with the mortal remains after the bag or coffin has been sealed.
8E. Prohibition of viewing and storage of body at home
A funeral undertaker must deliver the mortal remains on the morning of burial and not the night before the burial and must ensure that the remains are not touched during viewing.
8F. Environmental cleaning and control
(1)The mortuary must be kept clean and properly ventilated and illuminated at all times.(2)Surfaces and instruments should be made of materials that can be easily disinfected as prescribed in the Human Remains Regulations.(3)Surfaces, where the body was prepared, should first be cleaned with soap and water, or a commercially prepared detergent solution. After cleaning, a disinfectant with a minimum concentration of 0.1% (1000 ppm) sodium hypochlorite (bleach), or 70% ethanol should be used to disinfect.
8G. Disposal of mortal remains: burial or cremation
(1)Cremation is highly recommended where a person has passed on due to COVID-19.(2)A burial or cremation of the mortal remains of a person who died of COVID-19 must be carried out in terms of the Human Remains Regulations.(3)(a)Burial services should be as short as possible but may not exceed two hours in order to minimise possible exposure.(b)Mourners should observe physical distancing during and after the burial service.(4)Only close family members should attend a funeral service of a person that died of COVID-19 or of other infectious disease.(5)For the purposes of protecting the health of the mourners at a burial service, a COVID-19 patient should not attend a burial service irrespective of his or her relationship with the deceased.(6)Those tasked with placing the body in the grave, on the funeral pyre, etc. should wear gloves and wash hands with soap and water once the burial is complete.
8H. Disposal of mortal remains in high risk situation
(a)The mortal remains may not be kept for more than three days at the mortuary.(b)Government may intervene where mortal remains are not claimed within two days.(c)Should the death rate appear to exceed the capacity of available space to keep mortal remains, the Government may intervene to facilitate mass burials.(d)District and Metropolitan municipalities should identify land that can be used for mass burial should a need arise.(e)Municipalities should ensure that a mass burial is done in consideration of human dignity and necessary controls should be put in place to ensure that mortal remains can be identified.(f)Machinery (for digging and closing of graves) can be used if deemed fit to prevent further spread of the virus and when hand tools are used during digging and closing the grave, the tools must be sanitised.(g)People carrying the coffin must wear disposable hand gloves which must be disposed of properly.
8I. Burial of non COVID-19 mortal remains
(1)A mortuary or an undertaker must not keep the mortal remains for more than ten days from the date of death.(2)Non COVID-19 mortal remains must be buried or cremated within ten days from the date of death.
8J. Persons returning
(1)All persons arriving from outside of the Republic through any port of entry will be subjected to screening and mandatory quarantine for a minimum period of 14 days in designated quarantine facilities.(2)In addition to screening, a person may be subjected to medical examinations to ascertain whether he or she is considered to be a suspect case for COVID-19.(3)Persons placed under quarantine will be subjected to testing and daily screening by health personnel.
8K. Aircraft or ship crew
A crew member allowed to disembark, irrespective of circumstances, will be subjected to screening and mandatory quarantine for a minimum period of 14 days or until such crew member is due to embark, board or depart for international travel at the employer’s cost.
8L. Designation of quarantine facilities
The National Department of Health, provincial departments of health, the Department of Public Works and Infrastructure and Municipalities must collaboratively allocate and designate quarantine facilities which will be under the management of the provincial departments of health which must provide, amongst others, the following:(a)Primary health care services including test swabs and supporting medical services;(b)Environmental health services;(c)Emergency medical services;(d)Forensic pathology services;(e)PPEs; and(f)Appropriate receptacles for the collection of medical waste including used PPE and the appropriate disposal thereof.
8M. Transport to and from quarantine facilities
(1)Transport to the quarantine facility must be provided by the designated quarantine facility.(2)Transport from the quarantine facility at the end of the quarantine period, must be facilitated by that individual or his or her family.(3)Transport from the quarantine facility where a crew member or traveller is due to embark, board or depart for international travel, will be facilitated by the designated quarantine facility.
8N. Cost of quarantine
Where exceptional circumstances make it necessary for the mandatory quarantine of a person returning to the Republic to take place in a manner which involves the incurring of additional costs beyond those ordinarily incurred as a result of mandatory quarantine, the Director General: Health may direct that such person is to pay the additional costs concerned.
8O. Evacuation of foreign nationals
(1)All foreign nationals evacuated from South Africa must be subjected to exit screening at the point of exit prior to boarding any conveyance which will be used for such evacuation.(2)Foreign nationals found to have an elevated temperature or symptoms consistent with COVID-19 will be subjected to a medical examination which may include testing and will not be allowed to board the conveyance.(3)Such persons may be subjected to mandatory quarantine at own cost for a minimum period of 14 days at a quarantine facility.
8P. Control measures for public places
Government departments, municipalities and private entities responsible for public places must(a)ensure that public hygiene measures are implemented in all public places as described in the National Public Hygiene Strategy, 2020;(b)ensure that public places are cleaned and disinfected;(c)provide for hand hygiene; and(d)enable the practice of physical distancing measures
9. Visitor from outside South Africa
(1)All accommodation providers who have visitors from areas outside the Republic residing on their premises must provide a list of such visitors to the National Department of Health within 24 hours of publication of this Direction.(2)All such visitors must be placed on quarantine at the accommodation establishment where they are residing and undergo temperature monitoring on a daily basis for a period of 14 days or any number of days determined by the attending health officials.
These Directions are applicable for the duration of the COVID-19 pandemic and the declared national state of disaster.
I would like to urge all stakeholders, sector departments, state organs, NGO’s and members of the public to support the teams that are leading the fight against the COVID-19 pandemic.Dr Zwelini Ence Mkhize, MPMinister of Health