Coronavirus Disease – COVID 19

Situation Note No.1 As of 18:00 hours, 26 March 2020

OVERVIEW OF SITUATION IN

HIGHLIGHTS

Two (2) COVID-19 cases confirmed in the country, both in San Pedro Town, Globally: 462,684 confirmed, . The second case is mother of the first patient. 40 598 deaths

February 8. Ministries of Health and Immigration announced that travelers Region of Americas: 75,712 confirmed, 1,065 deaths who have visited China within the past 14 days will be denied entry prior to arrival, On March 13, international cruises announced suspension of : Confirmed - activities. On March 15 the ban was extended to travelers from China, Hong Mexico 478, Panama 558, Costa Kong, Iran, Japan, South Korea, the UK, and Europe within the last 30 days. Rica 201, Honduras 52, Guatemala 24, El Salvador 13, March 16, 2020: First meeting of National Oversight committee established Nicaragua 2 measures to close the Western, Southern and any other small border points entries in Belize for passengers and left the northern border and the Philip S. W. Goldson International Airport open. Closure did not apply to cargo vessels. Social gathering limited to no more than 100 people and announced schools to be closed effectively March 22, initially for fourteen days until further notice depending on how the situation evolves and Belize’s

March 20: Second meeting of National Oversight Committee established Northern Border of Belize closed for travelers (in and out except for emergencies) but remained open for cargo transportation. Only Belizeans nationals, residents and diplomats residing in Belize were allowed entry subject to inspection and quarantine for 14 days. Philip S. W. Goldson International Airport closed after the arrival and departure of last scheduled flights but remained open to freight or cargo flights. It also limited social gathering to no more than 25 and recommended self-isolation.

March 21, 2020: Belize’s Ministry of Health was notified of an American national who was in Belize and tested positive for COVID-19 in the U.S. after departing Belize a week ago. The Ministry traced all persons that were in close contact with the American and those encountered showed no symptoms but were all placed in isolation for 14 days. As a result of this discovery, any national or foreigner arriving in Belize were viewed as a potential case and as such all persons arriving in Belize were required to go into a 14-day self-isolation upon arrival.

March 23, 2020: following the first confirmed case of COVID-19 in San Pedro Town, Ambergris Caye, , Government of Belize declared a state of emergency for Ambergris Caye initially for 72 hours to allow proper mapping and tracing of contacts. Residents and vessels (unauthorized) of the island were placed under mandatory quarantine and were not allowed to leave or return to the island. March 25, 2020: Mandatory quarantine in Ambergris Caye was extended to 30 days after Belize registered its second COVID -19 (Coronavirus) case on the island; all bars, clubs, and casinos countrywide were closed while restaurants were closed for dining, but take-out services were allowed.

UPDATE

● A second confirmed case for COVID-19 was reported on 25 March 2020 in San Pedro Town, Ambergris Caye. She is mother of the first patient. ● Currently there are two (2) COVID-19 cases confirmed in the country, both are in San Pedro Town, Ambergris Caye. The second case is mother of the first patient. ● The Ministry of Health reported that 87 tests have been conducted, to date. ● Five additional persons from two districts were tested, but all produced a negative result. ● State of Emergency for Ambergris Caye has been extended for total of 30 days but this will be reevaluated as the situation changes. ● 32 Cuban health professionals arrived in country to support COVID-19 response. ● Belize Port Authority prohibited vessels from departing and proceeding to San Pedro (23 Mar 2020).

COVID 19 Internation Situation Note - No. 01 | 2

● A COVID-19 protocol for public transportation still place. ● Daycare centers, public and private schools continue to be closed until 20 April. ● All bars, clubs, lounges and casinos countrywide are closed until further notice. ● Restaurants continue to be closed for dining-in, but take-out services allowed.

NEEDS/CHALLENGES

● Purchase of additional laboratory test kits and PPEs. ● Equipment and supplies for isolation areas in target health facilities and in other identified locations.. ● Reorganizing health services to address COVID-19 response needs. ● Continuous transmission of key messages to the general public (health promotion) ● The estimated budget for emergency response in the ECD/Education sector is as follows. o $70,200 USD to support Ministry of Education to reach 387,000 parents, teachers and children with continuous education and critical hygiene and prevention materials for education/WASH access ● The estimated budget to prevent undernutrition is USD 43,550: o 30,000 USD/month for the School Feeding Programme o 13,550 USD as requested from the Ministry of Health to provide 300 packages with Incaparina, oranges and bananas for children and pregnant women; and printing flyers to promote nutrition and hygiene. ● Protection sector needs - Budget estimates: o Prevention: 30,000.00 USD o Response: 50,000.00 USD ● WASH sector needs – Budget estimates: o USD $29,160: Reach approximately 30,000 children and their families in communities with health and hygiene education messages to help keep them safe from the virus with Ministry of Health. o USD $43,200: Production and dissemination of Health Communication materials to inform, save and minimize adverse consequences within the 9 municipalities ● Logistics sector needs: Budget estimates USD 300,000 ● Social Protection needs - 487,320 USD (TA: 58,320; Cash transfers: 429,000) - to be fundraised. o Funding will go towards enhancing technical capacity for the MHDSTPA as well as expanding/extending cash transfers to families most affected through the crisis and rapid assessment and improvement of response based on sharing of experiences within Belize and with other countries ● Data, Monitoring and Evaluation needs – Budget estimates USD100,000.00 ● Adolescent Health and Participation needs – Budget estimates USD20,000

RESPONSE

Health PAHO ● PAHO training on laboratory diagnosis of new coronavirus (12-13 Feb, Mexico). ● Purchased canisters and shipping packages for shipment of samples. ● Procurement of additional laboratory test kits and personal protective equipment (PPEs). ● Joint assessment of the level of preparedness of health facilities and isolation areas. ● Support for the implementation of risk communication and community engagement strategy. ● Awareness sessions for public and private institutions. ● Revising of National COVID-19 Response Plan. ● Providing COVID-19 awareness sessions for various public and private institutions. ● Provision of technical guidance for case management, reorganization of health systems and expansion of health services in response to COVID-19 UNDP ● UNDP is procuring an additional 20 laboratory testing kits and a ventilator at approximately USD 42,000 ● Support to the National AIDS program to ensure multimonth dispensing of antiretroviral therapy is being implemented.

COVID 19 Internation Situation Note - No. 01 | 3

Education UNICEF ● To reduce risk and provide appropriate response, UNICEF, along with the Ministry of Education, Youth, Sports and Culture, planned a meeting to review response plans to the threat of COVID 19. The meeting included the key participation of senior representation from UNICEF, PAHO/WHO, the Ministry of Education, Ministry of Health and the Belize Red Cross. The discussion was focused on advocacy and preparation for students, teachers and families for school closure and continuity of learning. The meeting covered plans to implement the safe school operations guidance with managements and local partners. In response, managements and schools will develop context appropriate strategies for continuous learning that allow pupils, teachers, and schools to utilize flexible and remote/home-based learning, which may include homework assignments, reading material, radio, TV, online content and internet-based learning. ● UNICEF received $70,000USD this week to support the response.

Nutrition UNICEF ● In collaboration with the Ministry of Education and Ministry of Health, UNICEF will provide funding to supply Incaparina, supplemented food used in Belize to prevent and treat undernutrition, to children who are part of the School Feeding Programme in Belize City, Dangriga, Rancho, Bermudian Landing, Flowers Bank, and Double Head. ● In partnership with the Ministry of Health, will provide funding for Incaparina to be delivered to children and pregnant women, and will contribute to information material to promote nutrition and hygiene for children and adults. In this way, will guide children and their caregivers around the country to practice hygiene to stop the spread of the virus and to include food that will provide children and their families stay healthy so they can better fight an infection. ● In collaboration with the Ministry of Health and INCAP, UNICEF supported further development and dissemination of information on safe breastfeeding. Materials with nutrition tips and hygiene were designed for children and adults and information of safe breastfeeding during COVID-19 UNICEF has agreed to provide funding to print flyers to promote healthy eating habits for the vulnerable population. The information material focused on: o Promote sanitary and hygiene measures during food preparation and consumption. o Strengthen the importance of personal use of cups, glasses, bottles, cutlery and other personal items (do not share them). o Promote healthy eating habits, safe plain drinking water, and the preparation of balanced meals as a family activity. o Protect, promote, and support appropriate breastfeeding, advising on handwashing before breastfeeding.

● Protection UNICEF ● Our work will be concentrated in communities impacted by COVID-19. The most vulnerable children and families are those children who are in Institutions (approximately, 200 (not disaggregated by sex); Children whose caregivers are in quarantine (TBD) and Children on the Move (TBD) ● UNICEF has strong Child Protection Partners in Belize both within Government and with Civil Society. The main partner to support the child protection response in prevention and response to COVID-19 is the Ministry of Human Development. Other potential partners include the National Committee for Families and Children and Youth Enhancement Services. ● Potential prevention activities include: Communication, information sharing, and advocacy around understanding cultural beliefs at community level, responsive parent-child relationships and inter-agency collaboration and plan to strengthen care of children and training of local health actors in preventing family separation and identifying and referring children who are unaccompanied and separated (UASC). It will also be very important to work towards documenting the Government plan for supporting social workers that have

COVID 19 Internation Situation Note - No. 01 | 4

to respond to violence during Covid-19, determining how communities will report and how the Ministry will respond to those reports during times of social distancing. ● Potential Response Activities include: Ensuring that safe, family-based alternative care arrangements are established for families that must be separated due to quarantine during Covid-19 and that if separated they have regular opportunities to communicate with their caregiver. Work can be done to establish a registration system to prevent long-term separation. Additionally, ensuring that when there are reports of violence that children. UNFPA ● Technical support and guidance including key messages on gender equality and gender based violence for prevention, protection, and response for adolescents and youth and women & girls.

Water, Sanitation and Hygiene UNICEF ● To reduce risk and provide appropriate response, UNICEF and other partners including PAHO/WHO, the Ministry of Health and the Belize Red Cross, have supported the Ministry of Education, Youth, Sports and Culture to review response plans to the threat of COVID 19. Partners have agreed to prioritize advocacy for WASH and a National Handwashing Campaign that was initiated on March 19, 2020. Additional promotional materials will be disseminated in the nine (9) municipalities to support behaviour change, with a focus on risk communication. This work will support the Sustainable Child Friendly Municipalities already strengthened with emergency preparedness and response and risk communication strategies.

Logistics

UNICEF ● UNICEF, with support from UNICEF Supply Division and LACRO Supply and Logistics Specialists, is in a strong position to support the Ministry of Health in planning for and addressing many of these gaps. UNICEF will collaborate with PAHO to support coordination of procurement efforts to bridge the gap in key skills and supplies and ensure acceleration and implementation of a response at scale to test, trace, care and treat.

Social Protection UNICEF ● Establish partnerships for the rapid and sustained analysis and monitoring on the impact of COVID -19 on households and children wellbeing; (i) household income; (ii) price increases of consumption basket, particularly food and essentials; (iii) employment; (iv) limited access to basic services, particularly for women and children. ● Develop messages, advocate and provide technical assistance to expand and extend cash transfers to families most affected through the crisis. Develop messages and advocate for the strengthening of SP instruments that go beyond cash transfer access. Support government in the adaptation of SP instruments to respond to COVID. ● Health insurance: develop messages and advocate for subsidies/waivers to informally employed/working poor; and inclusion of COVID-19 testing and treatment in existing policy coverage. ● Public works programs: Advocate for continuation of payment of benefits even when work is no longer possible due to government containment policies (i.e. travel/public space restrictions) ● School feeding prog.: Advocate for continuation of feeding/provision of take-home rations when school close. ● Develop options and messages/advocate for protection of work/income for families, with the private sector ● Ensure that poorest areas (such as rural areas, Toledo and Corozal, Belize Southside) are not left behind. ● UNICEF will work with these partners to support this response. MHDSTPA, NCFC, NEMO, Belize Red Cross, ILO, WB, WFP, PAHO/WHO.

Data, Monitoring and Evaluation UNICEF ● Our priority will be to reach the poorest and most vulnerable children directly and indirectly affected (children with parents in quarantine, hospitalized, and children who lose caregivers as a result of COVID -19). Among the most vulnerable and poorest children and families who could be affected, as a proxy, a possibility would be to target BOOST beneficiaries (5,867 people, of which 4,604 children) and Food Pantry beneficiaries (4,031 households, of which estimated 7250 children), and work on vertical and/or horizontal expansion. With special attention to children in households facing multiple vulnerabilities (including children on the move and those with disabilities).

COVID 19 Internation Situation Note - No. 01 | 5

● Current limitations to travel due to the risk of COVID-19 transmission and given the human resource constraints across sectors, it is especially crucial that Belize make the best use of technology-based data tools to contribute to monitoring and evaluation for decision-making. UNICEF has two platforms that can support rapid data collection while maintaining social distancing: ● MICS Plus: a new initiative that collects data through mobile phones from sub-samples of MICS - a flexible tool to generate high-quality, robust data for crisis monitoring, opinion polling and longitudinal analysis. The MICS Plus surveys harness the rigour of MICS with the flexibility and nimbleness of mobile platforms to allow channels for generating data on emergencies, opinion polling and follow up on specific issues related to programme coverage and other appropriate policy issues. ● U-Report Belize: Since its inception more than 4000 Belizeans have joined and are actively engaged in educational, informative and interactive polls. The tool provides a conduit for real-time, fast and reliable communication to U-Reporters of all ages, using various social media networks - WhatsApp and Facebook being the prime channels of communicating. The realization of this data technology tool has allowed fast feedback in real time from people at national and local level. The information is subsequently utilized in advocacy work across all media channels, and the platform offers one of the most widely used big-data tools in use in Belize for deployment during this time. ● Both platforms have the capacity to gather data nationwide. UNICEF will work with the regular partners supporting data collection on children and families in Belize including SIB, the NCFC M&E Sub -Committee, Municipal coordinators, and members of the national Technical Steering Committee for the Sustainable Child- Friendly Municipality initiative (SCFM), children, adolescents and adults enrolled in U-Report and households reached through the MICS Plus, and UNICEF’s Global MICS Advisory team. ● Use of these platforms will contribute to longer term capacity enhancement for rapid data collection in Belize. Through the use of the platforms for COVID-19 response, MICS Plus can be scaled up to support data collection for a larger sample frame. To do this, UNICEF will work in partnership with SIB and telecommunication agencies. Reports from the data capture and monitoring can be shared with UN interagency task team on emergencies (UNETT) and national sector leads for COVID-19 response. In addition to using U-Report to collect data, the platform can be used to disseminate and inform development of messages to increase knowledge and risk awareness around COVID-19 and to promote knowledge diffusion and health behaviours through social networks.

Adolescent Health and Participation UNICEF ● UNICEF works primarily with the multisectoral National Steering Committee for the Sustainable and Child Friendly Municipality (SCFM) initiative, and with the Ministry of Health to support programmes for adolescent participation and empowerment, health and development. ● To respond to COVID-19, UNICEF will work with these partners as well as selected civil society and faith-based groups, Ministry of Health; Ministry of Labour, Local Government and Rural Development to reach an estimated 90,000 adolescents in and out of school living in rural and urban areas, their families, health care workers, community workers to: o Integration and prioritization of COVID – 19 adolescent health measures into the ongoing programmes (including U-Report) o Production and dissemination of key messages on the preventative actions that adolescents are to practices. o Guidance on policy implementation for adolescents on COVID – 19, this will include provision of up to date policies for caring for adolescents in and out of school and conduct trainings for the partners.

Personal Protective Equipment (PPE) UNICEF ● Provision of personal protective equipment (PPE). UNICEF will provide WHO/M.O.H PPEs to prevent and mitigate the spread of the Virus. The PPE’s cost a total of $2,914,700.72. The Supply process has already been initiated by UNICEF and its ongoing. Description of items is below.

ITEMS Quantity Mask,surgic,typeIIR,tiestrap,disp. 151000 Mask,high-fil,FFP2/N95,no valve,nonster 300000

COVID 19 Internation Situation Note - No. 01 | 6

Hand sanitizer, Alcohol >60%, 60ml 300000 Thermometer, clinical, IR,handheld set 1000 *HE Apron,protect,plastic,disp/PAC-100 15 *HE Apron,protection,plastic,reusable 1000 Bag,biohazard,red,100L,box/100 50 Body bag,infection control,adult 250 Body bag,infection control,child 100 Boots,rubber/PVC,reusable,pair,size42 300 Boots,rubber/PVC,reusable,pair,size43 250 Boots,rubber/PVC,reusable,pair,size44 300 Cap,surgical,bouffant,non-woven,box/100 5000 Coverall,protection,CatIII,type 6b,L 2000 Coverall,protection,CatIII,type 6b,M 2500 Coverall,protection,CatIII,type 6b,XL 5000 Gloves,w/o powder, nitrile,L,disp,box/100 5000 HE*Gloves,w/powder,nitr,M,disp,box/100 5000 Goggles,protective,indirect-side-venti 300000 Gown,surgical,non sterile,non woven,disp,L 150000 Gown,surgical,non sterile,non woven,disp,XL 151000 Oxygen Concentrators and accompanying items1137 Test kits (cepheid Xpert Xpress SARS-CoV-2 kit) Xpert Xpress SARS-CoV-2 kit 2000 Nasopharyngeal swab collection, kit of 100 units1000

USEFUL LINK OR SOURCES OF INFORMATION

Websites: UN https://www.un.org/coronavirus

WHO https://www.who.int/health-topics/coronavirus

PAHO https://www.paho.org/en/topics/coronavirus-infections/coronavirus-disease-covid-19

UNFPA https://www.unfpa.org/covid19

Government of Belize COVID-19 Website: https://covid19.bz/

Government of Belize Press Office Facebook Page: https://www.facebook.com/GOBPressOffice

Office of the Director of Health Services Facebook Page: https://www.facebook.com/dhsbelize/

Ministry of Health Belize Website: http://health.gov.bz/www/

The next situation note will be issued on 9 April 2020.