INFORMATION FOR DIETITIANS
Are dietitians regarded as essential services during the national lockdown period in response to the COVID-19 outbreak?
This question is addressed according to the sector of employment / practice.
The Minister of Cooperative Governance and Traditional Affairs, Dr Nkosazana Dlamini-Zuma, issued amended regulations in terms of the Disaster Management Act, 2002, on 18 March and 25 March 2020 respectively; with regards to the national lock-down in response to the COVID-19 outbreak.
These regulations detail the restrictions in terms of the movement of persons and goods during the national lockdown period and specifies that every person is confined to his or her place of residence, unless strictly for the purpose of essential services. Medical and health services are included in the list of essential services, but the list doesn’t explicitly mention dietitians. It is further prescribed that the head of an institution must determine essential services to be performed by his or her institution, and must determine the essential staff who will perform those services (Paragraph 11B(2) of Government Notice 398 of 2020, dated 25 March 2020).
Persons who have accordingly been identified to be performing essential services must be fully designated in writing by the head of an institution on a form as prescribed in Annexure C of the regulation.
As such, individual institutions will determine essential services. ADSA, together with SASPEN, has developed a statement and supporting document to demonstrate the importance of dietetic services during the lockdown period, specifically pertaining to hospital and critical care settings. These documents may assist individual dietitians to be recognised as essential services by their respective institutions.
With regards to dietitians in private practices outside of hospital settings, the Health Professions Council of South Africa (HPCSA) granted special approval for practitioners rendering essential services to remain accessible to their existing patients through the use of tele-health for managing clients remotely using virtual platforms. This approval only applies to the lock-down period and within prescribed guidelines. Please refer to Question 3 for further details.
According to the directive issued by the Department of Public Service and Administration on Wednesday 25 March 2020 (view here), respective national and provincial heads of departments will identify the minimum critical jobs necessary for service and business continuity and implement operational measures accordingly. Further guidance can be obtained from respective provincial health authorities in this regard.
National COVID-19 Restrictions Alert Level 3 – what are the implications for the dietitian?
The ADSA Executive Committee provides guidance on the implications for the dietitian as the country shifted from Alert Level 4 to Alert Level 3 on 1 June 2020, as well as links to important documents on safety at work and self-care resources. Access the guidance document here:
How can I protect myself and my patients during the
Members are encouraged to use their professional judgement to assess all risks and deliver safe care in your places of work.
Familiarise yourselves with the protective measures recommended by the National Department of Health (NDOH), National Institute for Communicable Diseases (NICD) and the World Health Organization (WHO), including washing your hands frequently with soap and water; social distancing; avoid touching your eyes, nose and mouth; and coughing or sneezing into your flexed elbow or tissue.
Wherever possible move face-to-face consultations / meetings / interactions into the virtual space as per the guidelines on tele-health from the HPCSA (see question 3).
Don’t shake hands, maintain a reasonable distance between you and your patient.
Follow the guidelines outlined by the National Department of Health that specifically adhere to the use of personal protective equipment (PPE) under specific circumstances. Only wear PPE as indicated so as not to use these resources unnecessarily.
Consult with your institution for training on the correct use and disposal of PPE. Ensure that you follow the step-by-step process for don/doff of PPE as per directives.
Minimise personal effects in the workplace. All personal items should be removed before entering clinical areas and donning PPE. This includes jewellery, cell phones, pagers, stationery, etc.
If you are required to consult with a client during an emergency, ask your client to inform you immediately if they are diagnosed with COVID-19 and inform your clients and close contacts immediately if you are diagnosed with COVID-19.
Do not meet with clients if you are experiencing symptoms such a fever, runny nose, cough, shortness of breath or a sore throat and vice versa.
Department of Health Guidelines for symptom monitoring and management of essential workers for COVID-19 related infection
Can dietitians participate in telehealth?
According to the COVID-19 outbreak in South Africa: Guidance to Health Practitioners released on the 26 of March 2020 and amended on 3 April 2020, the HPCSA permits the use of Telehealth for managing new and existing patients remotely using virtual platforms, including video and telephonic links, within specific guidelines and provided such consultations are done in the best clinical interest of patients. . This guideline is only valid during the COVID-19 pandemic and the HPCSA will inform practitioners when this guidance will cease to apply.
Watch a brief introduction to ADSA's Telehealth Guidance Document, as well as a second video on practical telehealth tips for dietitians.
What do I need to carry with me when I go to work?
1. Form 2 of Annexure A in the Government Notice R.480 of 29 April 2020: Permit to perform essential or permitted service.
(This should be completed by your institution)
2. My ID
3. Proof of HPCSA registration (precautionary measure)
Where can I access reliable information on the COVID-19 pandemic?
To learn more about COVID-19 and to access the latest information and advice, we further recommend that members refer to the following resources:
COVID-19 Corona Virus South African Resource Portal: https://sacoronavirus.co.za/
South African Coronavirus Disease 2019 Public and Emergency Hotline: 0800 029 999
South African Coronavirus Disease 2019 WhatsApp Support Line: 0600 123456
National Institute of Communicable Disease (NICD), including technical resources, guidelines and updates on COVID-19: http://www.nicd.ac.za/diseases-a-z-index/covid-19/
Public communication on COVID-19, for South Africa: http://covidcomms.org.za/
Updated statements, speeches and news by the South African government: https://www.gov.za/welcome-official-south-african-government-online-site
Department of Public Service and Administration: http://www.dpsa.gov.za/
World Health Organization, including clinical guidelines and advice for the public on COVID-19
Clinical guidelines for Critical Nutrition Care for COVID-19
New guideline from the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (ASPEN): Nutrition Therapy in the Patient with COVID-19 Disease Requiring ICU Care
New ESPEN statement: ‘ESPEN expert statements and practical guidance for nutritional management of individuals with sars-cov-2 infection’ – journal pre-proof article
European Federation of the Associations of Dietitians (EFAD) compilation of COVID-19 information on nutritional support
Irish Nutrition and Dietetic Institute (INDI) resources for nutritional support for patients in Intensive Care Units
Practice-based Evidence in Nutrition (PEN) resources
European Society for Clinical Nutrition and Metabolism (ESPEN)
American Society for Parenteral and Enteral Nutrition (ASPEN)
Last updated 6 May 2020
This guidance may change as knowledge evolves and ADSA will endeavour to keep this page updated. For the most up to date information visit the websites as provided above.