Prevention is key: Poor sanitation already plagues informal settlements such as RR Section in Khayelitsha
When Day Zero comes, a select group of people will gather at Cape Town’s Tygerberg Hospital, ready to respond to potential threats that could come with water shortages: diarrhoea, cholera, listeriosis and typhoid.
The 80-strong team which includes provincial health department officials has been working on a response plan to the drought since November 2015. It includes some of those who helped out during August’s fires in Knysna.
The day after the taps run dry, they will arrive at Tygerberg Hospital to respond to incidents reported by an extensive network of city employees, government departments and relief organisations.
Red flags for the emergency team will be listeriosis, diarrhoea, cholera, typhoid and avian flu. Western Cape Premier Helen Zille also raised her concern about a potential disease outbreak due to the water crisis.
“It’s very unfortunate that this crisis comes at a time when we are also having [an outbreak of] listeriosis. And listeriosis requires a lot of washing to contain [it]; that is the major challenge,” Zille said this week.
Vectors such as rodents and flies infected by still-standing bodily fluids can, in turn, infect humans and cause diarrhoea, Western Cape disaster medicine director Wayne Smith said.
“Obviously, there are concerns that if sewage doesn’t come through [the pipes due to the water shortage], we can see diseases spread. But the city takes the lead and we, in turn, would be advised about where the risk is and where it would present itself.”
The team will rely on clinic and hospital staff, school teachers and the public to phone in cases. A health inspector will be dispatched and if an infection is confirmed, it will be reported and the person will be isolated and treated.
Smith said the Western Cape was currently experiencing its annual “diarrhoea season”. “But if we notice an increase of reported diarrhoea cases, we need to be sure it’s not due to water [shortages]. Sanitation is important, but more important is surveillance. If we can catch it early, we can prevent it.”
The Western Cape reported the second-highest number of listeriosis cases in the country during the current outbreak, the National Institute for Communicable Diseases said last week. A total of 767 laboratory-confirmed listeriosis cases were reported by January. Of those, 13% (or 101 cases) were from the Western Cape.
Western Cape head of disaster management Colin Deiner explained: “The problem is that it’s all about hygiene. At this stage, it’s a manageable risk. We’ve got a very good tracking system for diseases in the province since it’s compulsory to alert the department once [an infection has been] confirmed.”
Smith said the best way to combat listeriosis would be by washing food products, adding that the department’s distribution of hand sanitiser products to hospitals would help ensure the water shortage does not spread the disease.
The avian flu left 2.7‑million birds dead in the Western Cape last year. Combating it requires a “thorough wash-down of the laying areas” for chickens. Deiner said two more cases had been detected this year.
The risk of a cholera outbreak would mainly be a result of malfunctioning sewerage systems, as well as dirty water in large water tankers that will supply distribution points.
“It’s a serious risk. You’ve got to have such strict control over every single container that goes out there to make sure you’re not transporting contaminated water. It can get contaminated easily, but it can be treated.”
Deiner said the sewerage system was a major concern.
“[It] has been raised in our disaster meetings that you need water to flush the sewerage system. We know that Day Zero doesn’t mean we’ve run totally out of water; there will be certain systems still running. But you could get a situation where you could have no moving water and you’ve the risk of diseases like cholera.”
The provincial government’s push towards bottled water is also motivated by the risk of contamination in the large water tankers.
“We’ve got to make sure there’s an extremely well implemented health regime in any tanker operation. That’s why we’re focused a lot more towards bottled water, which limits the possibility of contamination, has longer shelf life and is easier to transport,” Deiner said.
Cape Town disease disaster unlikely
A cholera outbreak or an increase in listeriosis cases in the Western Cape linked to water shortages is highly unlikely, says Juno Thomas, head of the Centre for Enteric Diseases at the National Institute for Communicable Diseases (NICD).
To spark a cholera outbreak in the Western Cape, a person infected with the bacteria would have to contaminate a central water source — an extremely unlikely event, Thomas says.
“There is far greater risk of people contracting other bacterial infections from shigella and E.coli.”
Both bacteria are spread by drinking water contaminated with faeces and result in mild to severe fever and diarrhoea, according to the Mayo Clinic in the United States.
As for listeria, water shortages are unlikely to lead to a spike in cases. But Thomas stresses that frequent hand washing remains one of the best means of prevention.
Most people who eat listeria-infected food will not get sick, but people with weaker immune systems caused by, for example, HIV, diabetes or chemotherapy, are at risk. Pregnant women are also at risk, as are newborn babies who can contract it in the womb.
Since the NICD first reported a spike in listeriosis cases in October 2017, over 760 laboratory-confirmed cases have been recorded, largely among people with compromised immune systems.
While the NICD is not planning for any increases in diseases related to Day Zero, the Western Cape health department’s emergency and disaster teams have asked the NICD to be available to conduct tests for shigellosisand E.coli if needed, and provide advice should there be an outbreak. — Joan van Dyk