Shifting patterns in Covid-19 cases leads to redrawing of battle plans

Some provinces or even localised districts may stay in tighter lockdowns than other parts of the country as South Africa embarks on a risk-based approach to reopening the economy and allowing the limited movement of people. 

This was revealed by Health Minister Zweli Mkhize during a briefing to Parliament’s joint committee on health and social services.

Mkhize, who is in Kwazulu-Natal, briefed members of Parliament in a video conference and told them that models of the rate of infection and transmission patterns have changed since the first reported case in South Africa in early March.

Gauteng, which has for weeks been the province with the highest number of confirmed cases, was last week overtaken by the Western Cape. As of Sunday night, the Western Cape had 1 608 cases and is now the epicentre of the outbreak in South Africa.

Health officials have identified large numbers of cases in factories and among shopping centre workers, who have been declared necessary to the economy during the lockdown. 

“There’s a change in pattern. We are seeing cluster outbreaks in workplaces that were originally identified as essential services. So, to look at it, we need additional support for that province [Western Cape],” Mkhize said. 

Officials are also reporting a spike in cases in the Eastern Cape, while the outbreak in KwaZulu-Natal remains a problem. 

“KZN has also been quite high, but we are also concerned that the Free State, that was once a concern, has now been overtaken by the Eastern Cape. In the Free State the pattern was based on one incident where there was a church gathering, where many people got infected. That has now been contained. The numbers have remained stable around 110. But the Eastern Cape has shot up. The outbreak is being driven by social gatherings, mainly funerals, and [the recent outbreaks] in the correctional services area.”

Mkhize is now shaking up the Eastern Cape health department. He’s assigned a deputy director-general, Litha Matiwane, to the Nelson Mandela Bay metro and is fast-tracking the appointment of a chief director to oversee the province’s effort and to appoint doctors and nurses. 

A group of Cuban medical personnel, who arrived in South African in the early hours of Monday morning, will also be deployed to the Eastern Cape once they have completed a period in quarantine. 

“It looks like some of the work that has been done is quite promising. The numbers [of cases] are increasing. But we have to ultimately concentrate on how we contain the spread,” Mkhize said. 

The government may also decide to enforce lockdown in one province or district while opening up in other parts where the risk of infection is lower. 

This could particularly affect the Western Cape, Gauteng, KwaZulu-Natal and the Eastern Cape. 

Lockdown levels could also shift up and down, from the partial relaxation of regulations to a total clampdown on movement and the economy depending on the rate of transmission. 

“We don’t think the return to normality will be symmetrical and happen at the same time. There will be areas where it will be quicker to return to normality, and there will be areas where we will be more measured the way we go about it, “Mkhize said. 

The health department’s acting director general, Anban Pillay, warned MPs that reopening commercial and industrial sectors too quickly could have the opposite effect of revitalising the economy. 

“Pandemics itself will depress the economy, public health interventions do not … Evidence from the 1918 Spanish flu pandemic is that those economies who decided to move early in terms of restarting the economies without the infection rate in their economies being reduced significantly had a negative economic outcome relative to others. It is critical that the economy waits for the public health interventions to achieve its full effect,” Pillay said. 

Although there is concern about the rate of transmission in some provinces, the health department said there is no major strain on the hospitals yet. 

The department has earmarked 288 quarantine sites with capacity for 23 000 beds. More than 200 of these sites are being used and are largely in the Gauteng area. This is because of the number of people who have been repatriated and having to be in quarantine before returning to their homes.

“Our ICU utilisation rates are still fairly low. Those on ventilation are still fairly low. Across the provinces, there is not a high demand for high care relative to when you get into a surge period, so the image is that our hospitals are currently not overwhelmed at this stage,” Pillay said.

“We have more quarantine sites than we need at this stage, but we need to keep them in wait if we have an increase in the number of cases.” 

Answering MPs questions, Mkhize gave no details of when schools will reopen, but said it would happen in a safe and staggered manner.

Today’s (Monday) media briefing by the ministers of basic education and higher education was postponed. They were to have given details about the possible reopening of learning institutions

Mkhize said: “We will have a phased reopening of schools. But the risk to children is not as strong as far as contracting the infection. It’s not so much the problem of the children. It’s more a problem of how they will infect their parents or grandparents when they come back.” 

On protocols for certain sectors of the economy that will reopen during the level 4 phase of the lockdown from Friday, Mkhize said the department was giving advice on protocols to keep workers safe. These include basic hygiene measures — using hand sanitisers, wearing masks and physical distancing — to the staggered reintroduction of people into the workplace.

Mkhize also answered an MP’s question about the efficacy of sunlight in helping treat Covid-19. The minister said there was no evidence to this effect. This is in contrast to United States’s President Donald Trump who had, during a live media briefing, called on his medical experts to look into ultraviolet light and its effect on the disease. 

“I think there may be some elementary observation that people may be trying to make an association. But we don’t have any randomised control studies. Sunlight is good for you, fine. But it’s not something we can link with the coronavirus and that we have evidence off,” Mkhize said. 

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Slides 27th April 2020 by Mail and Guardian on Scribd

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Lester Kiewit
Lester Kiewit
Lester Kiewit is a Reporter, Journalist, and Broadcaster.

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