Minister of Health Dr Zweli Mkhize, noted “extreme concern” at a “fatigue” that appears to have set in three months after the country went into lockdown on 23 March and as the Covid-19 curve in South Africa is about to spike.

Cases in South Africa, as on Monday 29 June, totalled 144,264 while 1,567,084 tests had been conducted, with 38,075 new tests reported. A total of 2,456 deaths have been recorded while 68,925 people have recovered.

The opening up of areas of the economy had led to a migration inland which would see Gauteng emerge in “coming days” as the province with the highest Covid-19 numbers, said Mkhize. 

People returning from and to work under Level 3 had seeded community spread, he said. Also, the congregation of people in mines, factories, taxis and busses had amplified cluster outbreaks, like in the North West mining belt. 

But, as we head for the eye of the Covid-19 storm, South Africans were finding it difficult to adhere to the most crucial “non-pharmaceutical” interventions – washing hands, wearing masks, social distancing, quarantine and isolation.

“We see poor or no social distancing in communities. Masks are being abandoned or not worn properly and there is laxity setting in around frequent hand-washing. This will directly influence the rise in numbers in the next two weeks,” Mkhize warned.

The government was so concerned that a multi-sectoral Ministerial Advisory Committee on Social Behavioural Change is being pulled together to encourage “fundamental reform at grassroots levels for the sake of saving lives”. 

The need for wider public education and engagement is critical at this point. 

In the Western Cape, which featured as the epicentre of the Covid-19 pandemic, residents are pushing back against isolating in the province’s quarantine facilities.

Mkhize noted that “community members remain reluctant to subject themselves to quarantine and isolation, despite government having secured these sites in various parts of the province”.

The idea of being isolated from one’s family in a quarantine site is a terrifying one, to say nothing of the fear and anxiety a positive diagnosis brings with it.

To be separated from those you love in your moment of need, to be placed in the hands and at the mercy of strangers is a big ask and the reluctance to take up quarantine speaks perhaps to the lack of trust in the public health system. 

On 19 June, Western Cape Premier Alan Winde said 2,568 people had accessed quarantine sites, with just over 600 in various facilities across the province.

While there were “provisions for authorities to enforce law”, South Africans themselves had to “partner with government in its efforts,” urged the Mkhize.

“We remain committed to work together with civil society in an empowerment exercise that enables each individual to make the right decisions – decisions that allow people to protect themselves, protect the elderly, protect those with comorbidities and protect the poor and vulnerable,” he said.

A lesson to be learned from Western Cape’s original response to Covid-19 was that a  “hospicentric focus” on case management on its own proved inadequate. The province’s intensive contact tracing, quarantine and isolation programmes had also been “suboptimal”, said the minister.

While the province was “working hard to address these gaps”, getting buy-in from residents with regard to quarantine remained an urgent challenge. 

In spite of this, the Western Cape, Mkhize noted, “had not reached the surge as expected by modellers” but remained a key hotspot. The hospitalisation rate continued to increase in the Western Cape, which still had the highest number of admissions. 

Gauteng would need to increase hospital beds urgently and the department would support the province as it has done in the Western Cape. Crucial early case detection and contact tracing will be ramped up and quarantine and isolation sites activated.

Seasonal migration between Western and Eastern Cape had contributed to a cluster of outbreaks in Eastern Cape, said Mkhize.

The province’s collapsing health infrastructure and its inability to deal with the escalating caseload required a strengthening of the health system “in its entirety”.

“We had initially deployed a team of epidemiologists from the National Department of Health who intervened on an emergency basis to focus on the bottleneck in personal protective equipment (PPE) procurement and the immediate outbreak response,” said Mkhize.

Experienced senior managers were being deployed to the province to deal with “overall health systems management” and to assist with the ground response.

National issues Mkhize addressed included the reopening of schools and the ability to “successfully sustain” this in the aftermath of cluster outbreaks in schools.

Government expected all provinces would begin experiencing an increase in Covid-19 cases “even those with low numbers now” Mkhize announced.

Hotspots would need reinforcements and health intervention teams would be deployed to assist, he said

The department was in the process of piloting a track-and-trace app which had already proved successful “in the geo-location of cases, tracking and notifying contacts, and providing information and alerts”.

Clearing testing backlogs was a priority in “reducing the turnaround time to less than 72 hours”.

As at 27 June, the bulk of hospitalised patients were in Western Cape at 36% (1,629) followed by Gauteng at 26% (1,164) and Eastern Cape at 17% (775).

Nationally, the highest number (80.1%) of those being treated were in general wards (isolation wards) while 11.3% were in ICU  and, of those, 58.6% were on ventilation. 

Hospitalised patients on oxygen made up 15% and “as such, we recognise that we have not reached our full bed capacity”. 

Public/private partnerships were paramount and negotiations were now concluded, said Mkhize.

The government had also revised dexamethasone protocols “to ensure early administration to the most critically ill patients”.

South Africa’s mortality rate remained stable at between 1.8% and 2.1%, said Mkhize.

“We must all appreciate that there is a direct causal link between the surge of cases and our ability, or inability, to adhere to these very basic principles. We do not have a vaccine. We do not have a cure. Our ability to break the cycle of infection depends on our willingness to remain focused and disciplined and take non-pharmaceutical interventions seriously.” DM