South Africa

CORONAVIRUS

‘Unless we move fast we will soon be swarmed’ – Zweli Mkhize

Minister of Health Zweli Mkhize briefs the media on the details of government interventions in various sectors of the departmental portfolios on COVID-19 at DIRCO Media Centre on March 16, 2020 in Pretoria, South Africa.Health Minister Zweli Mkhize. (Photo: Gallo Images/Phill Makagoe)

On Wednesday night, Health Minister Zweli Mkhize launched the rollout of the large-scale Covid-19 testing campaign in targeted communities. He also warned that the next few weeks would be key if the country hoped to beat the pandemic. We publish his speaking notes from Wednesday night.

Let me start by conveying our deepest shock and sadness at the loss of Professor Gita Ramjee, one of our top vaccine research scientists and an HIV prevention research leader. She had returned from London a week ago but reportedly showed no symptoms of Covid-19 initially. We convey our condolences to her family, loved ones and colleagues – this is indeed a great loss for the South African academic community.

As at today, the total confirmed Covid-19 cases are at 1,380. This is an increase of 27 cases from yesterday’s (Tuesday’s) announcement.

The provincial breakdown is as follows: 

Gauteng 645 cases;

Western Cape 326;

KwaZulu-Natal 186;

Free State 76;

North West 9;

Northern Cape 7;

Eastern Cape 15;

Mpumalanga 12;

Limpopo 14;

Unallocated 90.

To date, 44,292 people have been tested, largely in private laboratories. A total of 47,541 tests have been completed, of which about 6,000 were performed in the public National Health Laboratory Service.

This is way too few considering the size of our population and other important factors such as inequality, poverty and underlying disease burden we have.

The President has approved a “Covid Home Visits Programme” of mass community-based screening, referral for clinic testing, quarantine of suspected cases and appropriate care for Covid-19 patients. 

The programme includes the deployment of Community Health Care Workers to the field for door-to-door household screening. Each province has been requested to start working on this strategy, by deploying provincial community healthcare workers with appropriate Personal Protective Equipment, to undertake a house-to-house programme of “no-touch” screening for Covid-19 symptoms and to refer symptomatic people to clinics for testing.

In addition, PEPFAR-funded District Support Partners to support provinces in this programme have been availed.

The CSIR and Right to Care have assisted us in mapping the most vulnerable populations – through this process, 993 strategic priority wards were identified using the social vulnerability index.

We take this opportunity to thank these partners for joining us in the war against Covid-19. Tonight, a list of priority districts will be finalised by MECs in a teleconference.

Launch of mobile testing units

To ensure there is adequate capacity to test citizens being screened, the NHLS has procured 60 mobile vans, in addition to the seven currently deployed to provinces, totaling 67 mobile testing units.

Today, we are here to launch these mobile laboratories that will be deployed across the country to all districts and metropolitan municipalities.

At this stage, the focus will be on collecting nasopharyngeal specimens for PCR tests or GeneXpert testing. The current capacity is 5,000 tests in 24 hours in 10 laboratories countrywide – when we reach full capacity we will be able to process 30,000 tests per 24 hours.

Rapid antibody tests have been used in many countries throughout the world and we are aware that there is interest in using these tests in South Africa. Our authorities are working round the clock to assess the efficacy of these tests in our context with the aim to make them available for future application.

Message to MECs

This morning I sent … my personal message [to] MECs as colleagues and leaders in this fight to save our nation from probably the most devastating enemy that has ravaged many nations and destroyed many lives in recent times.

I send this note as a way to encourage them all to be strong in the face of what may become the worst challenge our country may face for generations. I believe that if we are focused and united we can collectively defeat Covid-19.

We have seen a slower growth of Covid-19 positive cases in the past few days. I ascribe this to several factors:

First, we closed borders and reduced importation of infection.

Second, enforcing quarantine of the inbound travellers and returning citizens has slowed down the infection from the travelling community to a resident community.

Third, the lockdown slowed internal transmission by reducing the risk of spread through large gatherings and overcrowded transport routes in trains, buses and taxis.

However, there are areas we must be alert to. We need more vigilance now than ever before.

Internal transmission has started and it may have a tendency to spread silently as people with less means and slight symptoms may be slow to seek medical help as they are few and far apart, initially. 

Our testing criteria of patients with symptoms is currently reactive and restrictive.

By and large, people with access to private family practitioners have tested – most of whom had a history of travel to epicentres in Western capitals and are easy to suspect if they develop symptoms.

This means we don’t yet have a true picture of the size of the problem.

We need to test hundreds of thousands of the population to get a better picture to refine our containment strategy.

The lockdown may have had the inadvertent effect of limiting access to health facilities for those who depend on public health services in poor and densely populated and underserved communities because of transport difficulties.

This means that the release of a lockdown may have a huge rebound effect of releasing every constraint that made the infection slow down and we may have a runaway train with no way to apply brakes.

We need to engage all community leaders and call for volunteers in community and civil society formations to support the campaign, spread the message and teach our people to take the containment measures seriously and support all affected individuals and families.

The message of stay at home and importance of hygiene must be made more emphatically. The message must be that Covid-19 is serious but can be defeated and we need each person to make this a personal fight to save the nation.

Those on antiretroviral treatment and other chronic ailments must stick strictly to their medication.

Each person’s actions will count.

Let us break the chain of the coronavirus infection.

Next month (May) the ‘flu season starts, thus making more people sick with similar symptoms, and therefore no way of distinguishing common colds from an upsurge of Covid-19 infection.

These will flood our clinics and hospitals and create fertile ground for coronavirus to spread or be masked in its presentation.

This means what we may currently be experiencing is the calm before a heavy and devastating storm. There will therefore be no further warning before the pounding descends upon us.

There will not be time to prepare what we will not have put in place in the next seven days.

My plea to all my colleagues was to move with speed on the following:

1) Setting up of mobile units of health workers to move into communities with cases or contacts and set up testing and screening in communities initially starting with the symptomatic and then extending to the greater community.

We will now procure rapid test kits, taking into account any of the flaws anyone may point out. We will roll out testing and surveillance and start isolation treatment of patients and quarantine of contacts at an accelerated pace.

This means we will go out [to] look for and find patients and not wait for them in the hospital.

We will focus on dismantling the infection cycle by proactive action, rather than a reactive approach adopted up to now. We now combine the offensive strategy with the current defensive strategy used up to now.

There must be clearly defined targets at district and sub district levels structures with a clear short command line led by experienced professionals who can take clinical decisions quickly and act on the spot.

2) We need to procure additional beds and dedicated treatment centres where only Covid-19 patients will be treated in every town.

Where necessary we will find treatment centres and places to treat near communities where the burden of infection is high.

3) More quarantine beds must be identified with clear lines of control and food supplies as well as monitoring of temperatures daily, beginning with areas where the disease has been detected already.

4) Health professionals must be earmarked for release to focus on Covid-19 when the storm hits us.

We are requesting reinforcements from countries such as Cuba and China via WHO and these should be expected from next week. They must find our machinery well organised to reinforce effectively.

5) Encourage the release from hospitals of those patients that can be managed as outpatients and reduce hospital patient load and risk of cross-infections.

6) Every institution, that is hospitals or clinics, must do daily reports of suspected or confirmed Covid-19 cases and take necessary steps to protect staff and patients and prevention of further spread.

7) All treatment and PPE requirements must be stocked for several weeks of supplies. The National Department of Health and provincial departments must assess areas where interventions are necessary to prepare for heavy loads of patients from the end of this week. 

Protective gear must be available for all health workers and every staff member must be taught to suspect infection and prevent spread and protect themselves.

8) Gauteng, Western Cape, KwaZulu-Natal and Free State must prepare dedicated capacity for additional hospital beds for Covid-19 and report progress every week.

Based on personal observations, the pounding of Covid-19 has started and it will intensify from this week and we may see rising mortality rates. We are losing families, friends, colleagues, community members, health workers and other professionals across all age groups.

We will look at scientific models when these are ready but we now have enough evidence to indicate that unless we move fast we will soon be swarmed.

We no longer have time.

We need to be strong, focused and courageous.

We need to be decisive in our actions. We need to escalate our response to a higher level.

I appealed for a focus on implementation and less on arguments and debates.

There can never be a perfect plan in a battle. Ground experience will refine our actions. Academic debates have their place but during this ground offensive we will entertain advice that refine and improve our effectiveness.

The country’s future will depend on our swift coordinated actions. DM

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