Parliament

With screening and testing up, more Covid-19 positive cases but average 1.9% mortality rate remains – Zweli Mkhize

By Marianne Merten 27 April 2020
Caption
Minister of Health Zweli Mkhize. (Photo: Gallo Images / Phill Makagoe)

A total of 42 Covid-19 patients are in intensive care, and 23 in high care as South Africa at the weekend arrived at 4,546 confirmed cases – and 87 deaths. This emerged in a Freedom Day briefing to Parliament’s health committees by Health Minister Zweli Mkhize and his officials.

Community screening is up – 5,832,572 across South Africa, with 41,707 people referred from this process for Coronavirus testing. A total of 168,643 Coronavirus tests have been conducted since the start of the pandemic, according to the Health briefing documents.

And while the daily Covid-19 updates show testing ranges between 6,500 to 8,5000 a day – that’s hovering around the half-way mark of claimed public capacity – Health Minister Zweli Mkhize has emphasised testing is increasingly done in the public sector.

“We are seeing increasing numbers (of testing) from the public sector. That is for us quite encouraging. However, we think there is still a long way to go,” he told parliamentarians on Monday morning. “South Africa really has not done badly. What we are happy about is that we are targeting areas where we are having problems.”

The interconnectedness of community screening, testing and South Africa’s overall numbers emerged in the Health briefing documents: of the 7,639 tests done on 25 April – 975 down from the previous day – 1,854 came from community screening initiatives.

According to the minister, the challenge was the supply of diagnostic kits.

But that may not be all.

Daily Maverick has learnt the National Health Laboratory Service (NHLS), which provides government testing, at Groote Schuur Hospital in Cape Town has been partially and temporarily closed due to Covid-19.

“In the last seven days, we diagnosed at least nine Covid-19 positive staff members in our laboratory,” said an official NHLS letter dated 27 April, seen by Daily Maverick, announcing the immediate temporary shut down of the chemical pathology and haematology laboratories until 1 May 2020. Other pathology services will continue as normal.

“Since the Covid-19 pandemic started in South Africa, the NHLS GSH (Groote Schuur Hospital) laboratory performed testing generally uninterrupted while implementing stringent measures to reduce workplace transmission and increase of staff awareness”.

The letter does not specify how the nine lab employees became Covid-19 positive.

But across South Africa, health care workers and front line staff, and their various trade unions, have complained about the lack of personal protective equipment, or PPE.

On Monday Mkhize said there were no shortages overall, but rather “unevenness” in supply. “We still have some stocks… The orders should cover the next six weeks.”

A team including trade unions and academics was now involved in what he described as “active management” of PPE stocks and supplies.

Regarding the situation in the Eastern Cape, where health care workers raised concerns more recently, Mkhize told lawmakers the situation was now corrected:

“We went into our stores and moved some (PPC) out immediately,” said the minister, explaining how the records had shown the Eastern Cape on track with its PPE supplies.

And following a ministerial visit to that province, the Eastern Cape now also has found 800 beds to quarantine people from the outbreaks in Nelson Mandela Bay.

Nationally, of the 288 planned quarantine sites, 81 actually are activated as of 25 April 2020. In terms of beds, that means 8,832 of the available 23,604 beds for quarantine have been activated, and are available.

Mkhize said South Africa was well prepared: “If people are not sick we can actually go a long way without the pressure of overcrowding”.

As of 25 April, three provinces do not have any Covid-19 patients – Limpopo, Mpumalanga and Northern Cape.

Of the 317 Covid-19 patients in hospitals, according to Mkhize, 175 patients in public hospitals and 142 in private hospitals.

Of those in hospital, 42 Covid-19 patients are in ICU: 19 in the Western Cape, 11 in Gauteng, nine in the Eastern Cape and three in KwaZulu-Natal.

Another 23 Covid-19 patients are in high care wards: 17 in Gauteng and seven in the Western Cape.

Countrywide, 27 patients are on ventilators – eight each in Gauteng and the Eastern Cape, with nine in the Western Cape and two in KwaZulu-Natal. Another 46 Covid-19 patients are receiving oxygen support: 21 in the Western Cape, 20 in Gauteng, four in the Eastern Cape and one in KwaZulu-Natal.

Mortality rates nationally average 1.9%, significantly lower than global trends, but important provincial trends emerge, signalling potentially dangerous health system deficiencies. In Limpopo, the mortality rate stood at 6.5% as of 25 April, the highest in South Africa, followed by the Free State at 4.5%.

And while the Western Cape is now the Coronavirus epicentre, the death rate stands at 2%. In comparison, the other significantly affected provinces Gauteng and KwaZulu-Natal have recorded mortality rates of 0.6% and 3.4% respectively.

Health acting Director-General Anban Pillay, who had taken the parliamentarians through the presentation before Mkhize joined, told lawmakers: “Community-level spread is still at a very low level…”

These testing, hospitalisation and overall epidemiological statistics are important as South Africa’s hard lockdown is set to ease somewhat from 1 May. That’s largely to allow the start of some economic recovery as the lockdown has dragged South Africa’s drooping economy further into recession, and around one million job losses in the formal sector are anticipated.

Government’s argument consistently has been to prioritise saving lives over livelihoods. Or as President Cyril Ramaphosa said in his last of six Covid-19 addresses to the nation:

“By delaying the spread of the virus, we have had time to prepare our health facilities and mobilise some of the essential medical supplies needed to meet the inevitable increase in infections. And it is in so doing, that we hope to save tens of thousands of lives. There is clear evidence that the lockdown has been working,” Ramaphosa said on Thursday last week. “We have to balance the need to resume economic activity with the imperative to contain the virus and save lives.”

On Freedom Day, Mkhize reiterated this. “It is critical the economic activity waits for the public health intervention to take its full effect”.

And that places the health minister in a central, and very powerful position, within government’s response to the Covid-19 pandemic – alongside Cooperative Governance Minister Nkosazana Dlamini Zuma and Trade and Industry Minister Ebrahim Patel. The securocrats have tended to remain more behind the scenes, as Defence Minister Nosiviwe Mapisa-Nqakula publicly indicated by presenting plans to the Covid-19 National Command Centre.

Taking off where Dlamini Zuma and Patel left off on Saturday, Mkhize on Monday reiterated the alert system may be differentiated as far down as to district level – depending on infection rates.

Health officials are noting the outbreaks in, for example, grocery retailers that are essential services, and other sites like the Glaxo Smith Kline factory in Cape Town, which was temporarily closed after over 70 workers were found positive for Covid-19.

Such trends have been cited as motivation for differentiated responses down to a local level within the five-level alert system.

That alert level system – the incoming Level Four proposes a 8pm to 5am curfew alongside mandatory facemasks in public and a larger range of goods for purchase, particularly winter goods – was published on Saturday for public comment.

“We are currently in the process of reviewing the comments regarding the alert system… These levels are largely dictated by the health response,” said Mkhize.

And exactly how South African life will unfold from 1 May will emerge on Thursday, when the updated regulations are expected. DM

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