Coronavirus Op-Ed

Western Cape Premier breaks down death stats and issues warnings 

By Alan Winde 7 May 2020

Western Cape Premier Alan Winde. (Photo: ewn.co.za/Wikipedia)

Western Cape is leading other provinces in the number of positive Covid-19 cases. There are various possible reasons for this. Provincial Premier Alan Winde shares analysis of the mortality data and reveals how the province is preparing for increasing numbers of sick people. We publish his statement in full because we believe it is important for people to be informed, making sure they have access to information that empowers them to play a role in flattening the curve.

South Africa is facing an unprecedented challenge. We have both a public health emergency, that threatens many lives, and an economic crisis, with major job losses expected countrywide.

In Western Cape, in line with our whole of government approach, we have been working around the clock to make sure we are prepared for the peak of infections that is still to come. But we have not stopped there. We are also making sure we can be innovative and smart in helping to get more of our economy up and running, and that this is done safely.

This week’s digital press conference will provide an update on our health response, with insights into what our data is telling us. We will also share details on our department of economic development’s interventions, as they help businesses adapt to this “new normal”.

The importance of accurately reporting Covid-19 deaths

I have received many questions from both the public and the media as to why Western Cape has more deaths than other provinces.

We take these questions very seriously, because our top priority is to save lives and every single death is one too many.

Western Cape provincial minister of health Nomafrench Mbombo convened a group of public health specialists, as well as academia, to provide an analysis of the Covid-19 related deaths in our province. 

We have world-class clinicians and epidemiologists in Western Cape and in the rest of South Africa and it is important that we leverage their insights and expertise.

Before I discuss their analysis, I want to make an important point about accurate reporting. It is essential that we accurately report and record every single death of a person who was infected with Covid-19. 

This sounds obvious, but it is not that simple. As we will share below, most of the people who have passed away due to Covid-19 had serious comorbidities. These include diabetes, hypertension and chronic obstructive pulmonary disease.

The virus can cause severe pneumonia, among other ailments, which can become fatal, especially in older persons and these people with underlying health conditions. It is therefore entirely possible for a death to occur in a health system and for the cause of the death to only be noted as one of these underlying health conditions. To confirm it is Covid-19 related, you would have to have tested the patient for Covid-19.

This requires well-run hospitals with the right expertise and a heightened awareness. If there is a suspicion that someone has Covid-19 it is important to confirm this, even if it happens after death.

This is essential because this information, like the number of infections, provides us with data on the progression of the virus and its transmission. And this data is essential to making sure our health system is prepared to respond at the peak of the crisis.

The Western Cape department of health both understands this and takes this very seriously. We believe we are accurately recording Covid-19 positive deaths in the province because of our rigorous systems and institutional expertise.

It is important that this happens across the country. If it does not, data will become incomparable and the effectiveness of its analysis might be impacted. 

Analysis of deaths in Western Cape

The breakdown of deaths to date in Western Cape is as follows:

 

  • Please note that the table reflects that some patients had more than one comorbidity.

 

The age breakdown of deaths in the Western Cape is as follows:

Our analysis of Covid-19-related deaths in Western Cape, done when we had 64 deaths on Tuesday, found that our death rate is at 1.8%. At this stage, this is in line with international data on the progression of the virus in other countries. As it stands now, the death rate is not higher in Western Cape than it is elsewhere in the world and is likely to be the same rate countrywide (accurate reporting of data assumed).

Other observations include:

  • There is a clear pattern between comorbidities and death, as indicated above
  • The deaths correlate with patterns of cases. Growth in numbers of deaths is linked to growth in the number of cases in line with this rate
  • Our age group is slightly younger than what we are seeing internationally (a significant number between 40 and 60 years old). Our health teams are analysing this further, but it is likely explained by our younger population and the general spread of comorbidities such as obesity and metabolic syndrome.

Where there is an outlier case (where the person who has died does not meet the trends we are noting above), our department will undertake a thorough review to try and understand what other factors may have contributed.

I want to stress an important point here: while the information we have shared above indicates that vulnerable groups are most at risk, this does not mean that those who are younger, or those in good health, should not worry. Not only could you help spread the virus and infect someone who is vulnerable, you could also get seriously ill. Every single person, regardless of age and health, should be part of our team effort to flatten the curve.

It is worth reiterating that we cannot avoid this virus – many of us will become infected. Our role is to slow its spread through our own personal behaviour choices, so that more people can receive treatment when they need it. Each of our actions now will determine whether our health system will cope. It is up to us all.

Treatment innovation

We have started to record promising findings on the use of proning (positioning the patient on their stomach) and high-flow oxygen in treating patients who are seriously ill, as opposed to the use of ventilators. Some interesting findings in this regard are also starting to be recorded abroad, suggesting it may be a more effective way to treat those patients who are seriously ill. We will continue to monitor this as it will inform our strategy as the number of confirmed cases in Western Cape increases in the weeks ahead.

Acceleration of confirmed cases – the curve is climbing

Last week, I discussed the importance of our active case finding approach to testing. This approach is where we actively follow the “bush fires”, or pockets of infections, and focus our screening and testing on these clusters.

We do this because we want to be as accurate as possible in recording our number of cases in Western Cape, as well as use our resources efficiently.

This allows us to monitor the progression of the virus in Western Cape and, in turn, allows us to prepare our health system through scenario planning.

So what is this data telling us? The transmission of the virus between people in Western Cape is accelerating. Community transmission is well established and more and more people are going to get infected by Covid-19 over the coming weeks as the virus spreads. Its nature, as we have seen globally, is to grow exponentially.

This is a new phase in the transmission of the virus, which the entire country will enter into at some point (and perhaps has entered into in some areas already), depending on their trajectory.

This has been made clear by both President Cyril Ramaphosa and Professor Salim Abdool Karim. The lockdown bought us time to prepare our health system for the pandemic and the peak that is still to come. It also allowed us to “flatten the curve”. It will not stop the virus and it will continue to spread.

Our focus must continue to be on preparing our health response so that we are ready for the peak, on protecting vulnerable groups of people, and on ensuring that we continue to test and confirm Covid-19 cases in our province based on epidemiological evidence.

Accurate reporting of data is also critical. We must be fully transparent and honest with the people of Western Cape at all times, because information is power. The more data we have, the better our health response can be. The more information our residents have, the better they can help us flatten the curve by changing their behaviour. We must work as one team, together.

Preparing our health system for the peak

Last week I announced that the Cape Town International Convention Centre was to be converted into an over 850-bed temporary Covid-19 hospital, following its approval by Cabinet.

The process of equipping the hospital has already begun. We will continue to update media on progress over the course of the next few weeks.

We are also in the process of finalising three additional temporary hospital facilities, which will contribute to more than 1,400 additional beds during the peak. Two of these three additional hospital facilities will be in the City of Cape Town, with the third in the Cape Winelands.

We can also announce we have the following testing and triage centres operational: Tygerberg Hospital, Victoria Hospital, Khayelitsha Hospital, Karl Bremer Hospital, Mitchells Plain Hospital, Paarl Hospital, New Somerset Hospital, George Hospital, Wesfleur, Eerste River Hospitals, Heideveld EC and Kraaifontein CHC.

The following testing and triage centres are currently nearing completion or are still under construction: Red Cross Children’s Hospital, False Bay Hospital, Helderberg Hospital, Worcester Hospital, Groote Schuur Hospital, Mowbray Maternity Hospital and Ceres Hospital.

We will make further announcements on these facilities soon.

Personal protective equipment stock increases

The Western Cape department of health has more than doubled PPE stocks in the past week and we now have R102-million worth of stocks on hand – with more on order.

The department has developed a dashboard that allows them to track the stockholding of each type of PPE at any given time. As equipment is used and new orders are received this will be reflected on the dashboard.

Full PPE kits are provided to medical personnel conducting Covid-19 tests and those treating Covid-19 positive patients. Community healthcare workers receive cloth masks and aprons for their work in the field when dealing with non-Covid cases and surgical masks for when they work with Covid-19-related cases.

Our healthcare workers are vital in our response to Covid-19 and their safety is of utmost concern to us.

Businesses are our partners in flattening the curve

At midnight on 30 April 2020, the country moved from hard lockdown to Alert Level 4 restrictions. This has meant many more people can return to work as businesses in certain sectors re-open.

This also means more people will be gathering at places of work, which increases the risk of transmission between people. We witnessed this already under the hard lockdown, where certain supermarkets and factories were the source of cluster outbreaks.

We have taken this learning from the hard lockdown seriously and realise that businesses should be viewed as our responsible partners in stopping the spread of Covid-19, as more of the economy re-opens.

Businesses, large and small, need to be empowered to follow very clear guidelines and protocols that will protect both workers and customers. They also need to know what to do when one of their employees tests positive with Covid-19. We need to work together in this way to flatten the curve.

Guidelines for businesses that re-open

To this end, the Western Cape department of health, closely supported by the department of economic development and tourism (DEDAT), has developed detailed workplace guidelines that cover infection prevention, advice on what to do in the case of employees becoming infected and additional guidance for specific sectors with regard to infection prevention.

These guidelines cover important aspects of workplace infection prevention, starting with performing a risk assessment of and implementing safety procedures in all areas of the workplace including employee and customer entrances, workstations, employee and public toilets, shop floors, change rooms, waste storage areas, payment areas, goods storage areas, delivery areas and canteens.

The guidelines also cover regular screening of employees, training with regard to infection prevention and the use of protective equipment such as cloth masks and face shields.

They detail how social distancing must be achieved by limiting the total number of people in the workplace to one person per 6m2 of office, factory or retail floor space. Businesses must rearrange workspaces to ensure that a distance of 1.5 metres is maintained between employees and/or customers and, where employees share workstations and equipment, these must be cleaned between shifts or use.

Specific guidelines are also provided for the following business sectors: office workplaces without public access, banks, post offices and government offices serving the public, public transport, e-hailing and private taxis, petrol stations, large retail stores and clothing stores, informal traders and small stores, services with prolonged contact such as hairdressers, spas, and beauty salons, construction, manufacturing and agriculture.

The guidelines give a thorough run-down of the measures expected of businesses which are currently operating, and those that may open in subsequent alert levels. Business owners who are not currently operating should use this time to start preparing their systems for when they may re-open.

For example, large retail stores will need to review their queuing systems, designating aisles for one-way traffic to reduce congestion and avoiding bottlenecks by restocking their shelves outside of trading hours.

In banks, post offices and government offices, visitors should bring their own pens to avoid sharing, contactless payment options should be encouraged and, where possible, they should consider scheduling appointments to avoid long queues and congestion.

For e-hailing and private taxis, drivers should not overload their vehicles, should drive with the windows open, ensure all occupants are wearing masks, provide hand sanitisers and open all car doors themselves to avoid passengers touching door handles.

Petrol attendants should not switch between pumps and should avoid hand-to-hand transfers of cash by putting the cash into a container and taking it to the cashier.

There are hundreds more examples and we encourage businesses to review and implement the guidelines with immediate effect. Our Western Cape department of health and the department of economic development and tourism are also available to provide support to businesses where needed to help stop the spread of Covid-19 in businesses. Please contact[email protected]

The guidelines can also be downloaded on the Covid-19 website.

DEDAT, together with Wesgro and the City of Cape Town, will be communicating these guidelines directly to business via their networks, websites and business support desks. DM/MC

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