By 14 June 2020, there were 156 confirmed Covid-19 cases and one Covid-19-related death in the Northern Cape. At 0.2%, the province makes up only a very small fraction of the country’s total of over 70,000 confirmed cases. 

But as the number of confirmed cases are rising in the province, so too are concerns among residents that not enough is being done to curb the pandemic in the province, that testing numbers are too low and the provincial health department is stingy with information on its Covid-19 response.

Mining for Covid-19 information 

The DA in the Northern Cape submitted a Promotion of Access to Information Act (PAIA) application to have the province release more detail around testing and screening efforts earlier in May 2020. Provincial DA leader, Andrew Louw, in a statement at the time, said when faced “with a war on an invisible enemy, the best defence is to arm all citizens with a combination of transparent, thorough and accurate data”. 

There has been no official response to this PAIA application. 

Spotlight has since requested an interview with Health MEC Mase Monopole and head of the provincial health department on the province’s Covid-19 response. After many follow-ups, however, it was health spokesperson Lebogang Majaha who responded with only sparse answers to this list of preliminary interview questions.

Last week, Louw again slammed the province for “the lack of transparency regarding the Northern Cape’s deficient testing capacity, as well as the lack of urgency that it is being dealt with”.

The National Education, Health and Allied Workers’ Union (Nehawu) in the province is also not happy with the department’s Covid-19 response. The union – which says it represents over 2,500 healthcare workers, of which 600 are nurses – has been calling for health and safety stakeholder meetings in every region in the province. 

According to Nehawu, 18 healthcare workers tested positive for Covid-19 in the province, but the provincial health department earlier put this number at four.

Nehawu’s provincial secretary, Steffen Cornelius, told Spotlight “the number of people tested is way too small”. He also flagged limited personal protective equipment (PPE) as a serious concern. “Remember this [issue] doesn’t start now. For example, EMS [Emergency Medical Services] personnel are only receiving PPE now after many requests over the past years. There is literally no appreciation of public servants,” Cornelius said. “The infection among workers is increasing and that’s partly because of the ignorance of the department,” he said.

Testing and screening in the Northern Cape

Nongebo Phindiso, who for the last nine years has been a community health worker at Masakhane Clinic in Kimberley, told Spotlight she is now under quarantine after two of her colleagues tested positive for Covid-19. According to Phindiso, the department is not doing enough to curb transmission for Covid-19 in the province. 

“They’re failing us. They don’t have enough equipment, especially the testing kits, there are not enough, we only do screenings. They only want a person to have symptoms, that’s when they will test you. If you don’t have symptoms, then you will not get tested. The department’s communication is very poor because we’re constantly sending them our complaints and they never respond. This means if you don’t have signs and symptoms, but you’re infected, you will not be tested or quarantined.”

Figures released by the National Institute for Communicable Diseases (NICD) show that the Northern Cape has tested far fewer people per 100,000 than provinces like Gauteng and Western Cape. When asked about this and if the department thinks it is testing enough, Majaha insisted the province “is on par when it comes to testing on Covid-19”.

According to figures released by the Northern Cape government, the department had conducted 1,346,486 screenings and 11,722 tests for Covid-19 in the province by 11 June 2020. Based on Statistics South Africa estimates, however, there were 1.23 million people living in the province – almost 150,000 fewer people than the number of screenings reported.

Earlier in May 2020, Monopole said in a statement that the health department “recognised the need for more testing and plans to test more people admitted to hospitals, as well as their close contacts”. 

Testing difficulties

In response to concerns about South Africa’s testing numbers, Minister of Health Dr Zweli Mkhize has pointed to the “global need for test kits with countries in the north taking up the majority of the kits that are available, given the large number of positive patients in these countries”. 

According to Mkhize, testing strategies by some provinces have been refined to prioritise healthcare workers and vulnerable groups for testing. Mkhize has also acknowledged the backlog in testing affecting all provinces and indicated that provinces with higher transmission rates may be prioritised for testing.

But there are also other factors, as became clear recently when Dr Kami Chetty, CEO of the National Health Laboratory Services (NHLS) briefed MPs in Parliament’s Portfolio Committee on Health and Select Committee on Health and Social Services on testing capacity and provincial action plans for Covid-19. 

ANC MP Annah Gela asked Chetty about the lack of detail on testing and capacity in the Northern Cape. Gela pointed out the Northern Cape is not listed among provinces where PCR equipment (polymerase chain reaction) is distributed. “Why are they not receiving the machines? Is there no need?” Gela asked. DA MP Delmaine Christians also raised concern over the lack of statistics in the Northern Cape. “What is the true picture of the Northern Cape?” she asked.

Chetty said the NHLS has been monitoring the Northern Cape as its numbers increased and they intend “to capacitate the province”. “The Northern Cape is not being excluded. Our current platforms we are using for testing, except GeneXpert tests, are tests that have to be signed off by a virologist. So it can’t be done in any lab. But not every lab has a virologist,” Chetty said. 

“So, we are looking at a plan to get a virologist to support the Northern Cape so that we can get equipment there.” There is also no virologist among the Cuban healthcare workers assigned to the province. She said the province has GeneXpert test kits and does “some of its own testing, but over and above [that, we] will get more equipment into the Northern Cape”.

It’s unclear when, as Chetty did not elaborate.

So what is the ‘true picture’ of testing capacity in the province?

The provincial health department’s responses to a DA question posed in the Northern Cape legislature on testing capacity showed the province received six of the 67 NHLS mobile testing units that were allocated to provinces. 

The department in its response also said in April 2020 the NHLS received 100,000 swab-sampling kits for the province. Swab samples are collected from the public health laboratories in the districts and then sent to provinces like the Free State and the NHLS laboratory in Cape Town. At these laboratories, only 300 tests per day are for the Northern Cape’s samples. The private sector does its own testing in the province. 

According to an earlier statement by Manopole on 27 May 2020, the total number of tests done was at 6,600, meaning about a month after, the province still had about 93,400 test kits. Last week (8 June 2020), the department’s figures showed the number of tests in the province stood at 11,722. On 11 June, the number of tests rose to 14,854.

So far, the province only tested people if they met the criteria set by the National Institute for Communicable Diseases (NICD). In its response to the question in the legislature, the department said they now also started testing all close contacts. The plan is to test all in-patients and all frontline staff.

Capacity challenges

One challenge in the Northern Cape is a lack of specialists in key areas. Recently, when DA-MP Siviwe Gwarube asked the minister of health in Parliament about the number of virologists, epidemiologists, biostatisticians and any other medical specialists relevant to the fight against Covid-19 in the province, the answer showed none. It showed no virologists, no epidemiologists and no biostatisticians were among the 30 medical specialists the province has to help with its Covid-19 response.

It is not only human resources that the province has a shortage of. Based on epidemiological modelling that the national Department of Health relies on, it is recommended that the Northern Cape should have at least 71 critical care beds with ventilators for Covid-19 patients at the peak of the epidemic in the province.

“Currently, we have identified 30 ventilators, which gives a shortfall of 41 ventilators. We have been earmarked 30 ventilators from the CSIR Ventilator Project and await confirmation. The various mining houses in the province have promised to donate 18 ventilators before the end of June,” says Majaha.

First Covid-19 death

The Northern Cape reported its first Covid-19 death on 19 May 2020, after 60-year-old Nomihlali Mkala from Jan Kempdorp succumbed to the disease. As Spotlight understands, Mkala was admitted to Jan Kempdorp Community Health Centre (CHC) for congestive heart failure, among other complications and died on 11 May. Mkala’s younger sister Nosummer Mcumba told Spotlight that her late sister was also a diabetic.

Mkala visited the Eastern Cape earlier in 2020 and returned to the Northern Cape during the inter-provincial travel window period that ended in May. The family is still puzzled about how or where Mkala could have contracted the virus. 

Mcumba said her late sister was a prayer warrior who enjoyed worshipping the Lord. She said she is saddened by her sister’s death. Mkala was buried on 23 May 2020. 

“I don’t know whether she got the virus from home or she came with it from the Eastern Cape,” Mcumba said. 

“We only received the news that she died of Covid-19 on 16 May, the fifth day after her death while we were making funeral arrangements. The news about the cause of her death affected us badly. We started worrying about family members who were in contact with her. Everyone in the family tested for Covid-19 and our results came back negative. We were told the body was not supposed to stay for over four days, so we then had to rush the funeral arrangements with no assistance from the department. No one visited the house to come and sanitise. It wasn’t their concern how we were affected and we didn’t receive any counselling,” Mcumba said.

Majaha, however, told Spotlight that the MEC assigned the department’s clinical team to offer counselling and support to the bereaved family. 

After Mkala’s death, the Community Health Centre (CHC) in Jan Kempdorp was temporarily closed, and staff and patients tested. This was followed by a visit by Manopole.

Unpacking the Northern Cape response

Spotlight asked the department about what appears to be a slow start for the province’s Covid-19 response, but did not receive a detailed answer. Majaha said since the start of the national lockdown, the department has intensified [its] screening campaign to determine those eligible for testing for Covid-19. He also said public education has played a major role in empowering communities about the importance of hand hygiene, social distancing and wearing of cloth masks in public. 

Majaha acknowledged the union’s concerns over the lack of PPE, requests for danger allowances and fatigue due to many vacancies. He said the department has since met with the union to assure them of its commitment to address all challenges confronting the healthcare services in the province. Majaha said the issues are “receiving attention” and confirmed there is sufficient PPE stock at the moment and more orders have been placed to ensure that no facility runs out of PPE.

According to Majaha, there are over 760 contact tracers across the province and this number will gradually be increased based on the workload.  

The department’s figures show four healthcare workers have tested positive and they are all in self-quarantine, Majaha said. “These healthcare workers have a travel history outside the province. One of them was a doctor working at Robert Sobukwe Hospital in Kimberley, who recently tested positive for Covid-19. Her results caused a minor uproar at the hospital on 20 May whereby most healthcare workers at the time felt unsafe to continue working there,” Majaha said.

“At Robert Sobukwe Hospital, the tracing and testing teams have been hard at work. So far, 46 staff have been tested and placed in quarantine, including 30 nurses, 8 doctors, 5 porters, 2 cleaners and 1 administration staff member.”

Of the 217 Cuban healthcare workers the government recruited to help with the Covid-19 response, 11 were allocated to the Northern Cape. Majaha said they will help with surveillance of Covid-19 identified hotspots, monitor new cases, help prepare for a Covid-19 surge and help monitor progress made in the department’s preventative strategies such as contact tracing, mass screening and testing.

Views from the community

Meanwhile, Thabiso Seatlhodi from Kuruman feels there is a lot to worry about. “Solely because there is no plan or mitigating factors in place with regard to preventive measures for Covid-19. I have seen no people trained to assist those poor communities and bear in mind that the Northern Cape is the biggest province and very dispersed,” Seathlodi said.

“People are mostly screened at the shops. The stats are low because there is not much done, like your health promotions to reach out to the marginalised in poor rural areas,” she said. “The stats are not the true reflection of what is done in the province. The MEC is not conversant where issues of health are concerned. They’re definitely not visible.”

Kimberley resident Monwabisi Ka Jobela feels most residents no longer care about lockdown restrictions. “I think people will only be serious if someone close to them gets sick. That’s the only time it will hit home.” 

Ka Jobela said he believes in advice to treat everyone as if they have the virus. “This will keep you on your toes and you will be cautious and adhere to the rules. I’m really worried because the numbers in the province make people relaxed and not follow the necessary precautions.”

 Another Kimberley resident, Lerato Sebe told Spotlight she is unaware of any safety campaigns by the provincial department. “[There is] little to no information about testing centres, leaving many people untested.  Regulations are not necessarily followed by the citizens of the Northern Cape. There is too much movement, no physical distancing, no wearing of masks and many kids playing in the streets. So, there’s a lot to worry about even with the low numbers.”

Sebe said she is concerned because the virus could spread “without us knowing”. “I am worried cause this might take us back to Level 5 if the virus spreads at this rate and we don’t have the resources and the capacity to salvage such a problem as a province.” She too cited concerns that not enough people are tested.

Thapelo Moncho, who is a community healthcare worker from Jan Kempdorp, told Spotlight what is needed is “mass testing and closing of all provincial border posts”. “Our province has the lowest number of cases and our facilities have enough PPE and systems in place to curb the pandemic,” he said. DM/MC

This article was produced by Spotlight – health journalism in the public interest. 

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