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Covid-19 second wave crashes over four provinces

Covid-19 second wave crashes over four provinces
Covid-19 second wave crashes in SA.

While prevention is the strongest weapon South Africans have, many seem reluctant to follow recommendations.

First published in the Daily Maverick 168 weekly newspaper.

Ten days after South Africans got the December party started, Minister of Health Dr Zweli Mkhize announced that a second wave of Covid-19 infections was sweeping the country with a worrying rate of infections among young people.

With more than 8,000 new cases confirmed on Thursday, outbreaks in four provinces are driving the current wave of coronavirus infections, with the majority of new cases from the Western Cape (30%), followed by the Eastern Cape (24%), KwaZulu-Natal (23%) and Gauteng (17%).

The National Department of Health (DOH) has set an incidence rate of five per 100,000 people as the measurement for a hotspot. All four provinces had exceeded this rate, Mkhize said. While his announcement was accompanied by strong words of caution, he did not specify further restrictions.

In the first week of December, Nelson Mandela Bay was declared as a coronavirus hotspot. This led to additional localised restrictions being set, including limiting social gatherings and religious services, stopping alcohol sales on Fridays and over weekends, banning the consumption of alcohol in public and setting an earlier curfew of 10pm.

Eastern Cape: Bearing the brunt

By Estelle Ellis

The Eastern Cape on Thursday had 9,519 active cases and a provincial infection incidence rate of 75.4/100,000, according to the Department of Health. There were 1,075 Covid-19 patients in state hospitals and 619 in private hospitals.

All districts in the province have infection rates higher than the hotspot threshold of 5/100,000.

While the rate of infection is slowing down in Nelson Mandela Bay and the Sarah Baartman District, which have borne the brunt of the latest outbreak, the incidence rate in the Port Elizabeth metro is still high at 160/100,000. This is followed by the province’s other metro Buffalo City, in East London, with 137/100,000.

According to the department’s latest epidemiological report, there is a concerning increase in cases in the OR Tambo, Joe Gqabi and Alfred Nzo districts. These districts have been flagged as “very vulnerable” by the provincial government.

The report states that the province has a 30% positivity rate, meaning that one in every three tests are positive.

Following a meeting of the provincial command council, Eastern Cape premier Oscar Mabuyane’s spokesperson, Mvusiwekhaya Sicwetsha, said there were no plans to request additional lockdown measures for the province at this stage. He said people should take responsibility to help prevent the spread of the virus.

“We don’t have plans to test people as they enter the province. What we want to do is to encourage people of our province and those who will be visiting to always wear masks, wash or sanitise hands, keep physical distance and stay away from crowded places.

“Compliance is a personal responsibility. Every person must comply. Every business that does not comply will be penalised. We cannot rule out closing establishments that break the regulations of the lockdown.”

He said testing would continue with a special focus on cluster outbreaks and hotspot communities.

With regard to initiation season, Sicwetsha said high-risk areas had been identified and families taking their children through ulwaluko would have to enforce infection control, including having the boys tested, making sure they wore masks and washed their hands with soap. He said the use of alcohol-based sanitisers would not be allowed during ulwaluko as they contain alcohol.

He added that the “homecoming ceremonies” were suspended as they are usually attended by a lot of people.

Closing the Eastern Cape’s beaches was being considered as “one of our options” as there were strong indications that allowing people to go to the beach could cause “tremendous infection spread problems”.

But “we don’t want that”, he said. While that option was not off the table, “we are looking into a broader safety plan for the festive season right up to January 2021”.

When it came to Christmas, Sicwetsha said families should take responsibility for the fight against this virus.

“Government can only do so much. We can issue regulations but it is up to all of us to comply with these. Failure to comply leads to the spread of infections and this kills many innocent people. The current regulations limit the number of people visiting homes, the numbers of people at events and it specifies what is to be done.

“The Premier is concerned that the reckless behaviour of some of our people puts the lives of our health workers at huge risk. Our health system, like any health system in the world, will not cope with high numbers of people requiring hospitalisation,” he said.

Dr Charl van Loggerenberg, the general manager of emergency medicine for Life Healthcare, said the group’s East London hospitals were seeing a rise in admissions.

While thanking health workers for their dedication, he said hospital capacity was a fluid scenario that changed on an hourly basis. “Given the capacity pressures in the Eastern Cape, we started postponing non-essential surgeries as of a few weeks ago to assist with capacity as infection numbers started rising.

“Additional nursing staff from other areas in the country have been deployed to the East London area with some Life College of Learning nursing students … being deployed to support healthcare workers.

“If people are not careful and don’t follow the requisite guidelines – including the use of masks, handwashing, social distancing and avoiding crowded superspreader gatherings – then they are being intentionally irresponsible. The impact on healthcare workers, hospital staff and high-risk individuals is astronomical and cannot be ignored,” Van Loggerenberg said.

“It is a very real concern that if holidaymakers behave irresponsibly, attend ‘superspreader’ events and don’t follow basic guidelines, then the second wave will be significantly worse [nationally] than the first and the entire healthcare system, public and private, will struggle to cope – as we have seen in other countries.”

He said of every 100 patients admitted to hospitals nationally, 17 would die; 50% of those admitted to ICU with Covid-19 would die; and 66% of those needing to be placed on a ventilator would die.

A passenger in a taxi. Photo: Deon Ferreira

Western Cape: Highest increases

By Suné Payne

The Western Cape had the highest recorded increase of Covid-19 cases, Mkhize said when he confirmed South Africa had entered the second wave of coronavirus infections on Wednesday. The province made up 30% of new cases.

The Western Cape’s confirmed cases had already started to increase in mid-November. On 17 November, the province issued a “hotspot alert” for the Garden Route, as cases were increasing rapidly there.

At the time, epidemiologist Professor Mary-Ann Davies pointed to a recent school holiday and the influx of holiday makers as a potential reason for the cases. Dr Keith Cloete, head of the provincial department of health, would later confirm at a media briefing that the Garden Route was experiencing a second wave.

Less than a week later, as cases started to increase in every district, the province issued another “hotspot alert” – this time for the Cape metro.

After Mkhize’s announcement of a second wave, the province held its 31st weekly briefing to outline the Western Cape’s safety protocols for the holiday season.

Dr Cloete warned that along with the increased cases within the Cape metro, increases in the Cape Winelands region were starting to concern him. A report compiled by surveillance teams warned of more cases and hospital admissions in the region, which includes Stellenbosch, Witzenberg, Drakenstein and Langeberg municipalities.

Dr Cloete said surveillance teams identified a low incidence of mask wearing in towns and on public transport, as well as cluster outbreaks at schools involving teachers in the Langeberg Municipality.

Dr Cloete told DM168 that during the first wave, cases were imported through international travel; this time, however, local “mobility” was an issue. He pointed to increased movement around the province, the relaxing of restrictions and the holding of more gatherings as causes for the increases in the region, which is adjacent to the Cape metro.

According to data released by the provincial health department, there was an increase of 133% of cases in the Cape Winelands over the past seven days. More than 650 new Covid-19 cases had been reported along with 24 deaths.

Sharp increases were reported all over the province.

In the department’s latest surveillance report, which DM168 has seen, problems in compliance with basic Covid-19 hygiene rules were apparent. Some districts of the Cape metro reported multiple people sharing masks in taxis, for example. There was also an increase in hospital admissions, as well as an indication of widespread community transmission.

But one of the biggest concerns for the province was the rise in Covid-19 cases among healthcare workers. According to Dr Cloete, in the past seven days, 204 public healthcare workers had tested positive for Covid-19. In comparison, 159 cases among healthcare workers were reported the previous week. Three more healthcare workers have died since the beginning of December.

“Our key concern is that our healthcare workers face significant strain over the coming weeks. We need to safeguard them and their families,” said Dr Cloete.

The worry, Dr Cloete said, was the number of confirmed cases among healthcare workers in the rural parts of the Western Cape. George Hospital had 49 cases among healthcare workers and Mossel Bay Hospital reported 28 cases. In comparison, in the Cape metro’s biggest hospitals, Groote Schuur Hospital and Tygerberg Hospital, 43 and 40 cases had been confirmed respectively.

Gauteng: An unholy mess

By Rebecca Davis

In the high-density province of Gauteng, home to the largest population in South Africa, there has been widespread confusion around Covid-19 owing to big problems with data collection and reporting.

Two doctors speaking on condition of anonymity told DM168 that the past fortnight had seen a “definite rise” in Covid-19 admissions in hospitals in the province.

“It’s happening,” said one, in reference to the Gauteng second wave. The doctor suggested that the pattern looked similar to June, in terms of the onset of an exponential spike in infections.

But Dr Shabir Madhi, professor of vaccinology at the University of the Witwatersrand, told DM168 that in terms of the surveillance being carried out at Chris Hani Baragwanath Hospital, what was evident thus far was a “slow, steady increase” in terms of hospitalisations.

Contrary to anecdotal reports that the ICU is already full at Bara, Madhi said there were beds available. “We have not seen that massive surge. There is nothing close to 100% [occupancy] in critical care units,” he said.

Jacques du Plessis, managing director of Netcare’s hospital division, told DM168 that Netcare could not answer specific questions about hospital admission numbers.

“While we have seen an increase in the number of Covid-19 cases, mainly in hotspot areas, Netcare hospitals countrywide have capacity to attend to any members of the public requiring medical assistance,” Du Plessis said.

Data from the National Institute for Communicable Diseases (NICD) on Covid-19 hospital admissions shows that Gauteng hospitals saw 2,624 new patients in the 30 days between 10 November and 10 December.

The NICD figures are some of the only reliable data currently available for Gauteng. Madhi described Gauteng as “somewhat wanting” in terms of the availability and accuracy of its Covid-19 data, which he said makes it difficult to draw firm conclusions about the profile of patients and fatalities at present, as well as the provincial hotspots.

Whether Gauteng has been accurately reporting its figures has been a question repeatedly raised by the DA in the province. In mid-November, DA Gauteng health representative Jack Bloom pointed out that Gauteng was reporting fewer active Covid-19 infections than the number of people in hospital at the time with Covid-19. A data “harmonisation” process was then undertaken, which has seen the provincial government fail to report daily data on a district level for several weeks.

This has left people with no sense of where the Covid-19 hotspots in the province are – and on Wednesday this week, the province suddenly reported 1,162 new infections.

Until Health Minister Zweli Mkhize’s second wave announcement, the accepted wisdom was that Gauteng looked likely to keep infections on a manageable scale until mid-January 2021, when people started arriving back in the province from holidays spent elsewhere.

On 27 November, Gauteng Premier David Makhura said there had been a “stable seven-day rolling average” of between 5% and 6% positive tests in the previous few weeks.

“Experts are predicting low case numbers [owing] to anticipated decrease in mobility in the province in the last few weeks of December,” Makhura said.

But by the beginning of December there were already anecdotal reports of temperature checks and sanitisation measures being relaxed in taxis, stores and malls around Gauteng. What seems to have also thrown a spanner in the works is potentially the effect of the Matric Rage superspreader event in Ballito, KwaZulu-Natal, which at least 1,300 Gauteng youngsters attended. Gauteng contact tracing teams were said to be “working around the clock” this week to track down the students and ensure they are tested.

The Gauteng Department of Health has expressed confidence in its health facilities to withstand another Covid-19 surge, with about 10,631 beds available in both state and private hospitals. Jubilee District Hospital in Hammanskraal, Tshwane, has 60 new beds ready to go in a new 300-bed facility built in preparation for a possible Covid-19 surge. Spokesperson Kwara Kekana did not respond to questions from DM168 about whether a plan was in the works to revive the expensive Nasrec field hospital.

At the time of writing, provincial authorities had not yet indicated specific Covid-19 containment or mitigation measures in response to Mkhize’s second wave warning. It had already been announced, however, that motorists travelling to and from Gauteng over the holiday season would face screening and testing. Meanwhile, there are already indications that the Covid-19 pandemic has put strain on wider systems in the province: more than 53,000 Gauteng pupils have failed to return to school since the outbreak began.

(L-R) Lennox Mabaso, KZN Provincial Government Communication, Bheki Ntuli, KZN MEC for Transport, Community Safety and Liaison and Ravi Pillay, KZN MEC for Economic Development, Tourism and Environmental Affairs Department have a meeting outside Cubana during the launch of the multi-disciplinary crime-fighting intervention programme titled Operation Vala on December 10, 2020 in Durban, South Africa. Photo: Gallo Images/Darren Stewart

KwaZulu-Natal: Festivities on hold

By Desiree Erasmus

“We haven’t quite got there yet,” KwaZulu-Natal premier Sihle Zikalala told DM168 when asked on Thursday about the possibility of an extended lockdown in the province’s Covid-19 hotspots.

Zikalala said he had been juggling walkabouts to monitor compliance ahead of the province’s festive season rush, which officially starts on the Day of Reconciliation public holiday on 16 December. But, when it comes to Covid-19, things change quickly.

Last week, the KwaZulu-Natal cabinet put a temporary halt on large festive season events that could draw crowds where a lack of physical distancing could lead them to become “superspreader” events, as experienced after the so-called Ballito matric rages. “Small family activities” were advisable, the premier said.

Zikalala said the province had identified two hotspots – uMgungundlovu, particularly Msunduzi (Pietermaritzburg area); and Ilembe. The premier at first called eThekwini a hotspot, but then said it was more an “area of concern”, as available data was indicating a rapid increase in infections.

“There are also areas that we are monitoring closely – Harry Gwala [Kokstad area] and Ugu [lower south coast] – because of their close proximity to the Eastern Cape.”

The latest official figures for the province, released by KwaZulu-Natal’s department of health on Thursday, showed a total of 134,184 cases, of which 10,985 were active. This was up from 9,578 the previous day. New infections stood at 1,576. eThekwini had, by Thursday, recorded 64,451 confirmed cases since the start of the outbreak, 1,682 deaths, and 58,679 recoveries.

Hotspots are uMgungundlovu district which had 17,378 cases (with 15,662 recoveries and 467 deaths), while Ilembe had 7,890 confirmed cases (with 6,927 recoveries and 129 deaths). But the numbers do not tell the whole story. In June, just over six months ago, the province’s health department released a Covid-19 Situation Report, compiled with the National Health Laboratories Service which shows that the case volume distribution has not changed since then, with uMgungundlovu and Ilembe districts already considered hotspots. eThekwini was included at the time.

The local economies of these three regions are intertwined, with people often living in one, socialising and working in the others.

In June, there were 2,869 total cases, of which 49.9% were active, with a death rate of 2.1%. Six months later, active cases make up just 8.2% of the total 134,184 overall positive cases in the province, with the death rate just marginally up to 2.6%.

Zikalala said more roadblocks would be set up in the province, as would checkpoints on the streets for “those who go around without masks or those who drive while under the influence of alcohol”.

“We are expecting an influx [of patients],” he said, “but we don’t believe we will run out of bed capacity.”

As for hospital staff, the contracts of those employed to add capacity since the outbreak would be extended to March 2021, he said.

Tourism is big business for KwaZulu-Natal, and eThekwini is a prime holiday destination for the working and middle class. According to the metro, the city attracted “over 3.8 million overnight visitors [domestic and international] and approximately 1.3 million day visitors in 2019”.

“In 2020, the numbers were expected to increase by approximately 4% domestic and 2% international” for eThekwini – but that was before the virus hit. The metro anticipated a R2-billion injection into the local economy over the 2019 festive season, but it’s unclear what these projections are for 2020.

There are also other mass gatherings that have to be taken into account, such as the Shembe church’s three-day barefoot pilgrimage up the “holy mountain” Nhlangakazi in the Ndwedwe area, on the first Sunday of the new year. Up to 100,000 pilgrims make the annual journey. Ndwedwe falls in the Ilembe district.

Nazareth Church spokesperson Thokozani Mncwabe said congregants would “respect the law” as to whether they could proceed or not with their pilgrmage.“I do not know how it would be possible to take [only] 500 people to the mountain when we have thousands. We will wait for [the inkosi] to make a decision while monitoring what happens in the country.” DM168

Additional reporting by Lwazi Hlangu.

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