With a failing sewage system, recent flooding, frequent water outages, infrastructure damage, vandalism to sewerage works and an ongoing drought leading to low water levels in reservoirs and dams, Nelson Mandela Bay is at extremely high risk of a cholera outbreak. 

A metro at high risk

A boil-before-drinking notice is still in place for the metro’s potable water after borehole water was introduced to increase the amount of water available to the metro’s residents. 

On Thursday, National Health Department spokesperson Foster Mohale said there are no cases of cholera, to his knowledge, in Nelson Mandela Bay. Eastern Cape health department spokesperson Yonela Dekeda confirmed there were none in the province. 

But the metro’s department of public health is introducing innovative new technology to map the city’s sewers and link them to communities, which, coupled with wastewater surveillance, will provide an early warning system and show which community has a cholera case.

Read more in Daily Maverick: Top SA scientists present action plan to fight nationwide cholera outbreak

On Thursday, metro officials were meeting with the South African Medical Research Council, Nelson Mandela University, the National Institute for Communicable Diseases and the National Health Laboratory Service to discuss this project as well as drinking-water surveillance and the monitoring of infections caused by antibiotic-resistant bacteria.

“Surveillance is about being ahead,” said Dr Patrick Nodwele, the metro’s deputy director for health services, explaining their programme.

“If we pick up something in the wastewater, we will know which community to go to in order to stop an outbreak.”

He added that the metro can ill afford an outbreak of the disease as that would put huge pressure on the public hospitals.

A similar early warning system was introduced during the pandemic, providing an indication of a rise in Covid cases.

Dr Patrick Nodwele from the Nelson Mandela Bay municipality announcing an early warning system for cholera in the metro, 8 June 2023. (Photo: Deon Ferreira)

National situation

So far, more than 600 people with suspected cholera symptoms have been treated in Gauteng and Free State hospitals, Mohale said, adding that the death toll stood at 31.

Read more in Daily Maverick: Cholera outbreak in Gauteng – what you need to know about the disease, its spread and how to stay safe

Government teams have managed to reach over 300 contacts as part of case-finding and contact-tracing activities, which include health promotion and continuous distribution of 3,000 hygiene packs donated by Unicef and Doctors Without Borders to homes and schools in the affected communities. 

A field hospital has been opened in Kanana, Hammanskraal, and a multi-disciplinary team is working on stopping the spread of the disease, according to the latest Cabinet statement issued on Thursday. 

High-risk drought

“We still have a drought in the metro,” Nodwele said. 

“The lower the water levels drop, the more drinking water is exposed to the sediment in the dams and the more difficult it becomes to treat the water.”

Despite high levels of rainfall in the metro during May, dam levels are still only at a combined 16.37%. 

Nodwele confirmed there were no cases of cholera in the metro and no tests had picked up cholera in the water. 

He said they are constantly looking at the quality of drinking water and doing surveillance on surface water. 

“We are testing on a weekly basis. This is more than what we are required to do. We are doing very active surveillance. All the samples are testing clean,” he said. 

“Drinking water quality is still acceptable.” DM