The Western Cape Department of Health presented the situational analysis of the Covid-19 pandemic which was based on the results obtained from residual specimens of patients who had sought COVID-19 unrelated services. These results had been proven useful for monitoring trends, with regards to infection rates, and comparing locations when tests targeted the same patient groups. General comments included the reduction in COVID-19 infected persons in the Cape Metro as well as in the Rural Districts. More recently, the Cape Metro acute hospitals decreased their COVID-19 bed capacity and re-introduced normal clinical services.
The remarks from Committee Members focused on the mortality and hospitalisation data which continued to stabilise, reflecting that the health platform had coped with the cases requiring admission during the initial surge. The emphasis was on importance of ensuring a strong focus on surveillance and containment for the next 18 - 24 months. A Member sought more information regarding the contingency plan in place along with what the Department’s strategy for densely populated areas was.
The Chairperson welcomed the Members and delegation to the meeting and the rules of engagement were explained
Western Cape Government: Department of Health Situational Analysis of Covid-19
Dr Keith Cloete, Head of the Western Cape Department of Health, began by interpreting the sentinel serology data which was based on residual specimens from patients who went to services for reasons unrelated to COVID-19 such as antenatal care and HIV routine viral load testing. The tests had been useful for monitoring trends or comparing locations when tested in the same patient groups e.g. antenatal testing was the mainstay of HIV prevalence surveillance for many years. These patients differed from the general population in many ways which made generalisation more difficult and they included;
- People who use the public sector
- People using health services where they may have infection exposure
- Limited to people of particular ages or in case of antenatal care to women
- Socio-economic differences (HIV more prevalent in poorer areas) or differences in person-to-person exposure
Preliminary serology findings:
The study was only approved last week and the preliminary findings with detailed results are still to follow
- Approximately 2700 tests have been conducted on residual specimens of primary care antenatal and HIV
- Patients coming for routine pregnancy and HIV blood tests in Cape Town Metro facilities
- Antibodies to SARS-CoV-2 suggesting previous infection in 40% ranging from
- 30% to 46% across the subdistricts in the Metro
- 37% (antenatal) to 42% (HIV) by patient group
- 33% (Men with HIV) to 45% (Women with HIV) by gender
- 36% to 43% by 10-year age group between the ages of 20 and 60
- The general population seroprevalence likely to be substantially lower than this, but difficult to estimate with any precision at this stage
- Nevertheless, the data supports the interpretation that, especially in poorer communities, a relatively high proportion have been exposed to and infected with COVID-19
- This seroprevalence is in line with what we would expect based on the number of deaths and the epidemic trajectory (declining in spite of lessening restrictions)
Implications of serological findings – what is to come:
- Unlikely in the short term to see explosive outbreaks in high-density vulnerable communities which have already experienced high morbidity and mortality
- Even in areas with high seroprevalence and lowered risk of repeat outbreaks, many individuals remain susceptible
- Substantial heterogeneity in seroprevalence is highly probable and there will likely be communities or population groups where ongoing vigilance is critical in order to interrupt transmission through outbreak response
- There are not, yet, reliable tools to predict the likelihood, location or timing of future resurgence – ongoing surveillance is the key to the next phase together with learning from countries ahead of us.
South Africa and Western Cape surveillance strategy for next phase:
- National task team with involvement of Western Cape epidemiologists
- Uncertainty about likelihood, timing, location and magnitude of resurgence
- Important to monitor global experiences
- Pattern of inequality and spatial geography might result in ongoing risks differing extensively by location and socio-economic status
- Local surveillance and responsiveness to emergent data (case management and strategic responses to epidemiological trends) are critical
- Updated surveillance strategy proposed
- Case-based surveillance and outbreak response are a key foundation supplemented by population surveillance approaches (serology, molecular, wastewater)
Acute service platform – general comments:
- The COVID pressure has eased off considerably in the Cape Metro and more recently in the Rural Districts
- Cape Metro acute hospitals are beginning to decrease their COVID bed capacity and are beginning to re-introduce normal comprehensive clinical (non-COVID) services
- Thusong and CTICC Hospital of Hope have been closed; Brackengate (renamed Hospital of Hope) currently has 29 patients and Sonstraal has four patients
- Nurses and doctors from the Metropole are assisting the colleagues in the rural districts with their COVID response
- The Diabetic project continue to achieve good results: for cases assigned to the VECTOR team who present early, the mortality is very low (4.5 %) compared to 28% mortality pre-intervention
Key tenets of the re-introduction of comprehensive services:
- The community-oriented primary care (COPC) approach and the gains made in various geographic areas will be leveraged
- Each service sector will implement service plans based on the life-course approach (in line with the “restoring well-being” priority)
- The re-introduction of comprehensive services across the platform will enhance the implementation of Universal Health Coverage (UHC) in the province.
- The gains made during the ‘Whole of Government’ (hotspot strategy) as well as ‘Whole of Society Approach’ will be leveraged to introduce healthy lifestyle and prevention approaches across all sectors
- The case, mortality and hospitalisation data continue to stabilise
- The health platform has coped with the cases requiring admission, during this initial surge
We remain in a position to contract with the private sector if required
- We started scaling up comprehensive health services in a balanced manner, building on the innovations from the last five months
- It is essential to ensure a strong focus on surveillance and containment for the next 18 - 24 months
- We are finalising a formal review process to develop a coherent plan for the next 18 - 24 months based on our collective learnings
Ms W Philander (DA) asked what the contingency plan was and a detailed explanation on the mentioned strategy going forward from the Department when it concerned the more densely populated areas such as informal settlements and rural areas.
The Chairperson asked for detailed information on the serological test and the benefits of knowing the number of people who had been exposed to Covid-19. She enquired whether it would be helpful or not for everyone to be going for antibody testing and what people in their communities could do to continue keeping the elderly and high-risk individuals safe as COVID-19 is still present despite the decline in numbers.
Ms R Windvogel (ANC) wanted to know how the increase of access corresponded to the COVID-19 infection rates along with the linkages between mentioned dates. She asked about the aim of the household survey for blood testing that would be conducted in the Western Cape and if the proposal strategy for testing was still limited to the high-risk groups.
Dr Cloete responded that the serological tests had the benefit of showing that somebody had been exposed to the corona virus by doing a blood sample two or three weeks or longer after infection. He further clarified that the blood sample had no place in confirming whether someone currently had COVID-19 or not. The only benefit of the blood test was to say whether a person at some or other point over the last three months had been exposed to the corona virus, whether they had symptoms or not. It merely showed that the virus had been physically in a patient’s system but had very little personal benefit to the patient or individual concerned.
Regarding the household survey, he mentioned that it was being done by the Human Sciences Research Council together with the National institute for Communicable Disease and the national survey was being collaboratively worked on by the Western Cape Department of Health and local universities. The Department was currently working on the sample size and needed to make sure that there were enough samples to give a clear indication of the number of people who had been exposed to the virus. Officials would be going into communities and knocking door to door, taking blood samples which would be tested. The implications of those findings were that they could not generalize the population until they had the community’s prevalence, and only then could they pronounce on community coverage. However, an early indication saw that exposure to COVID-19 had been more prevalent in densely populated areas.
The Department was taking a blanket approach to say vigilance would be key and the distribution of fresh face masks, the practise of social distancing, good handwashing and hygiene would be continually promoted, and these habits need to be practised until a vaccine is available. Within the last week, restrictions of testing in Metro’s had been lifted and six additional categories would be tested. The spot strategy focused on continuing to drive the message to make sure that masks were available to people who could not afford them, and the public continued to maintain social distancing in public spaces to ensure and curb the exposure to the virus.
The measures put in place to protect the elderly and more vulnerable people was through the restriction of movement and delivery of medication to their homes to avoid them having to go out in public. The most effective measure would be for the high risk and elderly to stay at home and to ensure less exposure.
He stated that it was now possible to extrapolate out of the seroprevalence study that the correlation was correct and therefore the vulnerability and proportion of exposure in Khayelitsha was higher as opposed to other areas. This was because when numbers reached a peak there were more people who had cases and died in Khayelitsha in relation to other areas.
Mr P Marais (FF+) wanted to know how the Department ensured that blood would not contaminate the next person it was given to with reference to blood donors who had not been tested. He thanked the Department and affirmed his respect to them for the brilliant job they had been doing.
Mr R Mackenzie (DA) wanted to know if a programme had been implemented to ensure that the staff were given a break and taken care of. In the event that a second wave occurred, staff members could not be exhausted, otherwise they would not be able to function effectively. He re-emphasised that the health and welfare of workers was essential for efficiency.
The Chairperson asked for more information on the concept of ‘long COVID-19’ and how COVID-19 was being dealt with as if it were a chronic illness. South Africa seemed to have missed its flu season which usually resulted in a large number of flu cases, however, it seemed that there had only been a single case of flu which had gone through the National Laboratory. She wanted to know if the absence of the flu season was a result of the lockdown regulations due to COVID-19.
Dr Cloete responded that there was an extensive review in place which was both epidemiological from the data achieved as well as the work that had been done with collaborative partners. Publications on the work that had been done, the successes and the many lessons learnt would be made available. The Department had also been approached by many academic partners for the purpose of doing proper academic pieces.
Over 600 000 medications had been delivered to people’s homes to avoid them having to visit their local pharmacies. It had been a big lesson learnt regarding working together across various partners.
He emphasised that the question of the blood donors was very important and explained that the Department had been working with blood banks to determine the criteria used for sample screening. Stringent and rigorous testing measures were put in place before anyone, even in hospitals, could donate or receive blood. The strict safety measures safeguarded patients in terms of blood donation and blood donors were given samples to first check their blood type which was another area where serological testing could be done.
As working staff, no team member could work for seven days nonstop and the routine adopted was that every seven days should be followed by a couple of days off in order to normalize the weekend resting period. Initially staff members had been working seven days straight with no days off. Rotational leave amongst senior managers was being done in order to make sure that replicating the resting and recuperating period was possible through the entire system. There was a need for staff members to rejuvenate after they had been working extremely hard. It was a resting break which they all deserved and needed in order to go back to work feeling refreshed and ready to work.
Regarding the ‘long COVID-19’ concept and the flu season, he mentioned that it had been wonderful that there had been no other reported flu cases. It was as if the lockdown had served to curb the spread of the flu as there had been significantly less interactions between people. The Western Cape had a huge flu vaccine drive with the province having the highest flu vaccine update over the last ten years and the combination of the flu vaccine and the lockdown both contributed to the absence of the flu season. Interestingly, when the dates for HIV and TB patients were compared, between 2019 and 2020, the flu had been the determinant in 2019 and the reason for the vulnerability and death of HIV and TB patients. Fewer people had died of HIV and TB in 2020 which was a fantastic outcome.
In terms of the ‘long COVID-19’ concept, it was anecdotal and there were very few cases. There were very few cases to give more informed answers and progress was being tracked as it was on the radar but not featured prominently.
The Chairperson thanked Dr Cloete and his team for the presentation.
The Committee jointly thanked the Department for their efforts and hard work during the pandemic period.
The meeting was adjourned.
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