COVID-19 Update & Government Response: Minister & Department briefing
27 April 2020
Chairperson: Dr S Dhlomo (ANC)
The Portfolio Committee on Health met jointly with the Select Committee on Health and Social Services, The aim of the meeting was to get a briefing from the Minister and his team on the progress the Department and South Africa as a whole were making in the global pandemic of COVID-19.
The Department reported that regionally, within SADC, South Africa accounts for 74% (4 220) of known cases, of which there is a total of 5 714. The country also accounts for 56% (79) of all deaths caused by the virus within the region, the total figure for which is 140. Continentally, Egypt and Nigeria constitute the other large contributors of known COVID-19 cases.
The number of new cases has increased despite a decline in test volumes over the past 4 days: 9 796, 8 820, 8 614 and 7 639 (through April 25). There is an approximate correlation between the total number of new tests and cases by day and the “total number of new tests and positivity”. In terms of community screening, 5 832 572 individuals have been screened nationally and 41 707 have been referred for testing as at April 24. The case referral rate does differ by province. In the Western Cape, the rate is “probably the highest,” followed thereafter by the Northern Cape, KZN, and the Eastern Cape.
Further details were given on patients subjected to hospitalisation and data on quarantine sites.
The Department provided an in depth exposition on the new risk-adjusted strategy for the resumption of economic activity. There would be five phased levels. He further spoke about how the system was developed and how it would work.
The Minister addressed the Committee regarding questions submitted to the Ministry. He answered, among others, the question of whether the flu vaccine would help against COVID-19; the question concerning lack of vitamin D due to a lack of sunlight exposure; and the concerns around communities with lack of access to water, electricity, food and sufficient living space.
The Minister then gave details about queries relating to when the country may return to normal life and economic activity. He also touched upon alleged forced isolation in Limpopo and Klerksdorp.
Additionally, he addressed Members queries about quarantine facilities, private hospitalizations, specialist equipment, Personal Protective Equipment, ventilators, and the readiness of mortuaries, cemeteries and crematoria.
He also reported to Members on reports of a COVID-19 vaccine, criteria for priority and admission to the ICU, whether bleach was to be used for surface sanitation, and the arrangement of foreign-trained medical professionals from Cuba.
Apologies were noted for the Deputy Minister who was receiving a delegation from Cuba (a medical brigade).
After taking attendance and welcoming those present in the audio conference, Co-Chairperson Gillion asked the National Department of Health to take the Committee through the presentation.
Progress on COVID-19: South Africa’s Public Health Response
Dr Anban Pillay, Acting DG, DoH, stated that globally we are reaching nearly three million known cases of COVID-19 and close to 200 000 consequent deaths, that is to say, a death rate of approximately “3% overall”. However, there seems to be disparities between the death rates across different countries. Some had lower than 1% and others much higher. For planning purposes, it is important for South Africa to understand the reasons behind these disparities.
Regionally, within SADC, South Africa accounts for 74% (4 220) of known cases, of which there is a total of 5 714. The country also accounts for 56% (79) of all deaths caused by the virus within the region, the total figure for which is 140. Continentally, Egypt and Nigeria constitute the other large contributors of known COVID-19 cases.
As regards the continental comparison of cases and deaths caused by the virus, South Africa has the highest rate in the number of known cases, the closest comparators being Egypt and Algeria. Yet in relation to deaths, both rank higher than South Africa, which ranks third. Thus we appear to be doing “better on the deaths” metric but we clearly have “more cases than [Egypt and Algeria] do.” The lesson to learn here is the importance of testing and early identification in order to supply adequate protection to those most at risk. The curvature of the rates of cases of various countries on the continent appear either to have flattened or are continuing at the rate at which we are currently observing.
In terms of global comparisons, South Africa is performing better than the global trend. The US is now the leading country in terms of cases, followed by Spain, Italy, the UK, Iran and China. South Africa has a low mortality rate relative to other countries around the globe.
As regards the epidemiology and surveillance data, the total cumulative cases reported in South Africa is 4 546 as at April 26, up 4.24% (185 new cases) from April 25, 2020. The national case fatality rate is 1.9% (globally it “appears to be three percent”). Across provinces, the numbers are disparate: The Western Cape and KZN constitute the biggest contributors, followed by the Eastern Cape. This needs to be followed carefully in order to identify cases and make contingency plans for those most at risk. According to the graphic on slide seven, the hotspots appear to be the in major metropolitan areas and constitute the biggest drivers of the epidemic in the country.
If we look at both cases and deaths since the time of initial reporting, it will be observed that the trend is increasing, although the rate of increase has reduced at (or about) the time of the lockdown. The Department is hopeful that this trend continues, although it will be watching to see which other mitigation measures can be introduced as needed in order to reduce the steepness of the curve.
Looking at the morbidity rate since the first case was reported in early March: The rate has remained “fairly similar” over the period.
With regard to the number of new daily COVID-19 cases and deaths: It will be seen (slide 10) that these figures have been following a trend, but from approximately mid-April there seems to have been an “uptick in the numbers,” which may be linked to Community Screening and Testing (CST) where we are seeking positive cases in persons who have not necessarily sought medical care as they may not have been aware of their status. Prior to CST we have largely been operating on a “passive system” where positive cases are only identified when a patient feels ill and actively seeks out medical attention. So to a “large extent” this contributes to the increase in numbers. Deaths have been following an “erratic trend” as may be observed from the slide: This is a function of the at-risk population and when they contract the disease.
In terms of cases by province (slide 11), there are some cases where we have not identified the province in which a particular case occurs. This is due largely to the fact that patients omit their province of residence, which results in an unclassified/unknown group. We have also seen a “huge spike” in the Western Cape, which has overtaken Gauteng as the province with the greatest number of cases. Something is driving this increase, and colleagues in the Western Cape should be able to provide more detail about this increase in the next few days.
Concerning laboratory services (slide 12), the total number of persons tested (as at April 25) was 168 643 (60% of which were private testing). Newly tested persons accounted for 7 639 (56% of which were public testing). This shows that new public sector testing now exceeds that of the private sector. This, again, is largely due to CST which accounts for 14% (22 906) of the total number of persons tested. “Screening involves screening an individual for the potential risk that they have COVID through a symptomatic assessment and thereafter they’re referred in for a test” (sic).
The number of new cases has increased despite a decline in test volumes over the past 4 days: 9 796, 8 820, 8 614 and 7 639 (through April 25). There is an approximate correlation between the total number of new tests and cases by day and the “total number of new tests and positivity”. As we are increasing CST, it does not seem to be making a “very big difference” in the positivity rate, which suggests that community transmission is still at a low level relative to “many other environments.”
In terms of community screening, 5 832 572 individuals have been screened nationally and 41 707 have been referred for testing as at April 24. The case referral rate does differ by province. In the Western Cape, the rate is “probably the highest,” followed thereafter by the Northern Cape, KZN, and the Eastern Cape.
In relation to contact tracing as at April 25, a total of 19 765 contacts have been identified through contact tracing, which shows an increase of 8% from the previous day (18 299). The national coverage rate has increased from 89% to 91% with the Eastern Cape (87%) and the Western Cape (82%) below the overall average rate. Contact tracing is clearly a critical aspect around the work of prevention. Contacts identified remain in quarantine as their status is determined, since they become the reservoirs of further infection in the community.
As regards hospitalisation, the number of cases is 4 546, recoveries 1 637, and deaths 87. Of the provinces with the highest burden of cases, the recoveries are looking “very good” in Gauteng and KZN relative to the Western Cape, which still seems to be lagging behind in recoveries. In terms of hospitalisation data, those who have been hospitalised, isolated, in ICU, and so on: You can see our ICU utilisation rates are still fairly low; the rate of those who are ventilation is also fairly low; and the rate of oxygen use is in the green. Across the provinces in general terms, there is not a high demand for high-care. This picture seems to suggest that our hospitals are currently not overwhelmed.
There are 288 planned national quarantine sites, of which approximately 28% have been activated (i.e. used); more will be activated as and if the need arises.
There are 23 604 planned national quarantine beds, of which approximately 37% have been activated; more will be activated as and if the need arises. Quarantine as a measure is being used predominantly in situations where people require it but cannot self-quarantine, or where South Africans are repatriated. Repatriated South Africans are quarantined in their province of arrival; thus quarantining in Gauteng is relatively high, since most people return through O.R. Tambo International Airport.
The objective of the risk-adjusted strategy for economic activity is that if we do not take any measures we know that this is the kind of curve we are going to see (slide 21), which indicates the health system’s capacity. The curve needs to be kept within the capacity of the health system. This will be done through a number of measures. Our intention with the risk-adjusted strategy is to see that the curve does not exceed our capacity but at the same time open up economic activity within that environment. It is important to emphasise that, in terms of economic activity, the pandemic—and not the public health measures—will depress the economy. This is evidenced from the 1918 Spanish Influenza epidemic, which made clear that those economies which decided to move early to restart their economies without reducing their respective national infection rates had a negative economic outcome relative to other nations. Thus it is critical that before restarting economic activity to await the full effects of the public health intervention. The restrictions to the economy will, however, and as has been intimated before, have to be adapted to the trends, will which necessitate what we call an “alert system” which allows us to relax or tighten the extent to which economic activity may proceed. We are currently in the process of reviewing the comments, released this past Saturday (April 25) regarding this alert system, which has five levels. These levels are largely dictated by the status of the health response. Higher levels of alert will correspond to heightened levels of the epidemic (i.e. decreased levels of economic activity) and, conversely, lower levels of alert will correspond to lower levels of the epidemic (i.e. increased levels of economic activity). The alert system will allow us to respond in this way.
The levels are as follows:
Level 5: High virus spread, and/or low readiness
Level 4: Moderate to high virus spread, with low to moderate readiness
Level 3: Moderate virus spread, with moderate readiness
Level 2: Moderate virus spread, with high readiness
Level 1: Low virus spread, high health system readiness
Ongoing feedback loop informs decision to remain at a particular level, relax restrictions further, or return to a higher level of restriction.
Our intention is to use this mechanism to classify provinces as well as districts so that over time we would have a differential response to the virus in terms of its spread and our readiness. So where there are low levels of spread and high capacity, we would be able to allow greater economic activity. As pointed out earlier, the epicenters of the virus appears to be in the metros across the country.
To determine which sectors should be allowed gradually to resume activity, three criteria will be used:
1. Risk of transmission (including the ease of implementing mitigation measures)
2. Expected impact on the sector of continued lockdown (including prior vulnerability)
3. Value of the sector to the economy (e.g. contribution to GDP, multiplier effects, export earnings)
The way the system was envisaged, was that my colleagues in the economic sector had gone through each of the different sectors (e.g. manufacturing, wholesale, retail, agriculture, etc.) to look at the contribution that each sector makes to the gross domestic product (GDP); also to look at the employment contribution in small and medium enterprises; the economic linkages, exposure, etc. They looked at all these factors and classified industries within each of these various areas and asked questions regarding the proportion of the payroll which is likely to paid at month end, what is the risk related to retrenchments, the proportion of large firms in the industry, the proportion of SMMEs etc. and developed a classification. Slide 26 gives a partial illustration of this classification. This classification was done in conformance with the above three criteria.
As regards the restrictions which have been released as part of the alert system, these will remain in place after the national lockdown, and in fact regardless of the level of alert at any given time.
There are restrictions regarding:
• Sit-in restaurants and hotels
• Bars and shebeens
• Conference and convention centres
• Entertainment venues, including cinemas, theatres, and concerts
• Sporting events
• Religious, cultural and social gatherings
• No gatherings of more than 10 people outside of a workplace will be permitted.
Passengers on all modes of transport must wear a cloth mask to be allowed entry into the vehicle, or whenever they are outside of the home. Hand sanitisers must be made available, and all passengers must sanitise their hands before entering. Public transport vehicles must be sanitised on a daily basis.
Additionally, companies should encourage their employees to work from home wherever that is possible. Workers who are above 60 years of age, as well as those with co-morbidities, should negotiate with their employer to work from home, as this demographic has a higher risk of morbidity and mortality from the data from other countries (including our own). There should be workplace protocols to monitor the spread of the disease. When workers return to work, they should be screened and tested continuously because the workplace is one of the environments in which the virus easily transmits, which may lead to widespread infection, to a greater extent than what we are currently seeing. Employees must also be encouraged to wear cloth masks; work environments should have sanitisers, and social distancing is of course also important in the workplace.
Before any sector resumes activity, the following conditions must be in place:
• In addition to generally applicable health and safety protocols, each sector must agree upon a COVID-19 prevention and mitigation plan with the Minister of Employment and Labour, the Minister of Health and any other Minister relevant to the sector.
• Individual businesses or workplaces must have COVID-19 risk assessments and plans in place, and must conduct worker education on COVID-19 and protection measures, including:
- Identification and protection of vulnerable employees
- Safe transport of employees
- Screening of employees on entering the workplace
- Prevention of viral spread in the workplace
- Cleaning of surfaces and shared equipment
- Good ventilation
- Managing sick employees
• Monitoring systems must be in place to (1) ensure compliance with safety protocols, and (2) identify infections among employees
It’s not simply a case of employees just going back to work as normal. In summary:
The alert system level (levels 1 to 5) will be determined by the National Command Council at each meeting, upon a recommendation from the Minister of Health and the Minister of Trade and Industry. A single national alert level may be determined, or an alert level may be determined for each province. The highest burden of the disease is currently concentrated in Gauteng, Western Cape, KwaZulu-Natal and Eastern Cape. The remaining provinces have a limited number of cases. Within the provinces the infection is concentrated largely in the metropolitan areas. Given the disproportionate distribution of infections there is an opportunity to have a differentiated approach to the lockdown based on the geographic distribution. The initial plan is to determine alert levels at a provincial level based on the number of cases in each province. Individual Ministers, upon consultation with, and approval from, the Minister of Health, may provide for exceptions and additional directions in sectors within their domain. A working committee should be established comprising officials from the Department of Health and the Department of Trade and Industry to consider changes to the sector restrictions as they are required.
Co-Chairperson Gillion thanked Dr Pillay for his presentation and recognised the Minister of Health, Dr Zweli Mkhize (ANC) for his remarks.
The Minister indicated that what was important for this meeting is that the Department wanted to share its progress with regards to where the nation is in its response to the outbreak. Members would be aware that we are seeing changes with regard to the outbreak on a daily basis. Gauteng started with the highest number of cases; that has changed to the Western Cape. There is a change in pattern such that there are “cluster outbreaks” which are occurring in workplaces originally identified as essential services. Thus additional support is to be sought in order to strengthen the response in that area. Similarly, KZN has also been “quite high". We are also concerned since Eastern Cape has overtaken the Free State in terms of the number of known cases. In the Free State, the pattern was based upon one incident where a church gathering was the primary cause of transmission; this has now been contained. In the Eastern Cape, the outbreak has been driven by social gatherings, mainly funerals. “Reinforcements” were put in place, since this occurred in a densely populated area. We will be looking at the distribution of the specialists coming from Cuba, so that we may “reinforce” some of the places with which we are dealing.
Another important issue is the increasing number of cases from the public sector, which is encouraging, however there is still a long way to go. Our constraint remains the supply of diagnostic kits, the procurement of the required quantities of which are taking longer than is desired. Daily explanations for delays are forthcoming. We not reached our desired capacity. We want to ensure we are ahead of the need for testing, but this is difficult in the face of shortages. “The past two weeks have assisted us” in terms of increased CST—we expect this continue for the “next few months”. South Africa has not done badly compared to the rest of the world; many countries have not done as much as we have. We are now focusing on testing in problem areas. It is important that we keep an eye on the supply of diagnostic kits, because that is “where our challenges are going to come from.”
The Minister sought leave from the Chairperson to answer questions which had previously been raised by the Committee.
Co-Chairperson Dhlomo agreed that prior questions be answered, but indicated that the Committee had agreed that, apart from certain NCOP members, no new questions would be raised in the present session, since he was not sure if members from the NCOP had been afforded the opportunity to submit their questions.
Co-Chairperson Gillion thanked Co-Chairperson Gillion and asked the Minster to allow the members of the NCOP (who were in a joint meeting with the Portfolio Committee on Health) the opportunity to raise their questions. These queries were to be limited to “clarity-seeking questions” and altogether new questions were precluded; this opportunity would be given to members of the NCOP after the Minister had given his responses to the initial set of questions already received, as to avoid potential overlap.
On whether flu vaccines will help with the fight against COVID-19; it does not stop anyone from getting the infection. There are many virus families. COVID-19 is a coronavirus which is different from the virus which tends to cause the flu which is the influenza virus. Normally, the flu vaccine will be a combination of the strains of the influenza virus. Thus it does not have a direct impact on the immunity against COVID-19. There is no cross-immunity. It does, however, reduce one’s chance of getting influenza, and thus it reduces the level of morbidity that would have occurred if the person had both the flu and COVID-19. Hence it “saves” people from the one virus so that they face one infection only. Influenza affects a large amount of people and actually has “a very high mortality” the only difference is that we are used to it so that we do not think of it as a “major killer.” At the moment, the recorded number of persons who have died from influenza tends to be much larger, and it is estimated globally that it approaches between “300 000 to 600 000.” Thus if you had both viruses it creates a “pressure point.” This is a concern as we approach winter.
On the question about the lack of vitamin D as a result of the lockdown, and the fact that certain scientists claim that sunlight might help the body’s immune system against the virus: there might be an elementary association here, but there are no randomised control studies which proves that this is the case. Sunlight is good, but that it can be linked with COVID-19 is not supported by any evidence.
Concerning the question of how communities with no water, no electricity, no food, no exposure to sunshine, living in a single room, and no ventilation are expected to cope with COVID-19: People who are living under these conditions are doing so as a result of poverty. The problem is social and economic, not due to the virus. However, there has been a lot of focus—particularly from the COVID-19 Command Council—to reach out to areas where there is a shortage of water and supply water tanks to assist those communities. National and local governments are attempting to remedy this problem daily. The shortage of water exacerbates the problem of poor sanitation. The issue of electricity is the same, particularly in informal settlements where this is one of the biggest issues. Densely populated communities will be even more difficult to manage because the number of people who get exposed to the virus from one person is quite large: Isolation, treatment at home, and quarantine become more difficult. For this reason, quarantine sites have been pursued.
Given that we are approaching winter, the next question related to when the Minister expects that South African’s may resume normal life. The return to normality will not be “symmetrical” as evidenced by the differential approach of the alert systems (i.e. the risk-adjusted approach) which classify certain areas according to the prevalence of the virus. “In this case we are at a level where the level of preparedness is very low, as well as the level of transmission is very high”—the desired position is the converse where the preparedness is high and the transmission level low. The question is balancing the various aspects which is a return to normality versus the reduction of the risk of transmission of the infection. We currently have a complex situation. Food outlets and health value chains have been deemed essential services, but this is “exactly where” there have been “cluster outbreaks”. In Cape Town, several Shoprite stores (among others) have been closed since people were found to have been positive. Returning to normality will therefore not be a straightforward issue. There will be instances in which the alert level is relaxed but is subsequently discovered to be unhelpful in a given area which sees higher than average transmission, in which case there will be a reversion to a higher alert level.
On forced isolation in Limpopo and Klerksdorp: in principle, when people are positive, they will either be asymptomatic, moderate, or have severe infection. If they are asymptomatic or moderate, they need not be admitted to hospital; they can be treated in their “own environment” in which case local doctors may assess their medical situation and decide whether they may be treated using home isolation. If the symptoms are severe, hospitalisation is required for treatment. Exceptions occur where, in asymptomatic and moderate cases, home isolation is not possible without the spread of the infection, and thus hospitalisation becomes an option. There are cases where someone’s condition has improved in hospital, and upon release had spread the disease to those at home with whom they had come into contact. In other areas, there are problems of noncooperation with the patient in their environment where it is “felt” that individuals need to be “taken” into quarantine or hospital isolation.
This situation arose in Limpopo. On the one hand, the patients (who are themselves doctors) felt that they were well within their rights to be treated at home “and so on and they were not very serious”. On the other hand, the Limpopo government had “felt” that there was a problem with cooperation and that “certain information was shared amongst them.” However, we went into the matter and, after a discussion with the MECs and others, “we said” that what was important was to “get the doctors” to undergo an evaluation to ascertain whether or not there was “a problem with the person at home.” “It looks like there could have been some misunderstanding between the doctors and where their house assistant was and so on” (sic). But at the end of the day the matter was taken up with the legal teams and ultimately it got resolved since the “patient was removed and the [indiscernible] legal teams were discussing the issue” (sic). I think the situation was unfortunate, and that adequate understanding is to be sought among the various parties so that the process of treatment does not become a “contentious” issue. But there have been a few incidences where we have had to involve “legal systems” to deal with the matter. A lawsuit was filed which was subsequently granted [it is unclear from the Minister’s remarks who filed suit]. These situations are to be avoided if possible.
That was in Limpopo. In Klerksdorp, the policy is not very different, but in this case “it would appear” that the patient was taken to a “designated ward” which was used to “hold” patients (of whom there are now five who are also being treated for other medical conditions) who were waiting for their results. In this case we do not have any record of forced isolation.
Addressing the question of quarantine facilities: for all the provinces, we are searching for sites where it is possible to quarantine people (because of their conditions and circumstances, which includes densely populated environments). In a number of instances people have been moved from their homes. In total, we have 8 832 nationally. The number of sites is 89.
On the question of facilities which were assessed and found to be compliant: 310 facilities have been identified which house 23 598 beds. We can absorb this amount of sick patients into beds, and we can go quite a long way with these numbers (without feeling the pressure) if people do not become ill at the same time.
The next question sought clarity regarding the number of private hospitalisations. As at “about” April 24, there were 317 patients: 175 in public hospitals and 142 in private hospitals. Three provinces did not have any patients whatever; others had patients in both the public and private spheres. More details are contained in the tables from the preceding presentation, the Minister intimated.
The following question concerned when the “gene expert” equipment would be used. We have started using this. We have recently done some validations. The challenge is that although this equipment can be quicker, we have a limited number of kits. We have received 10 000 kits, of which a large proportion will be moved to Cape Town, the Eastern Cape, KZN, Gauteng, and Bloemfontein. Another consignment of 15 000 is expected today (April 27). This will of course improve capacity. These kits are produced in the US. Since the US has restricted the export of these kits, there is another firm in Sweden which has been identified but they also have some challenges of which they have made us aware. We are hoping that they overcome these challenges. They have committed to increasing their supply to South Africa, but we are aware that the whole of Africa is looking for the same kits, and so there is concern about whether the Swedish firm will be able to keep up with the demand. We are in touch with the Africa CDC to look at how we can assist each other in this process.
Regarding the availability of Personal Protective Equipment (PPE): we do have PPE, but periodically there is unevenness in distribution (for example by district, or by hospital). There are areas where there are shortages. I was in the Eastern Cape last week and our reports where indicating that the province was still managing with their PPE supply. On the ground, however, doctors who were “presenting” were raising concerns about PPE and the exposure of staff. This is serious since our records were showing sufficient supply. It turns out that large quantities which were ordered had not in fact been delivered. This is a problem due to rampant price speculation; where the highest bidders are often prioritised. We intervened immediately by redistributing current supplies of PPE to the Eastern Cape to make up for the shortfall. However, we have also met with the private sector suppliers; I have looked at their available stocks. We still have stock, but the “level of commitment by the provinces means that sometimes they think they are waiting for an order. If it doesn’t come then they run short.” We need to have a more proactive approach wherein dormant stocks are efficiently distributed where necessary, irrespective of any provinces waiting for an order to which they have already committed their funds. There needs therefore to be an easy way to withdraw money for orders which have been placed but remain undelivered. In terms of the orders which have been made, they should be able to cover the next “six or so weeks.” The Solidarity Fund has the potential to assist; the fund acts as a bridging finance mechanism to help the suppliers to procure PPE and bring it into the country. Once stored within the country, provinces may order and pay for the required supply. I think we merely need active management to implement such a process in order to prevent supply shortages. The principle is that no staff member who is exposed to patients potentially positive for COVID-19 should be denied PPE—that is not correct. When I found out that this situation was occurring in the Eastern Cape, I got the manager to personally go check and verify the supply of PPE.
We have also formed the Occupational Health and Safety Committee which (among others) is responsible for raising the issue of safety of health workers. They should feel free to assist us in ordering the stock. It is one thing what the manager will report. It is another the above Occupational Health and Safety Committee will check and report. We will then act on the basis of that information.
On ventilators: we understand that we do have ventilators in the public and private sectors. We have not used “so many” yet so the question of future need is based on what we have seen in other countries. There have been companies in the country who are working with the Department of Trade and Industry (DTI), such as Ford, who have agreed to manufacture some of the ventilators which South Africa requires. We have also been liaising with clinicians to look at what else needs to be done, some of whom gave interesting proposals, including looking at companies who manufacture for the defense industry. We thought this was interesting and so we have got out team to look into that, particularly we believe that if it’s manufactured within the country it is something that is easily obtainable.
The general discussion is that there should be less agency or less rush towards putting people onto intrusive ventilators, so that “if that trend continues it allows us space to reach out to more people who would be covered by the equipment, they need the ventilator.” It is a matter of balancing the issues.
On mortuaries, cemeteries and crematorium readiness: the mortuaries, cemeteries and crematoria have a capacity of 36 000 units of storage capacity to deal with human remains. The private sector undertakers have about 28 000, and the government had about 8 000. We will engage more of the players in this sector so that we can create temporary storage capacity. We will have to look at this fairly carefully because we have to start encouraging communities not to store human remains for too long, even if it was not COVID-19-related, so that we do not run short of space.
On the reports of a COVID-19 vaccine: for a new infection such as COVID-19, the “only way of protecting the whole population” is for the population to have immunity. There are three ways to obtain immunity: (1) You get an infection and your body develops antibodies to fight the disease. These antibodies remain in your system so that every time a pathogen, virus or bacteria re-enters the body they get attacked. This is part of the normal immune response of the body. (2) A mother who has given birth, and who has the relevant antibodies, passes them on to her newborn through her breast milk. This helps to protect the baby from unfamiliar viruses. (3) A vaccine. This is the introduction into the body of an agent with features of the offending virus. The agent which is introduced is itself not harmful to the body and does not cause infection. However, the body develops immunity against the offending virus. We need to go into the direction of the vaccine because there is insufficient time to develop immunity for everyone, so that if we had the vaccine it would have “been useful.” This is just to say that we do need a vaccine and in the process of requiring the vaccine, we need to be aware that before it is made available it has to go through many trials. There are about 40 different vaccines undergoing trial and development throughout the world. Four of them have progressed to the first phase of trials in the UK, US, Australia and China. The next phase, which should start in a couple of months, is one in which many countries will be participating. We believe that South Africa has to participate in that phase because we have adequate clinical and technical research expertise to be able to monitor that vaccine trial so that we obtain the best outcomes—it is a contribution toward world knowledge concerning this disease, but at the same time if we do not participate, we will not be among the first to obtain access to the vaccine and other countries will get first access. These remarks are made due to comments in the media; trials today are more efficient and less draconian than they once were historically. All research in this regard had been subjected to ethical considerations. No human rights abuses will be accepted or tolerated.
Concerning the criteria of admission to the ICU: we have and will take guidance from the various intensive and critical care societies and specialists, who supply criteria that is to be used for admission to ICUs.
On whether it is likely that we will have another lockdown: the National Command Council (NCC) indicated that there will be a method of easing the lockdown, but it is not going to be a once-off, but a staggered, risk-adjusted approach.
In terms of using bleach to clean surfaces: there are a number of other disinfectants that are being used to clean surfaces, and we encourage people to use those to deal with the elimination of possible contamination arising from droplets on hard surfaces.
In relation to the call for the assistance of foreign-trained medical doctors: we have approached China and Cuba to get their foreign-trained doctors to come through to South Africa. However, if we are talking about foreign-trained doctors who are registered in South Africa, there should not be a difficulty in getting them to assist either if we have posts available or on a volunteer basis. It is important if you are going to used any trained professional, including doctors, that they be registered with the Health Professions Council of South Africa (HPCSA) first before they may practice, since then we may be assured of the quality of their training.
Co-Chairperson Dhlomo said that he had four further questions which had been collated from the various members and that Co-Chairperson Gillion had a further three.
Co-Chairperson Dhlomo noted that the Minister had covered the concern of PPE comprehensively but added that, if he wished, he could further elaborate on that.
The Sale of Cigarettes
He said that Dr P Dyantyi (ANC) had inquired about the rationale behind allowing the sale of cigarettes during the lockdown.
Disparity in the Provision of Information
He asked the Minister to comment on the fact that Gauteng, Limpopo and the Western Cape are showing good statistics per district, whereas we do not see that in other provinces. He asked what the reason could be for the disparity in the provision of information.
Challenges in the Eastern Cape
He asked the Minister to expand on the challenges experienced in the Eastern Cape.
Co-Chairperson Gillion asked why the release of statistics were delayed in Mpumalanga.
Her second question, also in relation to Mpumalanga, centred around a table provided by the Department which stated that there were “4 385 tested, 23 infected, 0 deaths, and 13 recoveries.” The question concerned the location of the 13 recovered and the 23 infected.
Status of CST Workers
She asked the Minister to could confirm if all those workers doing CST themselves tested negative for COVID-19.
Assistance to the Western Cape
She related that she had received numerous communications from residents of the Western Cape inquiring how the Department would assist the province as it has become the national “epicenter” of COVID-19 infections.
Reopening of Schools
Her final question related to the concern from parents regarding the reopening of schools, and how the National Department of Health was advising both the Departments of Basic and of Higher Education to deal with the opening of schools and higher learning institutions respectively.
Mr M Nchabeleng (ANC) wanted to know if there were incidences of corruption, and if so, what actions were taken to remedy those incidents so that they do not recur.
He also wanted to know about media reports of an individual driven from Cape Town to Limpopo who died at an unnamed hospital. He added that the individuals living with the unnamed person were said to be negative for COVID-19. He wanted clarity as to what happened in this regard.
Referred Cases in the Northern Cape
Ms D Christians (DA) asked about the referred cases in the Northern Cape. She said that these referred cases were very high while the prevalence of known cases of COVID-19 were very low. She wanted to know when the results of the referred cases would be released.
Masks and Sanitation in the Workplace
Additionally, she wanted to know what the regulations were around the wearing of masks and the use of hand sanitisers. She asked if masks were to be made available to citizens, particularly in places of work since obtaining one could be a problem. What workplace protocols are in place and what mechanisms will be used to ensure compliance in the workplace.
Quarantine Sites in the Eastern Cape
Mr M Bara (ANC) wished to enquire about reiterated concerns about the Eastern Cape, especially as regards the lack of quarantine sites and the “incoherent” approach to the “incorrect” reporting as regards the figures released. He wanted to know how severe the problem was and what interventions were put in place.
Testing Turnaround Time
He also raised a question about the turnaround time of testing relative to the pronouncement of results. He wanted to know if there was a backlog which could affect the figures.
On hand sanitisers and masks, he said that the Department “hopes” that employers will be able to provide employees with some of those. The Department was encouraging everyone to wear masks in public places. There was no government supply and people can make their own cloth masks. In relation to workplace protocols, the government was “working on that.” The basics should be observed, which include hand sanitation, physical distancing, masks, and that the number of employees permitted to come into the workplace must be staggered. People should also be screened.
In relation to the case of the individual who was driven from Cape Town to Limpopo and subsequently died: he said that he will inquire into the details of this event. He emphasised that if anyone is positive, it does not mean that those around them would necessarily be positive too.
On the incidence of corruption: there are no new cases of corruption in relation to COVID-19.
On the Northern Cape: results tend to come in “pretty quickly” and the only thing which may cause a delay is transportation, where the hospitals are far apart. The release of results should not take too long once specimens are taken and tested.
In terms of the turnaround time, there is no longer a backlog, which was the case approximately three weeks ago. If a backlog does occur and is identified, the public sector will assist the private sector in testing the specimens. The turnaround time is approximately 24 hours.
The reporting time is “a bit of a challenge.” When he—the Minister—reports results, he reports up until one minute past twelve at midnight the night before, and the day is used for reconciliation (i.e. to “clean up” the numbers). This is what tends to delay the time of reporting. There is a system which indicates “immediately” how many tests have been done. The indications from the system need, however, to be verified.
On how the government intends to assist the Western Cape, he has been in contact with, and will be visiting, the province. The Department will be increasing the supply of kits dispatched to the province, and will be working very closely with the clinicians who are treating patients to see what assistance they need, and will also be checking the supply of PPE. Additional reinforcements and medical staff (including those arriving from Cuba) will be dispatched. He also intimated that the government will work with the province on planning: Cape Town needs to be broken down into “small blocks”: Khayelitsha being one block, Phillippi another, and so on, so that there can be a concentrated approach due to the large numbers of people. We normally test people, he continued, on the basis of symptoms, so that anyone of the governments staff who displays symptoms will not be taken into the field.
On the opening of schools, there would be a “phased approach.” He advised members that the risk to children is not as “strong” insofar as contracting the virus in concerned. It is not so much a question of children being at risk as much as their infecting their own parents or grandparents.
On the Eastern Cape: he had raised the question of the figures. Considering the numbers of deaths that we are seeing, it is likely that if more testing is done, more positive cases will be discovered. This is why more testing kits, PPE, mobile vehicles, and experts have been dispatched. It needs to be ensured that testing is done in a way which is solving the problem, especially in areas where there is a “suspicion” of infection, identify positive cases and quarantine the infected persons immediately. He said he was not sure about the assertion regarding the lack of quarantine sites in the Eastern Cape. There are, according to him and the MEC in the Eastern Cape, at least 800 beds, he said. There is however a shortage of staff in the Eastern Cape, and a Deputy Director General had to be assigned in the district of Nelson Mandela Metro. The appointment of the Chief Director would also be fast-tracked and which would be given the authority to appoint “as many” doctors and nurses as is required, and to close the existing vacancies. Daily reports are being received which shows promising work done; the numbers are increasing and a focus is being placed on how the spread can be contained.
In Mpumalanga, most of the people who have tested positive in the province have recovered, and approximately seven are “still waiting."
In terms of the statistics per district, an attempt will be made to synchronize “this arrangement” since normally the provincial numbers are merely supplied. The provincial teams have been assigned to break down the numbers by district, which the provinces themselves are able to do.
Concerning the rationale for the sale of cigarettes during the lockdown, “various other considerations would have been taken into account but we can’t debate the issue of cigarettes, insofar as the health benefits are concerned there are none. Cigarettes as far as I know… we can indicate to you all the side effects of smoking, from the cardiovascular system, pulmonary system, causation of diseases, cancers of the lung, peripheral vasculopathy, a whole lot of issues that are caused by cigarettes, so you know, there’s not much you can say about the benefit of cigarettes and health, and that’s it as far as I would be concerned” (sic).
Adv Sibusisiwe Ngubane Zulu, Chief of Staff, DoH, wanted to add on to what the Minister had said in relation to KZN. The MEC for KZN responded in relation to the question of Addington Hospital and whether KZN has been ‘hiding” COVID-19 infections. The MEC asked that it be clarified that the province was not hiding the infections. The first infection was a nurse whose husband was employed at St Augustine’s and was infected there. As soon as the nurse tested positive, the matter was reported and the hospitals CEO addressed the staff to inform them and they immediately traced the nurse’s contacts who were also tested.
In relation to the Limpopo question: “Yes, the deceased patient had been moved from the Western Cape to Limpopo, tested positive, and then passed on. The contacts—there were 15 contacts—that were traced who were also tested and they all tested negative.”
Co-Chairperson Dhlomo thanked all members and encouraged them to continue sending questions, and thanked the Minister for arranging for the Cuban medical brigade to come to South Africa to assist the country.
Co-Chairperson Gillion thanked the Minister and his Department for their work, and also thanked all members from both Houses of Parliament. She adjourned the meeting.