Update on healthcare services in relation to Covid-19: Eastern & Western Cape Provincial Departments of Health briefings

Video: PC Health

Audio https://drive.google.com/file/d/1sVj5XVcspwfZduNzIa_eacE4eCrxvsT6/view?usp=sharing 


Western Cape Department of Health Presentation

Eastern Cape Department of Health Presentation

The Portfolio Committee on Health met on a virtual platform for a briefing by the Health MECs and Heads of Departments of Health in the Eastern Cape and the Western Cape on the progress that the provinces were making in coping with the Covid-19 pandemic and in preparing for the roll-out of the Covid-19 vaccine.

The Eastern Cape Department of Health briefed the Committee on the Covid-19 cases in the province, bed availability, Covid-19 admissions, oxygen supply, Covid-19 testing, circumcision schools, testing of mortal remains, availability of medicine and personal protection equipment as well as the plan for the vaccination roll-out in the Eastern Cape. The resurgence in infections in the province had peaked in the middle of December 2020, but the rise in infections had happened in different districts at different times and so the second wave was lasting longer than the first wave. The pandemic had seriously impacted health workers in the province with 9249 testing positive and 161 dying of the virus. 3.7 million people in the Eastern Cape were to be vaccinated against Covid-19, starting with 200 000 healthcare and related workers.

Committee Members asked what could be done from a national perspective to help the Department and to improve the quality of life in the Eastern Cape. What were the root causes of the challenges and what could national  government do to assist? What was the normal number of deaths in the Eastern Cape compared to the number during the pandemic? A Member asked if research had been done on Ivermectin, currently classified as a veterinary medicine, given to Eastern Cape patients who contracted Covid-19. Another asked what the province had done to hold accountable those who had given Ivermectin to humans without the approval of the South African Health Products Regulatory Authority (SAPHRA).

Members were concerned about the number of vacant posts in the Eastern Cape, even the Department of Health had an Acting Head of Department. As the province did not yet have a plan for the vaccine roll-out, when could the Committee receive a comprehensive plan? Had the planned bulk installation of oxygen started on 11 January 2021? Was there a need for new field hospitals in the three districts which had reached maximum bed capacity or could wards be changed into Covid-19 wards? Would the Rapid Antigen Test, recommended by the World Health Organisation to identify cases in high infection rate areas, be used for diagnostic purposes and what were the benefits of that?

Members noted that communities did not know what to do when people were ill with Covid. What plans did the Eastern Cape have in place to address that? When would the community health care workers be given permanent contracts so that they could assist in the response to the pandemic? Why was Joe Gqabi district experiencing an increase in new cases when the peak had passed? Why had Covid-19 patients been mixed with TB patients in the Empilweni TB Hospital? How were mortuaries in the Eastern Cape being helped to deal with the backlog? Were legal processes being followed before the exhumation of bodies to test them for Covid-19?

The Western Cape Health MEC declared that the Western Cape was ahead of the pack in managing the pandemic. The province’s technology system was well-developed to facilitate data collection and reporting of intelligence on a daily basis. Even deaths outside of the health system could be examined because the system checked against the data of Home Affairs. The province was working with organised labour on a planning level and municipal mayors were required to report on Covid-19 data and interventions in their municipalities. A critical lesson was that one could not strengthen the system without addressing the need for healthcare workers and they had been made a priority in the province. The Western Cape had urged the President to ban alcohol for two weeks during the festive season to create a breather from the usual high number of alcohol-related trauma cases at that time.

The Head of Department spoke on the Western Cape’s 5-point COVID Resurgence Strategy which was aimed at changing community behaviour, surveillance and response, scaling up health services capacity, maintaining comprehensive services and protecting healthcare workers. He said how the province would scale up the health platform, manage fatalities and he described the province’s vaccine strategy. All Western Cape districts were hotspots at the time, but the Garden Route had clearly passed the peak of the second wave and was on a downward trajectory. The West Coast showed an increase in cases, which was indicative of the area being at an earlier stage of the second wave than the other districts. The province had a large number of diabetic patients who were at a high risk of succumbing to the pandemic, but strategies had been learnt about how to manage diabetics during the first wave. Home delivery of medicines was taking place so that patients did not go to hospitals to collect their medication. The province was particularly concerned about the trauma experienced by health care workers that would require long-term healing.

Members asked what measures the Western Cape put in place to deal with problems associated with diabetes and alcohol; had the Health Department spoken to the Provincial Command Council about the low the level of compliance in the province for wearing masks and social distancing; and what was the province’s view on the country having paid R283 million for a vaccine which SAHPRA had not yet approved. A Member noted that some workers reported that they were being forced to go to work even if they were sick as long as they had no symptoms. How true was that? Who was filling the 1029 vacant positions of health workers who were ill? How did the province intend to close the gap in the oxygen ratio used in the public versus the private sector? Did patients disadvantaged by poverty who relied on public healthcare have a lower probability of access to oxygen? Was Afrox the only supplier of oxygen at the levels required? What would happen if Afrox could not supply sufficient oxygen as oxygen was a critical intervention?

Members asked if the Western Cape knew why districts that had been badly hit in the first wave were not suffering as badly in the second wave. Were there plans for allocation, transportation and storage of the vaccine, not just in the metro, but also in the districts? What was the plan to address the full ICU wards as the province did not want temporary structures? What were the critical areas that contributed to the high fatality rate in the province? What interventions would be introduced to reverse that trend? How was it communicating with communities about how to deal with Covid-19 at home and when to seek medical attention? Was the vaccine voluntary or mandatory and would that be clearly communicated to those who would be receiving the vaccine?

Meeting report

The Chairperson stated that the Committee had arranged for two briefings on the status of Covid-19 and the preparations for the roll-out of the vaccine by the Eastern Cape and Western Cape. He confirmed with the Parliamentary Liaison Officer for the Department of Health (DoH) that neither the Minister of Health nor any officials from the national Department of Health were on the platform.

Eastern Cape Department of Health
In his introduction, Acting MEC for Health in the Eastern Cape, Mr Nqatha Xolile, said the briefing would cover Covid-19 cases, bed availability, Covid-19 admissions, the status of the oxygen supply, testing for Covid-19, an update on circumcision schools, the testing of mortal remains, the availability of medicine and personal protection equipment (PPEs) and the plan for the vaccination roll-out in the Eastern Cape.

Covid-19 infections
Acting Head of Department of Health, Dr Sibongile Zungu, stated that the resurgence of infections in the province had peaked in the middle of December 2020, but the rise in infections had happened in different districts at different times and so the second wave was lasting longer than the first wave. The Eastern Cape had had 182 507 cases since the beginning of the pandemic, of which 7 379 were current cases and 1 705 patients were currently in hospital. There had been 9 036 deaths in total. The positivity rate for the province was 24.4 %. Only the Joe Gqabi district was showing a significant increase in numbers in January, despite the low population spread in that district.

The pandemic had seriously impacted health workers with 9249 testing positive and 161 dying of the virus. Critical posts were being earmarked for urgent filling. The province would be absorbing medical personnel graduating from their studies to do community service. The additional staff would begin work on 1 April 2021 when finance became available in the new financial year.

Oxygen Programme
Close monitoring of the oxygen programme was taking place. Although Afrox had provided 24/7 access to oxygen cylinders over the festive season, the company had indicated that its capacity to supply was under strain to meet the needs of the province and had advised that other sources be tapped for additional supplies.

Testing capacity
Laboratories in smaller towns had limited capacity to do tests and the number of tests undertaken in 24 hours was low. Rapid Antigen Testing was being rolled out in hospitals and via mobile laboratories and was proving successful. Since Oct 2020, 363 bodies had been tested, half of which had tested positive. Matric exam markers had to present negative results not older than 72 hours when they presented themselves at the marking venue. 292 markers had tested positive and were replaced.

Vaccine rollout
3.7 million people in the Eastern Cape were to be vaccinated, starting with 200 000 healthcare and related workers, 60 000 of whom were employed permanently by the Eastern Cape Department of Health. PPE would continue to be prioritised.

In terms of leadership and coordination, DoH had a task team in place but a committee at the Premier’s Office would work on an implementation plan for government non-hospital workers, such as teachers, other frontline workers and businesses. The electronic data capture system to be developed by DoH and rolled out to provinces, would be used to record information about vaccines. The vaccine roll-out plan was in draft form but would be presented to the provincial leadership within two to three days. Schools would possibly be used as vaccination centres in rural areas, but there were concerns about cold storage of the serum.

Mr A Shaik Emam (NFP) appreciated the comprehensive report. There had been repeated reports of the Eastern Cape being a problematic province when it came to the delivery of services and the ineffectiveness of governance, not only in the Health sector. From a health perspective, what could be done from a national level to help the Department improve the quality of life in the Eastern Cape? What were the root causes for challenges and what could national  government do to assist?

Mr Emam asked for the percentage of patients who recovered following a stay in hospital, especially those who had been admitted to the Intensive Care Units (ICU) and those on ventilators. What was the normal number of deaths in the Eastern Cape compared to the number experienced during Covid? He referred to Ivermectin, a drug that had shown positive results across the world. He quoted from the World Health Organisation Helsinki Declaration of 1964: In the treatment of a patient, where proven prophylactic, diagnostic and therapeutic methods do not exist or have been ineffective, the physician, with informed consent from the patient, must be free to use unproven or new prophylactic, diagnostic and therapeutic measures, if in the physician’s judgement it offers hope of saving life, re-establishing health or alleviating suffering.
Mr Emam asked if the Department of Health in the Eastern Cape had done research itself to see if Ivermectin could be a solution. What was the Department doing about advising the Provincial Command Council about the district that had not yet been declared a hotspot but where the numbers were rising?

Ms H Ismail (DA) asked about the percentage of vacant hospital posts in the province. How many CEO vacancies were there and how many CEOs were still acting? The country was talking about vaccines and at this stage the province should already have a plan in place. She requested a comprehensive plan for the roll-out of the vaccines that included the number of vaccines per day, per district, etc. Had the planned bulk installation of the Oxygen Programme started on 11 January 2021 as indicated in the presentation? She noted that Mr Shaik Emam had addressed the ongoing challenges in the Eastern Cape.

Ms Ismail requested a report on the needed infrastructure upgrades reported on over the years by the media. Had the upgrades been done? She asked about the EMS (Emergency Medical/ Ambulance Services) because people could not obtain hospital services if they could not even get to the hospital?

Dr K Jacobs (ANC) stated that he had questions on beds, staffing, testing, oxygen, EMS, deep rural areas, private practice, medical and nursing students. He noted that three districts had reached maximum bed capacity. Was there a need for new field hospitals or could the Department change wards into Covid-19 wards? There was an expectation of a third and fourth wave. Was it not an opportunity to improve on the facilities and prepare for the other waves to come?

Dr Jacobs stated that the number of deaths was a serious matter and the number of people in hospital and in the ICU was concerning. That brought him to staffing. Staff became sick, some went into isolation and some had even died. He appreciated the fact that medical doctors doing community service were being used to alleviate pressure on the medical staff, but he was also looking at the employment of ward assistants and community care workers as he knew the need for extra assistance in the wards, apart from medical services.

On the Rapid Antigen Test, the WHO had recommended that the test should be used to identify cases in high infection rate areas and to monitor the disease trends. Would it be used for diagnostic purposes? What were the benefits of that? It could certainly be used for testing in rural areas.

Dr Jacobs stated that oxygen was important. It was the mainstay of treatment. If every patient who had arrived at hospital could have been put on oxygen, many lives would have been saved. He realised that there were many challenges at national and provincial level on the manufacture and supply of oxygen. Cylinders to supply oxygen and the lack of equipment for a liquid form of gas was limiting. It was good to have bulk storage of oxygen but there had to be a guarantee that it got to the Continuous Positive Airway Pressure (CPAP) machines and to patients. He noted that ambulances had been the source of many problems but ambulances, when transporting patients, could not provide the same oxygen flow and so how could ambulances transport patients to high care hospitals? What had been done in providing facilities where people live? This was a particular concern in rural and deep rural areas. He was concerned about medical supplies reaching those areas, but he thanked the Eastern Cape for transporting oxygen with its own vehicles although there was a problem with drivers who had to be certified. There were many, many challenges in South Africa.

Lastly, Dr Jacobs suggested that private practitioners, medical students and nursing students should be part of the first roll-out, especially as the students assisted in hospitals from their third year of study. There had also been talk of final year students working in hospitals. He wished to emphasise that the province should consider all means of alleviating staff shortages.

Ms M Sukers (ACDP) extended her condolences to the families of healthcare workers who had lost their lives to Covid-19. On community-based care, the media had reported that, especially in rural areas, communities did not know what to do when people were ill with Covid. What plans did the province have to address that matter? [Ms Sukers lost connectivity at that point].

Ms N Chirwa (EFF) expressed concern about infrastructure. What was the plan to deal with infrastructure in the Eastern Cape? In reality, the Department had done nothing about that. For two years, the province had promised to fix the roof of a particular hospital, create office space for doctors and expand the waiting area for patients. The hospital had recently been upgraded from a district to a regional hospital but the province had not increased the capacity of the hospital.

Ms Chirwa stated that the Eastern Cape had known about Covid-19 for a while but had not upgraded hospitals. The incompetence and laziness of the Department had contributed to the comparatively high death rate in the Eastern Cape. Not only had money for EMS been wasted, the Department had squandered money on meaningless scooters, regardless that in some cases, ICU was four hours away. How did Dr Zungu as the Head of Health take responsibility as an accomplice for so many avoidable deaths? How did she take responsibility for having failed to improve infrastructure and equip the EMS, knowing very well that this disadvantaged those living in rural areas the most?

Ms Chirwa asked about the outcome of the investigation on the use of Ivermectin on some Covid-19 patients. What had the province done to hold accountable those medical staff who had given medication for animals, Ivermectin, to humans without the approval of SAPHRA?

She noted that Dr Zungu was leading the Covid-19 team established in the Eastern Cape in April 2020. Could the province explain the role of Dr Zungu and the impact of that team? Was it having an impact on lowering Covid-19 deaths and bettering conditions for those living in rural and deep rural areas? Why had a new HoD not been appointed? The Eastern Cape was the worst performing province and yet, in three months, that vacancy had not been filled.

Ms Chirwa referred to incorrect reporting on Covid deaths in the Eastern Cape. There was a reliance on the information provided but the Eastern Cape data had been incorrect and false during a number reconciliation in the past month, but the errors actually dated back to May 2020. How then could Eastern Cape data be taken as truthful and factual? In what way had that incompetence affected how it responded to Covid-19?

She asked about the contracts for those additional community workers in March 2021. Some hospitals had only begun functioning properly after the community workers had been contracted. The workers could not go back to being unemployed. When would the community healthcare workers be given permanent contracts so that they could assist in the response to the pandemic?

Ms S Gwarube (DA) understood that there had been a systemic failure in health care in general in the Eastern Cape and that had led to the province being one of the weakest links in the response to the pandemic. Ultimately, those were historic challenges in how the Eastern Cape and had been run in terms of governance and the system, resulting in high vacancy rates and infrastructure backlog. This meant that the Eastern Cape had been unable to mount a decent response to the pandemic.

Ms Gwarube stated that the vaccine roll-out would be the next big challenge. Dr Zungu had touched on the roll-out in her presentation, but if the province was targeting 3.7 million people, many in rural areas, what was the plan in specific detail in the light of the challenges in rolling out health care facilities? What was the actual plan? She foresaw that the province would have difficulty in rolling out the vaccine, which would have negative implications for the rest of the country. It was, therefore, important that the details on the roll-out were that much more pronounced. As the lowering of infections currently provided a reprieve, surely the province should be targeting most of its energy towards readying itself for vaccinating almost four million people. She requested more clarity on the plan.

Ms Gwarube asked how the Department would reach healthcare workers in private facilities, especially in Nelson Mandela Bay and Buffalo City where private facilities were completely overwhelmed. There was a huge need to vaccinate those healthcare workers. What did that strategy look like?

Ms Gwarube noted that Dr Zungu had not explained why Joe Gqabi district had an increase in new cases. Why was that district experiencing a different trend from other districts? Could Dr Zungu clarify that? The Eastern Cape had had massive fatalities – a lot more than other provinces. Why? Was it the broken health system that was unable to assist people who were affected? Were people dying at home? And why had the province only recently started to do posthumous tests? That had skewed the numbers presented to the country. The numbers released two weeks ago were said to be a backlog. The Eastern Cape Premier had said that there was to be an investigation into the matter. What was the status of the investigation? Could the numbers be trusted or were the numbers being doctored?

Ms Gwarube noted that, according to the presentation, there were 1 755 illegal initiations. What was an  illegal initiation?

Ms A Gela (ANC) extended her condolences to the families of health workers who had succumbed to Covid-19. She appreciated the good work that the Eastern Cape DoH was doing saving lives, despite challenges. Together the nation should address those challenges. As a national department, DoH had to intervene. She appreciated Minister Mkhize for providing oversight as well as the WHO representative who had visited the Eastern Cape. She thanked all the donors who had made donations to the Eastern Cape. She knew Eastern Cape was a rural province.

Ms Gela appreciated the work of the security guards, especially the guard who had seen to the arrest of a person for the alleged stealing of PPE the previous week. She also appreciated that the Eastern Cape had enough PPE in stock for its health workers. She asked what plans DOH had for supplying oxygen. She noted the increase in infections and asked how  it planned to manage the situation. When did it expect to have a full roll-out in the province?

Ms Gela stated that the people of the Eastern Cape had now seen that Covid-19 was real as it had reached the province. Some young people were trying to educate their elders by distributing pamphlets but they also needed to spread the message about wearing masks, sanitising, washing hands and staying safe. She noted that communication did not always reach the far rural areas and she appreciated the efforts in the Eastern Cape to reach those areas, such as Mount Fletcher.

She was praying to God to save SA because the pandemic was killing. She herself had had Covid-19 and knew what it was like and what was facing frontline workers daily. God had to assist all officials to overcome the pandemic as it was not of “our own making”.  All political parties must come together and assist the health workers. The country must speak with one voice and God must forgive sins and heal His nation.

Dr S Thembekwayo (EFF) said she had not heard mention of the 900 machines developed by CSIR, approved by SAHPRA and supplied by the Gift of Givers. How had that helped the province?
During the first lockdown, patients with chronic illnesses did not have access to their medication. What measures had since been taken to ensure that they had access to their medication?

She noted that mention had been made of 9 000 healthcare workers that had tested positive and 161 had died. A considerable number of healthcare workers had complained of fatigue. What had the Department done about that and had psychological help been provided? Some matric examination markers had been identified as Covid-19 positive. What psychological support measures had been put in place for them?

Dr Thembekwayo asked why Covid-19 patients had been mixed with TB patients in the Empilweni TB Hospital in Nelson Mandela Bay. The Vaccine Rollout Plan had not been finalised. The plan had to be in line with National DoH guidelines. The province did not even have a task team. It needed a finely detailed plan.

Dr Thembekwayo added that the number of excess deaths was a concern. What was being done to ensure that every death was properly recorded? How many Cuban doctors were working in the Eastern Cape and where were they deployed?

Ms E Wilson (DA) was worried about the collapse of the ambulance system. In the Eastern Cape, ambulances had to cover 20 000 km and yet the ambulances queued up outside hospitals for two to three hours waiting for their patients to be admitted. That was creating a backlog. What was being done about that? She noted that mortuaries were using refrigerated trucks to store bodies as they were not equipped to deal with the load. What was the current situation with mortuaries and how were they being helped to deal with the backlog?

Ms Wilson had a huge concern with the exhumation of bodies. There were cultural issues involved in exhuming bodies and there were legal boundaries. A legal process had to be followed to obtain permission to exhume a body. It appeared that those legal processes were not being followed. Exhuming the bodies of people who had died of Covid put those people involved in the exhumation at risk. What was being done to address the legal crisis and the risk to the lives of those involved?

Mr T Munyai (ANC) welcomed the comprehensive report from the Acting MEC which gave Members a sense of the state of affairs in the Eastern Cape. He was satisfied that the Eastern Cape was making good progress, especially in Nelson Mandela Bay and the other area that had been in the forefront of the pandemic. He asked if the Eastern Cape required additional help. He appreciated the guarantees in terms of the oxygen supply. A critical focus in the future had to be the testing of bodies. He had no other critical questions, but wished to congratulate the Eastern Cape. The situation had been bad at one point, but now one could sleep at night.

Ms Sukers continued her questions. She was aware that there had been extensive planning at the beginning of the pandemic in April and May 2020 but reports stated that implementation of the plans had been delayed. What was the cause of the delays?  Could the MEC and HoD give the Committee and citizens an assurance that they would be ready for a third and a fourth wave?

Ms Sukers referred to a media article in which a woman claimed that the community did not know what was right or wrong. The woman had lost six family members to Covid-19 and did not know what to do. What was the communication plan to inform communities of the symptoms and what to do to obtain early treatment as that would mean fewer critical cases? What plans were there to provide people with guidelines to care for family members and the home-based care of those who were moderately ill. It was well-known that people were suffering psychological trauma, especially where there were multiple deaths in a family. How would the province attend to the increased need for counselling, especially for healthcare workers and those who had suffered multiple losses in a family due to Covid-19.

The Chairperson said that he did not object to doing tests on bodies but asked the rationale for doing so and if it did not detract from the province’s capacity to test people. What was the value-add of the Cuban specialists who had been able to help with the pandemic? What impact had the Cuban specialists had in the province? 

He stated that the role of Dr Zungu had been remarkable, even if she was only acting HoD. Could she say where the Department had had maximum impact? How quickly would the province fill the Health HOD post?

The Chairperson requested a response and said that there would be no time for follow-up questions.

Response by Eastern Cape Department of Health
Dr Zungu, Acting HoD, replied that some responses would have to be provided in written form as she did not have all the information to hand.

She addressed questions on the challenges in the province, particularly its rural nature, the challenges that had long existed in the province and, particularly, the dwindling budget. The Eastern Cape did not start from zero; unlike the other provinces, it started from a negative point and had to catch up to get to zero. There were challenges with access to services and to water due to the typography of the province. It seemed that every season the province was hit by disasters. Those disasters hit the facilities and the communities and set the province back again in terms of the work already done.

Dr Zungu stated that the information on the percentage of patient recoveries was available but she did not have it with her and would supply that information in writing. In general, a high number of patients on ventilators and those in ICU had poor outcomes, especially where a co-morbidity or age was a factor.

She stated that the Eastern Cape was following guidance from the Ministerial Advisory Committee and by SAHPRA. The Joe Ngabi District had a rising number of cases, but it had been the last to come out of the first wave and the last to start the second wave.

The vaccine roll-out plan had been completed at province level and a task team appointed. The Department had guided the districts on how to structure the district teams. The provincial office was also working on quantifying the numbers of people to be vaccinated. In response to Dr Jacobs, she stated there were 60 000 medical workers in the public sector, but 200 000 vaccines had been earmarked for Phase 1, which included the private sector and health sciences students, as well as health workers in NGOs and clinics. The province was not yet sure if the work would be done by the private sector or if the Department would have to administer the vaccines for the private sector.

In determining who would need the vaccine in Phase 2, such as the frontline workers, the province had decided that it would be better to locate that team in the Office of Premier. The announcement of that team was imminent.

On infrastructure, Dr Zungu stated that there was a report that showed the provincial infrastructure upgrade had yielded over 3 000 beds which had enabled the province to address the issues of Covid-19. Unfortunately, she did not have the report with her, but would forward it. There had also been an injection of additional vehicles and staff into the EMS just before the festive season had started.

The province had started using the Rapid Antigen Test from 17 December 2020 and it had become a blessing in remote rural districts, such as the Alfred Nzo District. The Department had a detailed plan for the vaccine rollout right down to the spread of the population in each district. For example, in the Sarah Baartman District, the Department was looking at an outreach programme but it was also looking at issues of keeping the cold chain and how to deal with last-mile deliveries. The private sector was helping with the latter matters.

When referring to "Illegal initiations", she had been referring to illegal initiation schools. The province had been monitoring the situation and illegal schools had been closed down.

The province had distributed oxygen concentration equipment to some areas and in other remote facilities, triple the number of cylinders had been delivered. As the province was rolling out liquid oxygen, it had moved cylinders to areas that were more remote. The Department had used its own trucks to deliver the oxygen tanks to the rural areas.

The digging up of graves was most unfortunate, but people had to respect each other’s belief systems. She agreed that there were legal provisions for digging up graves. The Department would have to look for opportunities within the legal framework to make it possible for communities to perform their rituals. The realities of the people would be recognised through progressive efforts to build a bridge between the community and the need to dig up graves.

Dr Zungu agreed that health workers were experiencing challenges throughout the entire province. The Health Services did have a psycho-social stream which was attending to people across the province, together with support from the private sector and the religious sector. The Department had received endless requests for support and had arranged prayer sessions that were being transmitted via all community radio stations. The Department had a Wellness Manager who attended to staff and the Medical School at Walter Sisulu University was offering psycho-social support online and physically in workplaces. The province had extended the services of a service provider to all health workers in the province. Managers had been trained by an external provider, funded by donor funding, to provide support to their staff members.

On the question of mixing TB and Covid-19 patients, Dr Zungu informed the Committee that the Empilweni TB Hospital had been re-designated for patients under investigation (PUIs) and patients were tested there and redistributed to other facilities, as appropriate.

On excess deaths, the Department had engaged with the National Institute for Communicable Diseases (NICD), the WHO and the provincial epidemiologists. She declared that it was not that the data system was inaccurate but it provided data in a delayed fashion. The officials were now capturing the data and as the Department received the numbers, it reported those numbers. The province was not hiding the numbers. Committee Members would see that the numbers coincided with the curve of the pandemic.

The Eastern Cape had 35 Cuban medical professionals. Most of the Cuban doctors had become pillars of strength at the field hospital in Nelson Mandela Bay during the worst of the pandemic, but most of those doctors had since been redistributed across the province.

Dr Zungu agreed that ambulances had been parked outside hospitals. It was unfortunate but the Department had since opened up the public sector to patients on medical aid where they could not be admitted to overfull private facilities, but only if patients agreed to be admitted to a public facility.

The Chairperson suggested that a follow-up report in writing would be needed, but he was satisfied with the report that had shown what the province was doing. He thanked the Acting Eastern Cape Health MEC and HoD and permitted them to leave the meeting.

The Chairperson welcomed the Western Cape Minister/MEC for Health and the delegation from the Western Cape Department of Health.

Western Cape briefing
In her introduction, Dr Normafrench Mbombo, Western Cape MEC for Health, said she would be brief as she was aware of the time constraints and the need to leave time for Members to pose questions.

Dr Mbombo reminded the Committee that at the start of the pandemic, the Western Cape had developed a worst case scenario and had sharpened the axe to deal with such a scenario. Such a scenario had not materialised in South Africa. However, it had prepared the province for the second wave. Interventions that had been planned and implemented in the first wave were being refined and beefed up. Since the Western Cape was the first province to deal with the virus, the province had been treated like a laboratory. The virus kept changing and so the province had assessed interventions being implemented overseas. Various stakeholders, such as clinicians and the private sector, had researched aspects of the virus. Water testing and blood testing had been researched in conjunction with the universities and antibodies had been developed to assist in dealing with the virus in Khayelitsha.

As a result of that work, the Western Cape was ahead of the pack. The technology system was also well-developed to facilitate the collection of data and the reporting of intelligence on a daily basis. Even deaths outside of the health system could be checked for the cause of death because the system checked against the data of Home Affairs.

The province had an effective partnership between the private and public healthcare facilities. When the Department had realised that there would be shortage of beds and ICU staff, it had adopted the tariffs developed by the Minister of Health and had also developed protocols for the treating of public patients in private facilities so that public patients were not treated differently.

The province had worked with organised labour on a planning level, especially on health and safety. Organised labour was now working with the Department on the strategy for the roll-out of the vaccine. Working with local government was a key aspect of the Western Cape strategy. She suggested that the Chairperson might be surprised to learn that at local government level, the Mayors themselves were required to report on Covid-19 data, interventions in the health space, and more broadly on pandemic issues. The Western Cape had requested tighter restrictions at the end of December 2020 because the evidence gathered had shown the impact of alcohol on trauma units in hospitals.

The province had decentralised decision-making about how to strengthen the system and so hospitals had found ways of strengthening their capacity. For example, one hospital had found an old boiler room that it had been able to refurbish to take hospital beds. Lessons learnt included the fact that moving towards universal health care required not only the facilities to offer quality care, but also the power of partnerships, especially with the private health sector. One lesson learnt on the testing strategy was that one size did not fit all. Flexibility was essential. No one would have thought that the province could work with the taxi industry in the transfer of patients to hospitals and transporting people needing to go into isolation. The taxi industry had refurbished what it called “red-dot taxis” which could pick up patients from home and transport people to quarantine facilities.

Dr Mbombo stated that a critical lesson was that one could not strengthen the system work without the healthcare workers. Healthcare workers had been made a priority. The province had seen more than 1000 active cases of Covid-19 amongst health workers and 92 had passed on since March 2020. The psychological impact when a colleague was fighting for his or her life, or passed on, especially when people were in isolation, was severe. The province had worked with partners, including Metropolitan Life Insurance Company, to provide psychological support for healthcare workers at a local level.

The province had asked the President for a breather for two weeks during the festive season to give healthcare workers a breather. The alcohol ban meant that healthcare workers were not overwhelmed by the number of trauma cases that usually report to hospitals over the festive season. An additional factor was the need for medical facilities to provide extra care to mental health patients who were particularly troubled over the festive season and who, in the current situation, had been impacted by the economy and lack of food.

Dr Keith Cloete, Head of the Western Cape Department of Health, indicated that his presentation would inform Members how the province would scale up the health platform COVID capacity, the management of fatalities and would provide details of the province’s vaccine strategy.

Dr Cloete stated that the worst case scenario planning done during the first wave had assisted his Department to manage the second wave. The province’s  Five-Point Resurgence Plan was aimed at changing community behaviour, surveillance and response, scaling up the health services capacity, maintaining comprehensive services and protecting healthcare workers.

Covid-19 data
Dr Cloete presented a highly detailed and very specific document covering each of the identified areas. The detail was largely obtained from the IT system that the province was using to manage all Covid-19 data. Numerous graphs were displayed to show statistics and trends. He confirmed that all Western Cape districts were hotspots, but the Garden Route had clearly passed the peak of the second wave and was on a downward trajectory. The West Coast showed an increase in cases which was indicative of the area being at an earlier stage of the second wave than the other districts. The Central Karoo showed a 24% increase in cases, but the figure was based on small numbers of cases.

Community strategy
The Western Cape Community strategy included the implementation and enforcement of the Disaster Regulations, currently adjusted to Level 3. The Provincial, City and District Disaster Management Centres were co-ordinating the systematic enforcement of regulations, along with the South African Police Service (SAPS). Communication focussed on the central message of the risk of transmission, especially at in-door gatherings.

[The Chairperson indicated that he would have to leave the meeting as a result of a crisis. He requested Dr Jacobs to take over as Acting Chairperson].

Dr Cloete continued his presentation, noting that diabetic patients were at a high risk of succumbing to the pandemic but strategies had been learnt in the first wave on how to manage diabetics.  Home delivery of medicines was taking place so that patients did not go to hospitals to collect their medication.

The province had a comprehensive system to manage fatalities. Mortuaries, funeral homes and other role players were included in the planning.

Oxygen utilisation
The combined oxygen utilisation in the Western Cape public and private hospital sectors was approximately 73 tons daily: the public sector hospital consumption was at 69%; the additional 31% was used by the private sector. The combined utilisation was above the maximal production capacity of the Afrox Western Cape plant (70 tons) but Afrox had put contingency plans in place by bringing additional oxygen into the province daily to augment the provincial supplies. The Western Cape had allocated five bulk oxygen tankers for the daily delivery of oxygen supplies to individual hospitals.

Alcohol ban
The biggest problem had been trauma patients in emergency wards and the alcohol ban had reduced trauma cases by more than 50%.

Vaccine strategy
The vaccine was probably the most powerful global weapon to turn the tide against the Covid-19 pandemic.
The National Department of Health was driving the procurement process and the Western Cape aligned with its efforts. The Minister had announced on 7 January 2021 the acquisition of 1 million doses of the Astra Zeneca vaccine from the Serum Institute of India by the end of January 2021 and a further 500 000 doses in February 2021. Further negotiations were being pursued with other vaccine suppliers for more stock in addition to the stock to be secured via the Covax initiative. The Western Cape Department of Health was focussing on readiness to implement the vaccination programme in the province.

Covid-19 vaccination
Dr Cloete stated that the Western Cape intended to unite all sectors and parts of the community around a common objective, “Lets Unite to Vaccinate”, to turn the tide against COVID-19 and to lay a good foundation for collaboration between public, private and civil society for Universal Health Coverage (UHC). Phase 1 would comprise the vaccination of 100 000 health workers. The Vaccine Dashboard would record all vaccinations administered. The pre-registration process would be similar to that of a voter’s roll. The province was waiting for SAHPRA recommendations on vaccinations.

Key to the communications strategy would be to address misinformation about the vaccine, as well as the logistics for the administration of the vaccine.

Dr Cloete concluded by stating that the province was particularly concerned about the trauma experienced by health care workers which would require long-term healing.

The Acting Chairperson thanked the Western Cape for its detailed presentation and requested that Members be brief in their questions as time was short.

Mr Shaik Emam congratulated the Western Cape on the Hospital of Hope facility which he said was a fantastic facility and would really benefit the people who tested positive. The latest statement by Prof Salim Karim of the Ministerial Advisory Committee was that there was no guarantee that the vaccine was going to work as the virus was currently in its second variant from that prevalent when the vaccine was developed.  The development of a vaccine was a miracle as it had been developed in six months whilst in ten years a vaccine had not been developed for HIV/AIDS. Medical staff would have to check if the vaccine worked and if it worked, well and good. If not, scientists would have to do further research. That, together with the fact that one had expected many lives in SA to be saved by the vaccine, was a concern. He asked for the views of the Western Cape on that point. Dr Cloete had also mentioned SAHPRA. However, SAHPRA had not approved the vaccine despite the country having paid R283 billion for it. What was the province’s view on that?

A 40% positivity rate had been reported. Mr Emam noted that some experts questioned the accuracy of the report and Portugal had found that 97 out of 100 tests had produced a false positive. Could Dr Cloete comment on that as he was concerned about the number of patients testing positive?

He was aware that the province had highlighted the serious problem of alcohol and diabetes, and was aware that the Western Cape was the diabetic capital of SA. What measures did the province intend putting in place to deal with the problem of diabetes and alcohol?
Mr Emam returned to the question of the efficacy of the vaccine. Had the Western Cape considered looking at the statistics and the Ivermectin research because the evidence of the efficacy of that medicine was overwhelming across the world? There was a reported 100% success rate and a minimum 83% drop in mortality rate. He referred to the WHO Helsinki Agreement of 1964 that even if a particular drug was not registered, it could be used in order to save lives. Had the Western Cape considered that? What was latest recovery rate for patients admitted to hospital and for those on ventilators and in ICU? At one stage the recovery rate was three out of five patients admitted to hospital.

Mr Emam believed that the Western Cape was working hard to contain the virus but he asked if the Department spoke to the Provincial Command Council about the low the level of compliance in wearing masks, etc. in the province?

Ms Chirwa was aware that there was a high level of infection in the Western Cape but she had received reports that some workers were being forced to go to work, even when they were sick, as long as they had no symptoms. How true was that? What had the province done to investigate the claim and what had the MEC done to ensure that it did not happen again under her watch? What was the province doing to ensure health workers were protected? Clearly not enough was being done to protect healthcare workers.

Ms Chirwa added that the situation was being aggravated by the lack of community communication about Covid-19. What had the Department done to address the stigma attached to the virus and to ensure that communication was at the centre of the strategy? It was futile to have all the plans but not to educate the community. The outcome would be no different from the HIV/Aids campaign that had stagnated because of the lack of communication with the communities. Ultimately, it affected the safety of health workers. Why was the province not using community radio stations instead of billboards as they offered better opportunities for communication and engagement with the community.

Ms Chirwa asked about the worker replacement system when workers were absent because they were ill. Who was filling the 1029 vacant posts where health workers were ill? Were those posts currently vacant and the province was waiting for the 1029 workers to recover or were there volunteers in the posts?

She noted that only 10% of the population used private health care while 80% used the public system. However, the ratio of oxygen use in the province was inequitable in favour of the private sector in a ratio of 59:31. How did the province intend to close the gap so that those who relied on public healthcare had a higher probability of access to oxygen and were not disadvantaged by poverty?

Ms Chirwa noted that the Western Cape was a province that greatly modelled economic disparity across racial lines and had received great critique for not being responsive enough in addressing the differing levels of access to quality health care. How different was the response to quality health care in the prevention, education and community-based caring depending on how and where people lived? Did that directly affect the quality of health care that people received when contracting Covid-19? Had the Department created a system for coloured and black people in informal settlements who were not able to go into isolation in informal settlements? Hospitals in Khayelitsha were overcrowded but there had been no intervention from the province to address that. When would the province address overcrowding in Khayelitsha?

Ms Gwarube noted that the presentation had indicated that certain areas, such as Khayelitsha, that were hard hit in the first wave, were not as hard hit in the second wave. Why was that? Had there been interventions by the Department or was it some level of herd immunity? What was the reason for districts badly hit in the first wave not suffering as badly in the second wave?

She had heard Dr Cloete stress that the pressure on the system was tremendous. She was aware that the province had built up intermediate facilities to ease pressure at certain facilities but what other measures was the province taking? The province was in a second wave and health care workers were stretched. What other interventions were there to ease pressure at actual facilities, especially for non-Covid illnesses. If, for example, patients did not take diabetic medicines, that became a crisis. How was the system being augmented, especially for non-Covid patients?

Ms Gwarube noted the 48 tonnes of oxygen being used in the province. Earlier the Eastern Cape had stated that Afrox, which was its key supplier, could not meet the demands it had for oxygen. While the Western Cape had made provision for extra oxygen, was it not using Eastern Cape oxygen and could the province not diversify its source of oxygen? Was Afrox the only supplier of oxygen at the levels required? What would happen if Afrox started throttling the oxygen supply as oxygen was a critical intervention?

She noted that the vaccine plan was very detailed but asked for details on the logistics of getting the vaccine to the districts. Were there plans for allocation, transportation and storage of the vaccine, not just in the metro, but also in the districts? What was the plan in Beaufort West as it was very different from the metro? The vaccine required two doses. What strategy was the province going to adopt? Were two doses to be given to phase 1 workers using the current supply that the country had? The country did not have a steady supply of vaccine and there were no definite timelines for obtaining the vaccine. What was the province doing to mitigate the unstable supply? How would the province mitigate a situation where 100 000 health care workers had been vaccinated and the second dose of the vaccine did not arrive?

Ms Gela noted that current admission to hospital was 50% higher than in the first wave? How did the Department plan to manage that? District and rural hospitals were under pressure, particularly with oxygen supplies. Was there a plan in the Western Cape to address the problems in those facilities?

On the shortage of staff, Ms Gela asked when vacant posts would be filled. She had read in the media that the province had engaged nursing agencies to assist with the shortage of staff. Could the province clarify how far it was with that process? The Stellenbosch Hospital Medical Manager had said that 85 beds were needed in that hospital. How was the province going to address that?

Lastly Ms Gela was concerned that the ICU wards at certain hospitals were full. What was the plan to address that as the province had a high number of people dying, especially as the province did not want temporary structures? The presentation had highlighted that healthcare staff members had been affected by Covid-19. What percentage of health workers in the province had recovered from Covid-19?

Ms Sukers appreciated the well-prepared presentation and that it acknowledged the trauma of healthcare workers but she added that she believed the nation was experiencing a collective trauma.

Ms Sukers stated that she lived in the Western Cape and she had first-hand experience of the level and quality of health care in the province. The situation on the ground was very different from that shown in the presentation. There was a growing mistrust in the healthcare system with many people too afraid to go to hospital when they deteriorated. It was her contention that it was due to the growing mistrust that public hospitals were not as congested as private facilities. People refused to go to public hospitals. People were waiting hours to be triaged; people were waiting for high flow oxygen at districts hospitals because there were too few machines; people could not be transported to Tygerberg Hospital because there was no high flow oxygen in the ambulances. She knew of someone who had, that week, waited four hours to be placed on low flow oxygen. In December, only two ambulances were available in the whole of the Helderberg District. She was adamant that the situation on the ground for the people in the Western Cape was far removed from the world class presentation or the intelligence system mentioned in the meeting. Real life experience differed drastically.

Ms Sukers noted that the Western Cape had a much higher rate of fatalities per 1000 people infected as opposed to areas such as Gauteng. What were the critical areas that contributed to the high fatality rate? What interventions would be introduced to reverse that trend? What could be done immediately and what plans did the province have for the third and fourth wave?

She requested the statistics for the deaths that had occurred, including where they had occurred and how many deaths had taken place at district hospitals and at tertiary hospitals, as well as how many had died at district hospitals while incubated or waiting for ICU admission at a tertiary hospital.

Ms Sukers emphasised that community-based care would alleviate a lot of pressure from the hospitals. What was being done to incorporate home-based care for the moderately ill in the plan. What plans were being put in place to implement home-based care, especially in the poor communities?

She noted that fatalities were linked to a lack of oxygen but by time patients went to hospitals, they already had low levels of oxygen. The communities lacked reliable information on how to manage themselves if they had Covid-19. How was the province communicating information to communities on how to deal with Covid-19 at home and when to seek medical attention?

Dr Thembekwayo noted that the HoD had said that the first phase vaccine plan would only be available the following week. The Committee had been expecting that very plan today. Would it be made available to the Portfolio Committee, and when could the Committee expect to receive it so that it could be on par with the developments in that Department?

She noted that a consent had to be given for the administration of the vaccine. Was there a consent form to be signed and, if so, could the HoD make it available so that the Committee could check the content of the form as people often attached their signatures without reading what they were signing. Was the vaccine voluntary or mandatory and would that be clearly communicated, in the simplest of terms, to those who would be receiving the vaccine?

She asked how many Cuban doctors were employed in the province and in which facilities? A considerable number of health workers were suffering from fatigue. Whether one liked it or not, it was a reality. What was being done about it? Was there a clear plan? Had the province received donations of oxygen machines from the Gift of Givers and, if so, how was that donation helping the province?

Ms Wilson appreciated the presentation and noted that most of her concerns had been covered by her colleagues. She did note that the headlines on News24 that day stated that AstraZeneca Covid-19 vaccines could not be sold in SA despite the government’s claims of having been in talks with them for months. There was a lack of transparency on that front but the province had presented a plan for the roll-out of the vaccine, regardless of whether it was the AstraZeneca vaccine or not. Had the MEC or HoD had any direct contact with suppliers or developers of vaccines and had they been able to put any pressure on national government that would assist in the procurement of vaccines? At that stage, that was the biggest concern, and even more so after the morning’s headlines. Vaccines were critical to get ahead of Covid-19.

Ms M Hlengwa (IFP) asked what measures were being taken to ensure that every person received medical care when needed. Was the existing structure sufficient to meet demands? She noted that many healthcare professionals were advocating for the use of Ivermectin as an effective drug to treat Covid-19. What was the Western Cape DoH’s position on that? Was the Department in continuous contact with NDoH? Was the Western Cape independently seeking a novel treatment that might alleviate the suffering of citizens infected with Covid-19? Could the Department give the Committee a clear understanding of the side effects of the vaccine and what was being put in place to overcome the side effects?

The Acting Chairperson explained that AstraZeneca was being manufactured in India and the company that SA was receiving the vaccine from was the Serum Institute of India (SII) and it was exactly the same vaccine. There was not a huge discrepancy. The Western Cape had said that it would follow national Department guidelines for the procurement of the vaccine. He had liked that part of the presentation that gave a clear indication of the roll-out plan.

The Acting Chairperson agreed that staffing was a problem. There was a great concern about the number of health care workers who had died or who were in isolation and quarantine. He had a number of family members involved. The exhaustion, tiredness and feeling of being overwhelmed was very real. What plans were in place to support health workers, especially in respect of their mental health care, and to ensure a rotation of staff? What was being done in regard to the community workers and medical health care staff who had completed their training? Were they being taken into service to provide a kind of buffer or to provide an opportunity for the others to get some rest?

He was looking towards the third and fourth wave which was inevitable as people returned to their provinces, work, schools, universities, etc. He understood that the province did not want to invest in temporary structures, but he hoped that the work being done on existing facilities was of sufficient quality that it could be retained later on. He was particularly thinking of the reticulation of oxygen pipes and refurbishment and recommissioning of wards. He hoped those efforts would provide better opportunities in the future.              

The Acting Chairperson noted that there were time issues but the Committee meeting could go on until 13:00 in order to hear the responses from the Western Cape.

Response by Western Cape Department of Health
The Western Cape MEC requested the HoD go through the technical issues before she responded.

Dr Cloete replied about the effectiveness of the vaccine against the new variants. He shared Dr Karim’s reservations but the only people who could pronounce on that were the scientists and he was aware that they were currently conducting research to test the vaccine against the Covid-19 variants in the country. He was expecting an announcement from the scientists on the effectiveness of the vaccine fairly soon.

His Department was aware that SAHPRA was currently processing the application from the Serum Institute of India vaccine which was producing the vaccine trialled by AstraZeneca in India. He was expecting a pronouncement from SAPHRA by the end of the week or early next week.

On the accuracy of Covid-19 tests, many people around the world had had questions about the validity of the PCR (polymerase chain reaction) test. His Department was guided by the NICD and by the virologists who worked in that setting. Each test had been validated in the country and SAHPRA only gave approval for the use of tests if they had gone through a validation process. There were three big testing laboratories in the Western Cape and he was personally aware that all the tests had been validated before they had been used in the country. He, therefore, worked on the assumption that the validity of the tests had been proven.

On diabetes, Dr Cloete responded that during the first wave of Covid-19, the Western Cape had learnt much about diabetes. Those learnings had completely changed the way in diabetes was viewed and how it should be managed as a chronic disease or a lifestyle disease. The province had had a complete re-look at the prevention of diabetes, the early detection and the management and control of diabetes. If there was one thing that was positive about Covid, it was that re-look at diabetes. The province would shortly have some exciting things to announce as a group of experts had been working with Covid-19 patients and using various interventions, including tele-med, and supporting patient management of their diabetes. That work had resulted in a significant reduction in fatalities amongst diabetic patients.

Alcohol had a massive impact on trauma, gender-based violence, violence against children and homicide. In the Western Cape, Minister Mbombo and he were involved in a safety programme and because the health system measured the impact of “unsafety”, the Department of Health had become involved in the safety programme of the Western Cape. He guaranteed the Member that he would look at a combination of restrictions, behavioural modification and societal redress to deal with violence associated with alcohol.

The province would be guided by SAHPRA and the Essential Medicines Committee (EMC) on the use of Ivermectin. The medicine was currently prescribed only as a veterinary medicine but SAHPRA was looking at it, which meant that, despite the pressure on SAHPRA to approve the use of the medication, it was undergoing the normal tests that SAHPRA undertook to approve an application for a product to be used. SAHPRA would look at the trials and the effectiveness of the medicine before coming to a decision. Before medical staff in the Western Cape could prescribe that medication for humans, SAHPRA would have to give the go-ahead. SAPHRA was also looking at a few other medicines that might be able to assist with Covid-19.

In response to the question on the recovery rate in hospitals, Dr Cloete stated that the recovery rate was about the same as the recovery rate during the first wave. In a hospital, the recovery rate was about 80% and in the ICU ward, the recovery rate was between 50 to 60%. He could provide the details of every single death that had happened: when it happened, in which hospital and in which ward. All that information was on the Western Cape database. He would come back to address the perception that the Western Cape had a higher fatality rate.

Dr Cloete assured the Committee that his Department engaged regularly with the Provincial Command Council, the Environmental Health sector and with law enforcement. He agreed that there was a need to be very vigilant in cooperating with all of those sectors.

He informed the Committee that the allegation that healthcare workers had been forced to work when ill had been thoroughly investigated and there was absolutely no substance to the story. He emphatically declared that there was no substance to the story and that no healthcare worker in the Western Cape had ever been forced to work while ill. There was a detailed procedure for all facilities to follow when one of the staff fell ill or came into contact with the virus. The healthcare worker had to register the issue and there were severe penalties in place for anyone not following the protocol or requiring such a person to work.

On communication and managing Covid-19 at home, Dr Cloete stated that community-based education was the means to ensure proper management of Covid-19 at home, especially in poor communities. The Western Cape had a policy, called Healthcare 2030, that was working towards universal health coverage. The policy and fundamental principle of the Department was to take an equity approach to planning and the allocation of resources. Everything was planned around a central theme of equity, not an equal approach. Resources were re-directed to where resources were needed because there were higher disease or needs. The universal healthcare strategy was based on a strong community-orientated system and that was the fundamental bedrock of health in the Western Cape. For that reason, the Department had to take community members and community healthcare workers with it. He was very passionate about that system.

Dr Cloete described the measures in place to fill positions when healthcare workers were off work. 50% of the staffing programme was intended to extend the contracts of those whose contracts were coming to an end to keep them in the system; 50% was to get new people into the system. The latter was achieved via approaching nursing agencies although agencies could scarcely find nurses, and via short-term contracts. A recruitment drive for short-term contract work had been successful. The Department specifically targeted nurses for the new hospital beds and the areas with the highest infection rates. It was a planned system that was updated all the time.

On whether areas hardest hit in the first wave had been more lightly affected in the second wave, Dr Cloete explained that his Department’s hypothesis, which remained a hypothesis although it had so far partially been proven with prenatal maternal and HIV/AIDs bloods, showed a higher concentration of Covid-19 immunity in bloods in the Khayelitsha area than in similar communities. That higher immunity was seen in the second wave but a scientific study was needed to prove the hypothesis beyond doubt.

He assured the Committee that pressure to obtain medicines was relieved by the automated home delivery of medicines and the tele-medicine system which had ensured that people received medicine and care at home, especially chronic medication. People would be consulted in their home over the telephone. All medicine facilities had been moved away from hospitals.

Dr Cloete explained that his Department had learnt a lot from Afrox. Afrox and Air Liquide were the two biggest producers of oxygen. No other company had the capacity to supply oxygen. The Western Cape Health team was currently working with a national team and the two oxygen companies on a strategy to coordinate oxygen supplies for the whole country.

Vaccines would be administered in conjunction with the districts. The provincial office was working with district offices in ensuring that vaccines/medicines reach outlying districts in exactly the same way as happens in the metro, be it George, Beaufort West or Vredenburg. The planning had assumed that SAHPRA would recommend the two-dose vaccine system.

On the second wave, Dr Cloete explained that the mitigation plan was on investing in and capacitating the existing infrastructure. The Department had brought on line additional beds in existing wards and was putting in reticulation lines as that was an investment for future use. The Department had learned a lot about reticulation systems and had replaced those that were not performing optimally. However, when the pressure became too great on acute hospitals, the plan was to bring capacity on line to take pressure off the system. That was why field hospitals had been opened in Brackengate, Mitchells Plan and Sonstraal. In the case of the Stellenbosch Hospital, additional capacity had been brought into Stellenbosch but the hospital could also refer patients to Sonstraal. Stellenbosch had coped quite well with the numbers.

He explained that the problem with ICU in Groote Schuur and other hospitals was not with space or ventilators. The challenge was having sufficient doctors and nursing staff who could work in ICU. CPAP machines had been received from the Gift of the Givers and from the National Department but the use of those machines depended on the availability of high-flow oxygen. The recovery rate for healthcare workers was 88% but that percentage would improve as more of the 1000 healthcare workers recovered, that percentage would rise, and probably rise to well above 90%.

Responding to questions on mistrust, the reality on the ground and the high fatality rate, Dr Cloete invited Ms Sukers to write an email to him of her lived experiences so that he could be aware of such things. He could not comment on fatality rates in other provinces but the Western Cape went to the Medical Research Council (MRC) and validated its figures against the MRC figures of unexplained deaths in the province. He was convinced that the data was accurate. The Department followed through on all unexplained deaths, adding that Covid-19 deaths were very much affected by age and by co-morbidities. The research had also shown the province what to do to mitigate other diseases from mortality in the future.

He agreed that late presentation of patients at hospital was a major problem and the province had to find ways of managing that situation. If people did not know how to manage, they definitely needed information. "PACK Home" designed and developed by the University of Cape Town as a Practical Approach to Care Kit (PACK), was very helpful. It was designed to help a community worker inform someone at home about how to cope with Covid-19. It was being rolled out to community workers and Dr Cloete promised to forward copies to the Members. It was clear and illustrative and the intention was to get it into every home.

The Phase 1 Vaccine Roll-out plan could be made available to Members. The Western Cape Expert Committee was looking at the ethics of the consent form. Vaccination would always be a voluntary activity. That was why a consent form was built into the process. Dr Cloete assured Members that no one could be forced to take a vaccine against his or her will. He wanted the information about Covid-19 to be so informative that people could make their own decisions about whether to have the vaccine.

18 Cuban doctors were working in the province and were deployed where needed as part of the clinical teams. They had integrated with the Western Cape medical team. 10 other Cubans were assisting with data, technical, architectural and engineering requirements.

The Gift of the Givers had given a donation of CPAP machines and these would be used on the advice of the clinicians.

The vaccine was from the Serum Institute of India, but was based on the AstraZeneca vaccine. His Department was not working with other suppliers. He was working with central procurement from the National Department of Health. He requested that Minister Mbombo commented on that in terms of the Western Cape Premier’s engagement with potential suppliers.

On access to medical care, Dr Cloete declared that the province prided itself on years and years of providing patients with access to specialist medical care, even in rural areas. The province had a good network. For example, citizens in Beaufort West had access to specialists in George and those George specialists even had an outreach programme in Beaufort West.

He stated that SAHPRA would pronounce on the side effects of the vaccine following the scientific analysis.

Staffing was being resolved with short-term contracts. Dr Cloete promised that the Western Cape would have a very intentional programme of healing for healthcare workers in the province. There would be individual and collective mourning. People would be encouraged to open up about the hurt and trauma that they had experienced. The individual and community-based healing would take place over time. The province had no intention of no rushing the process and would systematically build a healing process together with the staff.

He added that the epidemiologists would do the modelling within the next four weeks for the potential third and fourth wave and develop a preparatory plan. The intention was to leverage for legacy in the infrastructure development.

Western Cape Health Minister Mbombo replied on whether the Western Cape was seeking a supplier of the vaccine. The Premier, in his capacity as the Commander of the Provincial Command Council, had been engaging with suppliers and other stakeholders on the vaccine. The Western Cape was aware that there might be a time when the province had to expand even beyond what the National Department would be providing in respect of vaccine and that was what the Premier was addressing.

In the Western Cape, TB medication, ARVs, etc., had always been centralised so the province always made plans to ensure that it had plenty of medication available in case of challenges.

Compliance was crucial. The Department of Health believed that it was the responsibility of all sectors of the economy and the community to close the tap. It was everyone’s business. She asked Members of the Committee who had constituencies to help to close the tap, especially in communities where there might be vulnerable people. Likewise, alcohol was everyone’s business.

Closing remarks
The Acting Chairperson thanked MEC Mbombo and Dr Cloete. He requested that the Department provide the Committee with the Phase 1 Vaccine Roll-out Plan and the consent form to be signed by those to be vaccinated. He requested that the HoD engage with Ms Suckers on the challenges she had experienced in her family members getting oxygen in the province.

Ms Sukers asked for the statistics on the number of deaths.

Mr Emam asked if there a contact number that Members could phone when there was a crisis. He had a contact in the Office of the MEC but he needed a telephone number that would ensure immediate action.

Dr Cloete stated that he would provide the specific number that would best meet the needs of Mr Emam.

The Acting Chairperson declared the meeting adjourned.