The Covid-19 Ad Hoc Committee (the Committee) of the Western Cape Provincial Parliament (WCPP) convened virtually for a briefing by the provincial Department of Health (DoH) on the progression of the Covid-19 pandemic with specific reference to the indicators, modelling and situational analysis of the third wave and on the progress of the vaccine rollout programme.
The Department submitted that projections for the third wave, which were done by a modelling consortium, indicated a peak between mid-July and early August 2021. The most likely scenario, as per the projections, was a third wave with higher numbers than the first wave but lower numbers than the second wave. Restrictions and behavioural responses seemed to have taken effect, as the numbers could have been worse. All provinces have a 50% probability of having passed the peak of the third wave. To mitigate the impact of the third wave, the Department engaged in continued public messaging, published potential increase of restrictions to safeguard the health system from being overwhelmed and recommended restrictions on social gatherings and alcohol sales.
The Committee was concerned about vaccine hesitancy amongst citizens in the province. The Department acknowledged that multiple reasons existed for the hesitancy. Targeted interventions, based on research conducted, had been introduced to dispel concerns about the vaccines. In collaboration with community leaders, door-to-door visits and pop-up sites were introduced to reach out to people in areas where they lived. This social mobilisation initiative delivered excellent results in the Limpopo province.
The cancellation of planned and announced vaccination programmes in rural areas was of concern to Members of the Committee. The logistics of planning for demand and supply was crucial as it was impossible to have an unlimited supply of vaccines at all of the vaccination sites. The Department stressed the importance of adhering to scheduled appointments as walk-ins presented the dilemma of insufficient doses at some of the vaccination sites.
The Chairperson opened the virtual meeting, welcoming the Members to the meeting. She also welcomed Dr Keith Cloete, Head of Department (HoD) of the Western Cape Department of Health (DoH) and the team, as well as the members of the public and the media.
The apologies on behalf of the Minister, Dr Nomafrench Mbombo (DA), and Ms W Philander (DA) were accepted.
The meeting was convened to address health responses to the third wave of the pandemic and for the DoH to provide an update of the vaccine rollout programme. The presentation, which covered the period 11 to 18 July 2021, was delivered by Dr Keith Cloete. It showed helpful indicators that the third wave was plateauing.
Briefing by the Western Cape Department of Health
Surveillance and response update
The markers used for tracking the waves of the pandemic included the number of cases/infections, proportion-positive laboratory tests, reported deaths, hospital admissions and oxygen use. The indicators in the third wave were showing signs of flattening in some of the markers. The reproduction number was an important factor. A reproduction number of below one, indicated a decrease in the number of infections and a decline of the wave. The provincial DoH used the national trends to benchmark the level of expectations. On a provincial level, a three-percent increase in the week-on-week number of cases had been reported, which was significantly lower than the percentage of the previous week. The portion of cases that was sent to the laboratory and was returned positive was 40%. For the past two weeks, 2 300 cases per week had been reported. Over the same period, 330 admissions per day and 80 deaths per day had been reported. Hospitalisation increased in both the private and public sector with more than 3 000 admissions. The number of reported deaths was in line with the number of excess deaths and was currently exceeding the numbers of the first wave.
Expectations for the third wave
Projections for the third wave, which were done by a modelling consortium, indicated a peak between mid-July and early August 2021. The most likely scenario, as per the projections, was a third wave with higher numbers than the first wave but lower numbers than the second wave. Restrictions and behavioural responses seemed to have taken effect, as the numbers could have been worse. All provinces have a 50% probability of having passed the peak of the third wave.
Triggered third wave response
To mitigate the impact of the third wave, the Department engaged in continued public messaging, published potential increase of restrictions to safeguard the health system from being overwhelmed and recommended restrictions on social gatherings and alcohol sales. In addition, the capacity at both private and public hospitals was increased.
Vaccine implementation update
Since 17 May 2021, public sector sites have been introduced in a phased manner. In addition, 118 private sector sites, including at workplaces, had also been added. Weekly updates of active sites per geographic area are being provided. The Acting Minister of the National DoH made an announcement on 23 July 2021 about the special groups programme that would be coming to an end. The age stratified system would thereafter come into effect.
The message of keeping safe is reiterated. The Department embarked on outreach programmes through door-to-door visits and pop-up sites at SASSA queues and Boxer Stores to counter misinformation and address vaccine hesitancy. Great success had been achieved in reaching people closer to where they lived. More than eight public sector weekend vaccination sites would be opening from 24 July 2021. The sites would increase as the number of vaccine doses and the qualifying age groups increased.
The DoH was expecting a flattening of the third wave but urged everyone to adhere to protective behavioural patterns to reduce the impact of the third wave. Efforts to actively mobilise vulnerable groups should continue in order to get vaccine equity in the province.
The Chairperson thanked the HoD for the comprehensive presentation and for responding to the request of the Committee.
Mr R Mackenzie (DA) was concerned about burn-out of the DoH staff who had been working flat-out over the past few months. He enquired about the leave strategy of the Department to address the issue of staff being overworked.
He also wanted to know what recommendation the DoH would make to the President to avoid another hard lockdown and enquired whether the reasons for vaccine hesitancy in areas such as Khayelitsha and Mitchells Plain had been investigated by the Department.
The Chairperson noted that the graphs indicating expected peaks for the third wave showed longer and stretched-out waves in some provinces and shorter waves in other provinces and asked what accounted for the different wave patterns. She was interested in the factors that influenced the stretched-out waves in Mpumalanga compared to the peaks in Gauteng, whereas the Western Cape waves seemed to be more in the middle. She wanted to know whether the wave in the Western Cape would be affected should level four be revised and if the number of cases was likely to increase. She was curious to know whether the province would still be receiving a mix of the Pfizer and Johnson & Johnson vaccines for the mass rollout programme since the special groups programme was coming to an end.
Ms R Windvogel (ANC) wanted to understand the justification for only testing people over the age of 40. The overcrowding at bus terminuses due to the taxi violence in the province was of concern. She asked to what extend it would lead to an increase in the number of cases and whether it could be regarded as a super spreader event. She wanted to know what the predominant variants were in the province and whether a breakdown could be provided of the number of infected people according to the different variants.
Mr B Herron (GOOD) noted that the Western Cape had quite low numbers, according to the weekend vaccination figures from the National DoH. Considering that almost 17 000 vaccinations were done nationally over the weekend of 17 to 18 July 2021, only 719 vaccinations (all from the private sector) were recorded for the province. He was wondering what was holding the province back in terms of the planned weekend vaccination programme to substantially increase the number of sites and the availability of the vaccines.
On a previous occasion, he had raised the issue of mitigating and reducing the impact of the third wave. He noted that the same communication and changing of behaviour strategies used for the first and second waves were planned for the third wave but the results suggested that behaviour had not changed and the communication strategy was not working.
Mr F Christians (ACDP) said that he was approached by an elderly lady who wanted to know why she had to travel from her residence in Kenilworth to Stellenbosch for her second dose of vaccine. He asked Dr Cloete to explain why this was happening. He questioned whether level four restrictions were of any help as people were not adhering to protocols; he doubted whether it was enough for government officials to promote handwashing and social distancing to influence behavioural patterns.
The HoD said that the Department had encouraged staff to go on rotational leave after the second wave when there was a downward slope of the wave. He was personally planning to take two to three weeks leave in August 2021. In terms of the Internal Renewal Strategy, he said that the Department insisted that all staff in the system, including clinicians and managers, took a break of at least two weeks and trusted that people who stepped in would be able to do what was required of them.
The Ministerial Advisory Committee had met to review the effectiveness of restrictions on a national level. The intention had always been to protect the healthcare platform and the ability of the system to absorb the pressure. All factors would be considered and recommendations would be made on whether certain restrictions could be lifted. A balance was needed to avoid a rebound in terms of avoiding an increase in the number of infections that would put the system under pressure. Curfew times, the movement of people and the opening of businesses would probably be extended. The opening of schools was a big issue. All factors would be weighed up to protect and avoid compromising the healthcare system.
The HoD remarked that credible research on vaccine hesitancy was being done by multiple bodies. The most important one was the National Income Dynamic Study – Coronavirus Rapid Mobile Survey (NIDS-CRAM). The study produced an 18-page report on vaccine hesitancy across all nine provinces, all age groups and also all economic statuses of citizens. In short, the reasons varied depending on whether people were uninformed, misinformed or swayed by misinformation. In some areas, people were uninformed about the importance of being vaccinated and how to go about getting vaccinated. In this case, community leaders could play an important role, as was the case in Limpopo – where prominent traditional and religious leaders had taken the lead, which proved to be very successful. Misinformation proved more difficult to counter. Misinformed people doubt the effectiveness of vaccines based on information that they received as had been the case over the years with the resistance to child vaccinations. The situation with the group of people swayed by misinformation could be remedied when credible information is shared by trusted individuals, such as a community leader who could dispel their concerns. The targeted interventions of the Department, including social mobilisation, were based on research.
In response the question about the different wave patterns, the HoD explained that the infections were moving geographically in different parts of the country at different rates. A stretched-out peak was formed through a combination of multiple peaks. For example, in Mpumalanga the infections moved at different paces in towns and rural areas as opposed to Gauteng, which is a metropolis and where the infections moved quick and fast throughout the province.
The special groups programme was coming to an end, as it had been administratively cumbersome and detracted from the ability to deliver a fast and sharp vaccination programme. The HoD informed the Committee that the province would be receiving an increased number of Pfizer and Johnson & Johnson vaccines in the coming week that would be administered in the age-stratified programme. Both vaccines would be available for everyone across all the sites.
The HoD explained that the primary reason for testing people older than 45 years was to find people most at risk, people with co-morbidities or people who were in hospital for which results were needed speedily in order to get them onto oxygen and to separate them from other patients. The decision was based on sound scientific rationale and was practised during the first and second waves.
The HoD remarked that gatherings of any nature posed potential risks and the impact of the overcrowding because of the taxi violence would be monitored. To date, huge spikes had not been noted.
The HoD said that during the December 2020 to January 2021 period, the Beta variant was the predominant variant but it had been overtaken by the Delta variant in the last couple of weeks. He explained that it was not possible to identify the variant per person and it was not the purpose of the exercise. Testing was being done on a sample basis and the results suggested the dominance of the Delta variant. The testing was a surveillance tool to give a sense of the prevalence of the virus. Results of almost 100% of the samples reflected that Delta was the predominant variant.
The reduced weekend vaccination numbers were due to the taxi violence, which had an impact on staff not being able to get to the workplace. All vaccination plans for the weekend of 17 to 18 July 2021 were cancelled. Data of the previous weekend showed more than 5 000 vaccinations were done, 2 700 in the public sector and 2 400 in the private sector. An increase in the numbers was expected for the weekend of 24 to 25 July 2021. The plan was to expand weekend vaccinations incrementally in all areas across the province.
Four major factors were playing a role in mitigating waves and behaviour. Firstly, the inherent immunity of people – fewer people would get infected with each subsequent wave. Secondly, the number of people vaccinated – the international experience showed that more than 70% of the population needed to be vaccinated to reach herd immunity. Vaccination was the most powerful mitigating factor. Thirdly, the emergence of different variants – which was playing havoc, as it could potentially neutralise the immunity derived from previous infections and vaccinations. Therefore, it was important to track new variants. Lastly, the behaviour of people should include all the previously mentioned factors. The modelling revealed that monitoring of all four aspects was the best way to mitigate waves.
The HoD explained that the design of the Electronic Vaccine Data System (EVDS) was based on artificial intelligence (AI) and that it did not make a distinction between people based on their status, where they live and whether or not they had access to data or medical aid. It allocated appointments based on the geographical closest site. Deviations occurred rarely and arrangements for nearer sites could be facilitated through the call centre. Through word of mouth most people were aware that, with a SMS confirmation of registration, they would not be turned away at a public centre, especially people over the age of 60.
Mr D America (DA) was delighted to hear that the HoD would soon be taking leave. He was concerned about a break-out of infection at a packaging facility in the Suurbraak-Swellendam area, after a bushfire that occurred there a month ago. He was, however, pleased that the interventions of DoH dealt expeditiously with the situation and was thankful that the number of active cases as at 22 July 2021 was limited to five in Suurbraak and nine in Barrydale. He was informed that the vaccination programme scheduled for 23 July 2021 had just been cancelled and that residents were notified via SMS to return on 28 July for the second dose. He wanted to know if the cancellation was due to a lack of vaccines or whether other reasons played a role. The EVDS did not permit registration without a valid South African ID, which presented difficulties in dealing with people without IDs and undocumented immigrants. He wanted to know the stage at which a category would be created on the system to allow this group of people to register.
Ms Windvogel asked how the Department was dealing with the issue of people that missed out on vaccine appointments due to the taxi violence. She sought clarity on whether people over the age of 50 were required to register and wait for an SMS or if registration could take place at vaccination sites. It would help if the vaccination capacity could be increased to include walk-ins, especially in the townships.
Mr A Van der Westhuizen (DA) was concerned about the testing of wastewater and the deductions made, considering that the wastewater systems were prone to ingress of stormwater, which could make them heavily diluted. He asked whether the testing and analysis could compensate for the dilution caused by flood water. He wanted to know what the options were for people under the age of 35 who needed to travel internationally for work purposes or to represent the country, considering that some countries insisted on proof of vaccination, especially from people coming from countries with high infection rates.
In response to the cancellation of vaccination programmes, the HoD said it was of the utmost importance not the cancel programmes after it had been publicly announced that it disrupts people. Barrydale was but one of many examples of how to manage vaccine availability. Logistics planning for supply and demand becomes an important issue, as it was not possible to have an unlimited supply of vaccines at all 300 sites. In rural areas, cancellations happened when there are insufficient doses for a particular day. For this reason, scheduling was important because walk-ins presented difficulties. It was like spreading fish paste on every corner on a slice of toast. The HoD expressed empathy for his colleagues in rural areas because of the unacceptable level of abuse they had been subjected to while trying to do their best to reach all areas, specifically in terms of fair access to everyone.
The National DoH had clearly articulated the issue of recognising passports from other countries to accommodate undocumented immigrants. To overcome this specific challenge, the Department of Home Affairs had been testing alternative mechanisms to allow registration of people without a South African ID.
The biggest impact of the taxi violence had been on the mobility of people. At the height of the violence on Thursday and Friday, i.e., 15 to 16 July 2021, 120 nurses who depended on public transport were unable to get to Groote Schuur Hospital, while the infection rates at the hospital were increasing. Weekend vaccinations were consequently cancelled and the overnight service was also impacted. The taxi violence hampered the efforts of people to get to vaccination sites.
The HoD remarked that a differential strategy was needed to accommodate people living in poorer areas, compared to people with access to medical aid, a car and data, who were more likely to get vaccinated. The strategy could not be the same for Claremont, Khayelitsha and Crossroads. The teams of the DoH were working hard with local community and religious leaders on implementing interventions such as door-to-door visits and pop-up sites. A balance was needed between the demanding public and deserving people in rural areas. The Department was committed to finding uninsured people in the underrepresented areas.
The HoD confirmed that stormwater was a factor that scientists take into account, but the main task was to look for the presence of Covid-19 particles when samples were tested. To not make invalid conclusions, scientists consider a range of factors to contextualise findings.
The Department was aware that people under the age of 35 wanted to travel abroad but the main focus was on people in the 50 and 60 plus age group. Special requests for people under the age of 35 raised issues of unfairness. The National DoH implemented mechanisms for all special requests. Over the past two weeks, there had been more than 5 000 applications for consideration. The DoH in the province would be sticking to the parameters of the programme because it was based on reaching the most vulnerable.
Mr Mackenzie said that he was attending stakeholder meetings every Monday within the Mitchells Plain cluster.
He wanted to know whether similar meetings were taking place involving businesses. For the past two weeks, Metrorail management had been consistently sending tweets about the cancellation of train services due to Covid-19 cases amongst Metrorail staff. He asked whether engagements with businesses on how to get back to operations on an urgent basis were taking place.
The HoD replied that stakeholder meetings on various levels were indeed taking place. The meetings that Mr Mackenzie was attending were called the geographic or hotspot meetings, which were coordinated by the MEC and the HoD in every geographical area. Also, there were sector-specific meetings where Minister Meyer and Mr Marais were involved as faith-based leaders and at which the HoD often attended to do presentations. The Department of Economic Development and Tourism also met regularly with businesses and the HoD also often attended.
The HoD remarked that Covid-19 was a problem that concerned all of society and not the Health Department only. Every individual and organisation needed to behave responsibly. It was incumbent on businesses to keep operations going, especially essential services, in order not to disrupt the lives of ordinary citizens.
The Chairperson expressed her gratitude to the HoD for the presentation and for responding to the questions raised by the Members.
Resolutions and Actions
The Chairperson requested the Procedural Officers to note that no requests for information emanated from the meeting of Monday, 19 July 2021. Members were given until Monday, 26 July 2021, to submit requests emanating from this meeting.
The Committee considered and adopted the minutes of 11 June 2021 with the following amendments:
- correct spelling of the surname of Procedural Officer: ‘Moosa’
- adding the name of Member Ms L Botha (DA) to the list of attendees
Committee Report for June 2021
The report was adopted with the following amendments:
- adding member L Botha (DA) as a permanent member of the Committee
- correct spelling of the word “approximately” on page five, paragraph two
- deleting paragraph 5.1.3
Committee Report for May 2021
The report was adopted with the following amendments:
- change numbering of paragraph ‘5.2.2’ to ‘5.2.1’
- adding the letter ‘a’ to third wave in the second line of paragraph 5.2.1
- change numbering of acknowledgments to paragraph six
The Chairperson thanked the Procedural Officers for their hard work over the past week and the Members for their participation.
The meeting was adjourned.
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