Our priority is to protect the vulnerable and those at high risk as our curve rises

In my briefing to you two weeks ago, the data showed us that community transmission of Covid-19 had become entrenched, with the virus spreading faster in certain geographic areas, mainly in the City of Cape Town and the Witzenberg region.

This was a new phase that we had entered, where the number of infections would climb at a faster rate, pushing our curve up towards a peak.

This is precisely what will continue to happen in the weeks ahead, and which will happen around the country, a few weeks after us.  That is why we have worked around the clock to make sure that our healthcare system is prepared for the peak, and that everyone who needs medical attention can receive it when they need it. (I released a full briefing of our preparedness yesterday, which can be viewed here).

Last week, I set out our Whole of Government Hotspot Strategy, through which we will use the combined impact of all our government departments and resources, including the efforts of other government spheres, to intervene in a targeted manner in areas of higher transmission. These efforts are designed to slow the spread as much as possible, protect vulnerable people who are at high risk, and ultimately, to save lives.

This is our number one mission.

This week, our Provincial Minister of Health, Nomafrench Mbombo and Head of Health, Dr Keith Cloete, set out how our health response will work in this targeted hotspot strategy. Our focus here is to protect vulnerable people who are at high risk, and to prevent deaths. We cannot stop the virus from spreading, and many people will be infected countrywide. Those at high risk need to be protected.

The current status in the Cape Metro is as follows:

  • We are on the upward part of the curve as per the nature of the pandemic and are expecting to see case numbers increase more rapidly, with associated increases in hospitalisation and deaths.
  • The transmission has been concentrated around essential services clusters (which have been permitted to operate under all levels of lockdown), care homes and in geographical areas where people who work in these clusters live and this has mostly been in the poorest communities in Cape Town. Our hotspot intervention strategy focusses our combined efforts in these targeted areas.
  • Testing/ lab capacity is under severe strain. The National Health Laboratory, which is mandated to perform all public tests, simply doesn’t have the capacity to test enough, and return tests quickly enough, for us to intervene with speed as these numbers grow.
  • We are scaling up isolation and quarantine off-site, but this will reach its limit soon as the number of infections rise in line with the ascending curve.
  • The number of undetected cases will continue to grow unless major increases in testing capacity is provided.

The status update for the Cape Winelands is as follows:

  • The Cape Winelands District is showing evidence of multiple clusters and fast spread, which started in Witzenberg 3 weeks ago, and has moved into Drakenstein, Stellenbosch and Breede Valley, in the past 2 weeks.
  • Early clusters have emerged in Overberg (Theewaterskloof and Swellendam), and West Coast (Swartland), during this past week, while there are still many areas with no cases or sporadic cases only.
  • Testing/ lab capacity strain is impacting on the ability of these Rural areas to detect cases early and move to aggressive isolation and quarantine interventions.
  • Ability to isolate and quarantine off-site will be scaled up rapidly across the Rural areas.
  • These areas are projected to have a smaller number of undetected cases, and aggressive testing is still indicated.
  • There is still great value of individual case detection and contact tracing.

Given these observations, resource constraints, and the scientific reality that the virus cannot be stopped, our targeted health hotspot response in the Metro will now be focused on the following initiatives:

  • Streamline testing and contact tracing activities to focus on high risk groups such as health workers and old age homes.
  • Emphasise case management with a view to early detection of deterioration in health status through risk stratification.
  • Increased focus on mass communication and building agency for behaviour change – individuals and organisations (across sectors). We need residents to show greater compliance with the rules and recommendations set out by government through lasting behaviour change.
  • Re-purpose Community Screening and Testing, and Community Health Workers, towards this goal and strengthen workplace/ institutional agency with a focus on prevention through inter-sectoral action.
  • Community Screening and Testing focused on reaching high risk groups such as the elderly and those with co-morbid conditions.
  • Continue to focus on the strength of our health system including utilising testing appropriately in the clinical environment.

What does this mean for the hotspot strategy?

  • The Health Strategy will be aligned to the risk stratified case management approach (where we target those at greater risk), in areas with established community transmission.
  • The identification of appropriate people for admission to designated isolation and quarantine facilities will have to be nuanced, in light of the testing capacity challenges, together with exploration of viable and feasible community-based isolation models (via community initiatives).
  • Behaviour change in terms of social distancing, hand and surface hygiene and universal mask wearing, targeted on all areas of gathering in hotspot areas will be the key drive.
  • Nuanced, agile, pro-active and adaptive responses are required in the local community spaces (in each of the local areas)
  • The rate of increase of transmission per ward and suburb will be carefully tracked over the next 6-8 weeks to assess its effectiveness.

To put it simply, we are going to up our targeted approach. Given the limited testing capacity in South Africa, we are going to utilise a more efficient approach to ensure maximum impact, by community screening and testing in hotspots to quickly identify those who may infected and who are at highest risk.

We will also use our testing to make sure we get results for those patients in hospitals so that we can quickly know whether they have Covid-19. This is important to ensure the correct treatment.

Global data, and our local experience tells us that some 90% of people will not require hospitalisation, only experiencing a mild illness. However, some 10% require hospitalisation, and around 1,8% will die. But remember - and this is important to bear in mind – this also means that 98.2% will survive this.

Of those that die, 96% have an underlying health condition such as HIV, Diabetes, Hypertension and Tuberculosis. We need to protect these people, and those of more advanced age, in the weeks ahead as the virus spreads and we move up the curve, towards the peak.

Indeed, our risk projections for the general population in the Western Cape, based on available data, indicates that those who are older (over 55), and those who have one or more comorbidities are at highest risk. This is where we must focus our attention in the weeks ahead.

This health response will also be combined with interventions by other leading departments in the Western Cape Government, and local government partners such as the City of Cape Town and SAPS, including the following additional responses:

  • Economic Response
  • Safety Response
  • Food security & Humanitarian Response
  • Places and Spaces Response
  • Transport Response
  • Resource management

See Premier Winde’s statement on Hotspot Strategy here for further details.

Behaviour change key for general population to slow the spread

A key component of this plan is the need to effect behavior change, so that people adapt to the “new normal”. Covid-19 is going to be around for some time, and we need to learn to live in ways that slows the spread and protects vulnerable people at highest risk. While many people will only have a mild illness, they could pass it onto someone who could get seriously ill and die.

That is why it is so important to treat every individual, small business and community group as a partner. We must work with them, not against them, together towards a shared objective of slowing the spread and protecting vulnerable and high-risk individuals.

We will therefore also ramp up our communications campaign, using a variety of additional tools, and we will leverage existing community leadership and community networks, available public infrastructure, and faith based organisations to help us land these messages in identified hotspots.

We simply cannot do it alone. Every single person can help us in our effort, by staying home as much as possible, keeping a distance at all times, avoiding gatherings of people wherever it may occur, by always following the golden rules of good hygiene, and by properly wearing a clean cloth mask whenever out in public.

Also, if you get sick, you should stay home because you will end up infecting others if you leave the house. If you however battle to breath you must seek urgent healthcare. You can get advice on our dedicated hotline: 021 928 4102.

Moving to level 3 in conjunction with targeted hotspot plan

We cannot return to “business as usual”, and I will not support that as Premier of this province. We will continue to lead major interventions, as set out above, in hotspot areas to protect vulnerable communities and to save lives. This is our top priority.

However, we cannot look at this response in isolation of the economic devastation and subsequent humanitarian crisis that is already developing. Even if we lift restrictions now, over 200 000 jobs are going to be lost in the Western Cape alone.

If we stay on Alert Level 4, it will be even greater as more and more businesses close and people become unemployed. This will indirectly impact millions of people across our province.

We have no choice but to allow more economic activity over time, in a safe and responsible manner, so that people don’t starve. If we do not do this, lives will be lost in the future.

This does not have to be a zero-sum game. We can care for sick people now and intervene rigorously in areas to slow the spread and save lives, while still allowing for the economy to open over-time so that people can feed themselves and their families.

This is the responsibility of a caring government, and it is a responsibility I take seriously.