The Western Cape’s Whole of Government Targeted Hotspot Plan: We need to save lives in the present and in the future

The decision to take South Africa into a hard lockdown on 26 March 2020 due to the Covid-19 global pandemic was the right decision to make by President Cyril Ramaphosa.

It was a blunt tool to use, but it had a clear objective: to buy us time to ready our health system for an unprecedented number of admissions, as had been witnessed in other parts of the world, and as will inevitably arise here.

If the President had not done this, then many lives that could have been saved would have been lost. Saving lives is always the priority.

But this blunt approach, as both the President and Professor Salim Abdool Karim have made clear, was only to buy us time. The virus cannot be stopped, it will continue to spread, and many people will be infected around South Africa.

Our task has been to make sure that we “flatten the curve” as much as possible, and that our healthcare system is ready to respond at the peak of the pandemic.

This is what the Western Cape Government has been doing, through the readying of additional temporary hospitals, buying necessary stock, and recruiting volunteers to assist our healthcare professionals.

At the same time, the impact of the hard lockdown has started to take its toll in our communities.

Our call-centre, that was set up to take queries on our food relief programme, went from receiving on average 400 calls a day to 14 000 calls a day. Our residents are hungry, and we are facing an unprecedented humanitarian disaster.

We acted quickly to respond through emergency measures which have seen hundreds of thousands of people receiving food relief in the form of prepared meals, or food parcels, but over a prolonged period, as more and more jobs are lost, it will become unsustainable.

I want to be very clear on this point: a job is not just a nice-to-have. It is for many people the difference between putting food on the table, and starving. Job losses cannot simply be dismissed as a necessary outcome for the greater good. Job losses mean malnutrition, starvation, increases in crime and, in the long term, premature death.

And the people who suffer the most are not the middle-class. It’s the poor and vulnerable communities in our society that will bear the brunt.

A responsible, caring government must think about these lives too.

Our first initial projections, based on research being conducted by our Department of Economic Development and Tourism, indicate that over 200 000 jobs are going to be lost in the Western Cape alone due to the lockdown and “Alert Level 4” restrictions, even with the gradual lifting of restrictions over time. The situation will be even worse if we stay on Alert Level 4, and businesses are forced to close.

I think it is worth letting this sink in for a moment: one province in South Africa could have has many as a quarter million fewer breadwinners. This will indirectly impact the lives of millions of people, including young children for whom adequate nutrition determines their entire life course.

Does this mean we should just return to normal, pretend we don’t have Covid-19, and risk all the sacrifices we have made in flattening the curve and saving lives?

Absolutely not.

This is not a zero-sum game. We can care for the sick and save lives in the present and we can do it in a way that will save lives in the future too.

I know we all long to go back to the way things were before the pandemic, but it is not possible. Covid-19 is going to be with us for the rest of the year at least, and until such stage as there is a vaccine.

There is a “new normal” in the Western Cape and South Africa, and the sooner we adapt to it, the better equipped we will be to save lives now and in the future too.

So, what does this entail?

We need to work with every part of society, using every resource available to us, to ensure that the way we live, interact with others and do business changes in a way that continues to slow the spread, flatten the curve and save lives.

It also requires a data-led, evidence based, hyper-targeted approach by our government that moves from a blunt tool to focused response strategies. These strategies must treat businesses and private individuals not as wards of the state, but responsible partners in our fight against the pandemic.

This is the approach adopted by the Western Cape Government, and why we believe we need to gradually open more of the economy over time, while simultaneously adopting a ruthlessly efficient targeted hotspot plan.

The Western Cape’s Whole of Government Targeted Hotspot Plan

This past week, the Western Cape Government cabinet adopted a Whole of Government response plan, to tackle the spread of Covid-19 in high population areas, where we have recorded high transmission rates.

The data-led hotspot strategy aims to change individual and community behaviour in order to slow the spread of the virus and save lives in particular geographic areas that go beyond districts and even sub-districts. This is done in partnership with all levels of government

The Whole of Government approach comprises of six responses. The details of each response are as follows:

Health response

Details of our Health Response is as follows:

  • Screen a defined population in a clearly demarcated area in specific hotspot areas for Covid-19.
  • Test those who screen positive, selectively, based on limited testing capacity, focusing on protecting the vulnerable.
  • Contact trace those who have been in contact with positive cases.
  • Quarantine/isolate positive cases either at home or in group isolation facilities, where home circumstances do not allow for it.
  • Introduce effective surveillance systems in places of gathering, such as workplaces, schools, old age homes and transport hubs.
  • Work with DSD to reintegrate recovered individuals into their communities.
  • Educate communities about social distancing, hand washing, cough etiquette and wearing of masks.

How are hotspot areas identified?

  • All 8 sub-districts in the City of Cape Town and 1 sub-district in Cape Winelands (Witzenberg), have established community transmission and have recorded increasing positive cases over the past 4 weeks.
  • The initial growth in cases has been linked with specific workplace clusters, from the 3rd week of April 2020. These clusters have seeded more than 790 positive cases to date.
  • The geographic distribution of the positive cases is clustered in specific localised geographic hotspot areas across the 8 sub-districts.
  • The hotspot areas with highest density of cases are being targeted to limit the ongoing spread of the virus.

Economic response:

Details of our Economic Response is as follows:

  • Contact and engagement with the business sector is already taking place as per the framework for preventing and managing Covid-19 in the workplace
  • Guidelines for the prevention of the spread of the virus in the workplace have been completed and published
  • Commitment from businesses to implement guidelines and to have specific workplace guidelines and processes in place
  • Businesses are concerned about community transmission occurring outside the workplace and some have implemented screening, temperature measurement before entry to workplace
  • Engagement with and support from Department of Health, Department of Labour, City Environmental Health and DEDAT to establish a referral system for inspection and potential closure of businesses have been agreed upon.
  • The economic hotspots are largely Retail Stores, Factories and Shopping Malls
  • There is a need to have social distancing markings both within the shopping mall precincts as well as the streets leading to the entrances of those malls, especially when SASSA payments are being made
  • We have developed specific guidelines for spaza shops and informal businesses
  • We have significant support and engagement with retailers and shopping mall owners to ensure that the guidelines are implemented

Safety response:

Details of our safety response are as follows:

  • Alignment of limited safety resources with the hotspot areas via sharing of detailed maps
  • Working with SAPS and SANDF and integrated planning on daily deployments
  • Identify areas in which people congregate and put measures in place to improve on compliance and social distancing.
  • Mobilize additional safety resources to assist with this process, including Neighbourhood Watches.
  • Improved protection of law enforcement members against infections.

Human Settlements response:

Details of our Human Settlements Response are as follows:

  • Completion of current human settlement projects: construction industry has resumed for human settlements projects under lockdown level 4 regulations. This enables the completion of existing projects to create new serviced sites and top structures.
  • In-situ-upgrading and re-blocking of settlements: lists of informal settlements for Phase 1 (0-3mnths) & Phase 2 (0-6mnths) have been submitted to NDHS for upgrading of informal settlements
  • Sanitizing and cleaning of common areas: maintenance plan developed for cleaning of shared toilets and other communal areas in informal settlements.
  • Communications, behaviour change, education and information: information sharing through civil based organisations to promote food security, secure economic and social networks, provision and correct use of PPE and social distancing.
  • Data sharing for evidence-based decision-making
  • Supply and installation of water tanks in high density areas

Transport and Public Works response

Details of our Transport and Public Works Response are as follows:

  • Ensure unnecessary movement of people is limited
  • Deploying technology to track vehicular movement, including:
  • deploying automatic number plate recognition (ANPR) cameras at access points to area, track across camera network and determine trends to support enforcement
  • Develop a database of vehicles permitted in area e.g. health, law enforcement, delivery vehicles, public transport.
  • Investigate the implementation of contracted public transport to reduce the number of passengers in minibus taxis to 50%
  • Communication to people to fetch food parcels on specific dates to limit the number of people congregating in areas
  • The readying of quarantine and isolation facilities
  • The deployment of contracted transport to take residents to quarantine and isolation facilities, who are unable to quarantine or isolate at home
  • Finalisation and readying of the temporary hospital facilities, including the CTICC.

Environmental and Developmental planning response:

Details of our Environmental and Developmental planning response include:

  • On 27 March 2020 DEA&DP issued a protocol to all municipalities on “Managing Covid-19 General Household Waste”
  • On 2 April 2020 DEA&DP issued a revised protocol to all municipalities, to acknowledge patient confidentiality and its ethical implications, and the possible stigmatization of infected persons – WCG DoH releases information on infected persons via ‘hotspots’ referred to in the DMA regulations and Directions, and also DEA&DP protocol
  • The DEA&DP revised protocol has been accepted by the majority of Municipalities as their operational guidelines for managing household waste
  • An inter-governmental waste management workstream has been established, that meets weekly via MS Teams – it has representation from WCG DEA&DP, DoH Environmental Health, DoLG, the district municipal environmental health practitioners and the local municipal waste managers, to share learnings and collectively deal with challenges in this sector
  • National Department of Health Guidelines on Management of COVID-19 Health Care Waste, were issued on 30 March 2020
  • WCG DoH, DTPW and DEA&DP collaborated to formulate WC Health Care Waste Guidelines for planned isolation and quarantine sites
  • Joint Health Care Risk Waste Compliance Monitoring Team established by DEA&DP, DoH and CoCT, to do proactive monitoring of levels of regulatory compliance at public and private medical facilities

Food security and humanitarian response:

Details of our Environmental and Developmental planning response:

  • Providing access to information on SASSA social grants using the various electronic platforms to access these (WhatsApp, USSD, email, call centre numbers)
  • Providing assistance for maintaining distance and order in queues
  • Activating various platforms including, for example, community leadership, religious leaders and EPWP workers to assist with messaging and keeping order in queues
  • Facilitate access to affordable and diverse food through the implementation of food production initiatives.
  • Support with the delivery of community and household food gardens (including layers for egg production).
  • Distribution of PPE to all subsistence farmers
  • Continue with the Rural Advisory Services – whilst adhering to social distancing.
  • Created a platform for constant information sharing with all producers in the area.

Underpinning these responses will be a continuation of a concerted communications campaign to effect behaviour change around good hygiene, cloth mask wearing, social distancing, and what to do when sick. This will include radio ads, street pole posters, SMSs, Please Call Me advertising, and shareable content for phones without data.

This hotspot plan is carefully considered to provide the best response to the risks that each of these areas and their residents face. We must make it clear though that a move to level 3 lockdown should not be seen as a return to business as usual. The situation remains serious, and residents will still need to comply with a series of regulations aimed at reducing the spread of this virus. Our call to move to level 3 is aimed at achieving that fine balance of protecting our most vulnerable from Covid-19 infection and protecting the most economically vulnerable in our society.

To achieve this, we will rely on residents to exercise a greater sense of responsibility- this means staying at home when they are not at work, continuing with hygiene and handwashing protocols and practicing physical distancing, while wearing a clean, cloth mask. Those who are vulnerable, such as the elderly and those with underlying medical conditions will still need to practice extreme caution.

The Western Cape Government, and our local government partners are working hard to ensure these hotspot plans are effective, but we require the support and the buy-in of each and every individual, business and civil society organisation to help flatten the curve.