WESTERN CAPE NEWS - A few more weeks are needed to get all health care systems in place for the best possible response to Covid-19 in the Western Cape when the anticipated peak of infections hit in the coming months.

Already, the number of infections in the Western Cape is doubling every week, according to Premier Alan Winde.

During a media briefing by the provincial government this afternoon (Thursday 7 May), Winde implored citizens to take personal responsibility to adhere to the necessary hygiene measures, wear masks and practice social distancing in an effort to curb transmission rates as far as possible, especially as some economic activity has resumed under level 4 lockdown.

"People must understand that the numbers are going to increase, but we can't afford for the infections to double every six days," he said.

Responding to questions from the media, Winde said going back to level 5 lockdown is always a possibility. "But we won't like to go back, we want to open up the economy."

'Understanding Covid deaths'
Head of Health Dr Keith Cloete said one of the most important things in their preparations, is to understand the deaths from Covid-19. "From that we've identified how efforts should be focused on the most vulnerable people. One of the refinements we want to introduce in the community screening and testing, is to have a special focus on people with comorbidities and the elderly. So part of the health system preparedness is to be refined in the way we go out and make sure we find the most vulnerable and that we protect them against transmission of Covid."

Winde added that although the highest number of deaths are recorded in the Western Cape, it is not because the death rate is higher than in the rest of the country, but because of the high infection rate. The death rate in the province, 1,8%, is on par with the national rate.

Screening and testing capability being increased
Cloete said at the peak of the infections, 90% of people will not need hospitalisation and the health care system is therefore also being prepared to deal with those people that will be well enough to remain at home. "We're scaling up more places where we will be able to do bigger numbers of testing. In order not to do it in a manner that exposes people, places are being prepared where social distancing can be done while screening and testing take place."

These facilities are already in existence at, among others, the following hospitals: Tygerberg, Victoria, Khayelitsha, Karl Bremer, Mitchell's Plain, Paarl, New Somerset, George and Wesfleur in Atlantis, as well as Kraaifontein Community Health Centre. Facilities are also being established at Red Cross Children's Hospital, Helderberg, Worcester, Groote Schuur, Mobray Maternity and Ceres.

Innovative isolation booths
Testing will also be done at a total of 106 primary care facilities that are being readied. The department has also established five sterile "isolation booths". Cloete said these booths are a useful innovation that enables a health care provider to take a sample from a person under investigation without coming into direct contact with that person.

He said the renovations to prepare the Cape Town International Convention Centre (CTICC) as a field hospital will be starting in the next week. "It will probably be the single biggest place where we will be hospitalising people with Covid."

Three additional places in the metro will be added for which agreements are being finalised. These will be announced in the next two to three weeks. All these facilities will bring the total number of Covid beds to 1 400, which should provide in the anticipated need during the peak of infections.

Excitement about new ways to manage Covid patients

Cloete said clinicians in the province have been looking at innovative ways of managing the disease. "There are so many different ways that are being learned across the world. There are two specific ones the clinicians were excited to share with us. The one is called proning, through which the patient is managed by them lying on their stomach instead of their back, while oxygen is administered."
Early signs are that it improves the recovery of patients. "Our team at Grootte Schuur is working very hard on that."

The other one is the use of high-flow oxygen instead of putting the person on a ventilator.

BCG vaccine trials
Referring to BCG (Bacille Calmette-Guérin) vaccine testing on 250 health care workers by TASK, a medical trials centre in Cape Town, Cloete said he is excited about the trials. BCG, that is used as a vaccine against tuberculosis in children, also has non-specific protective effects against other respiratory tract infections in children and adults. It is hoped that vaccination (and revaccination in the case of adults) could reduce Covid disease severity, hospitalisation and death in frontline workers. "Because we've done such a lot of work in TB research in the Western Cape, it is good for us to support this. It is early days and we don't want to pronounce on the results. We first want to see empiric evidence that there are protective qualities associated with it."

Herbal treatment
About herbal treatment with sweet wormwood (Artemisia annua) that the Madagascar health authorities believe might be helpful in treating Covid, Cloete said until there is sufficient evidence under trial conditions that there is impact, it will not form part of mainstream management of the disease. The same goes for other agents such as anti-coagulants and chloroquine (malaria treatment). National Health Minister Zweli Mkhize on Wednesday 6 May confirmed on eNCA that the Madagascar government has approached South Africa for possible assistance to investigate the use of the herb.

Cooperation with private sector

Cloete said the province enjoys good cooperation with the private sector. "We are very close to agreements that will enable us to do this (fight the pandemic) as a collective towards the peak."

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