WESTERN CAPE NEWS - Western Cape Premier Alan Winde during a Covid-19 update this afternoon said it is anticipated that about 80 000 people will become infected at the peak of the epidemic in the province. About 90% of those people are expected to recover.

When the peak of the crisis hits the province, an estimated shortage of 1 000 acute care beds (for moderate cases) and 750 critical care beds is expected, said Winde.

According to Health Department Head Dr Keith Cloete, they are already working towards filling these gaps. Advanced plans are in place to create 1 300 bed spaces to over-provide for the moderate cases in field hospitals (intermediate care facilities). In addition, the public health sector facilities internally will create 1 697 beds for Covid-19 intermediate cases.

With regard to critical care beds, the public sector can only make available 150 extra ICU beds, but talks are underway with the private sector regarding possible ICU beds that they can set aside to help meet this shortage.

Winde said to date 47 of the province's 14 000 health care workers have been infected with the virus. "We have to protect them at all costs. They are being vaccinated against the flu and we must ensure that they have the necessary PPE (personal protective equipment)."

PPE worth R44 million is in stock and PPE to the value of R185 million is on back order to prepare for when the peak hits. "The recruitment drive for volunteer health care workers has seen more than 1 000 volunteers coming forward," said Winde.

88,7% not in need of hospitalisation

Cloete said 88,7% of the total cases reported to date in the province did not need hospitalisation, 8,4% were treated in a general ward, and 2,9% in ICU.
These percentages are helping them in planning for facilities when the infection peak strikes. The higher vulnerability of elderly people and people with comorbidity is also illustrated by the death statistics in the province.
Currently eight doctors are positive with Covid-19 (three in the public sector, five in the private sector), 16 nurses (four in public sector, 12 in private sector) and 23 other workers (lab technicians, pharmacists, security guards, porters, etc, of whom 13 in the public sector and 10 in the private sector).

Testing ability

Current Covid-19 testing capability is 3 000 tests per day and by the end of the month it is expected to rise to 4 000, using the new Genexpert tests.
Cloete said laboratory testing shows that the testing pattern is changing. Whereas earlier cases were mostly tested in the private sector (mostly overseas travellers), with local transmission increasing, more tests are conducted in the public sector.
He said the department's screening and testing efforts are currently concentrated on containing the "bush fires" or pockets of outbreaks. Clusters driving the "bush fires" are in places like factories, supermarkets, and where critical care workers report for duty. People going home from work also start potential bush fires where they live.

'Lot of uncertainty'

Prof Andrew Boulle from the Centre for Infectious Disease Epidemiology and Research, UCT, said what makes planning difficult, is the uncertainty around the percentage of the population that will become infected, the proportion that are asymptomatic and those that have more severe symptoms, as well as other factors.

South Africa has a much younger population (who are not as vulnerable as the elderly), but at the same time our health care system has much more capacity constraints, and a lot of patients have comorbidities.

"We don't know how precipitous the epidemic is going to be in our setting. In terms of planning there are a lot of variabilities. We will constantly look at our own data and what is being produced by local and global academics and constantly update the forecasting."

He said the approach the Western Cape is taking in getting ready is to look at the countries that have preceded South Africa, and take the countries that have done badly as a benchmark for provision around hospital services, even given our advantage of being a young population. At the anticipated peak of the epidemic a need of between 6 000 and 7 000 acute hospital beds is expected, which results in a shortage of 1 000 beds. There is also a shortfall as Winde said of critical care beds, according to their projections.

Strategy to delay peak of curve

Cloete summed up the province's strategy consisting of four elements: community prevention, screening and testing, hot spot identification and response, and providing for isolation and quarantining.
"In the beginning most people could self-isolate, but we are now moving into the realm where people don't have the luxury of self-quarantining at home. These four steps together is the thrust of us trying to delay the peak of the curve. The suppression and containment phase is about preventing transmission, early identification, isolation of cases and tracing and quarantining of contacts."

Strengthening health system while preparing for Covid

Cloete said the next step is to strengthen the health platform response to test and triage, as the numbers start increasing. The health system must be able to test bigger numbers of people. While these preparations are being made for Covid-19 responses, the department is also endeavouring to strengthen the health system, from primary care and hospital provision to end-of-life care. "We want to strenghten all three these components as we deal with this pandemic.
"The adverse outcome is the one that most people are aware of - the number of deaths that you're going to deal with and the ability of the system to deal with the burials. It's also an area of planning that we have to start going into."

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