“It is a terrible time in the healthcare system. We are making a strong appeal to everybody in society: please help us to protect our health care system. Everybody must work together. This is real.”

This was the stark warning by the head of the Western Cape health department, Dr Keith Cloete, following a sharp rise in COVID-19 infections and the emergence of a new variant which appears to be driving the second wave in the province.

Speaking on VOC’s Breakfast show on Wednesday, Cloete explained that the variant was confirmed by scientists on Friday followed genetic analysis of infections. He said the mutation, dubbed 501.v2, was first detected in Nelson Mandela Bay metro, Garden Route district and the Cape flats and that it travels faster.

“The variant is much more infectious than the variants we had. That explains how rapidly this wave has spread both in the Garden route and Cape Flats and other parts of the Western Cape. They (scientists) have evidence that it is Kwa Zulu-Natal and Gauteng and is probably in the rest of the provinces as well,” said Cloete.

Health officials have confirmed that the number of active infections is 61% higher than during the first cCovid-19 wave in South Africa, with 34 694 patients diagnosed with the virus as of 23 December 2020. The highest daily infection rate also surpassed its 2158 mark registered on the 29 June 2020 and saw a 108% increase to 4508. The Western Cape Health Department predicts that the second wave is expected to peak within the next two weeks to a month.

Although the rate of infection in the Garden Route, which was recently declared a Covid-19 hotspot, has decreased, cases in the Cape Metro have doubled since the last wave.

“What a bigger second wave means is that we had fewer number of cases and it came slower. Whereas the deaths were spread out and less the first time, we have more deaths over a shorter period of time. The number of deaths per day and per death per week is much higher,” said Cloete.

Cloete said there is particular concern over the Western and Southern sub-districts where the biggest increases have been seen. He added that the infection rate is no longer higher in informal settings but also in “built-up areas where there’s formal housing”.

“Western starts at more or less from Groote Schuur hospital, from Woodstock onwards, all the way up to Atlantis. (Southern) is from below Pinelands all the way to Cape Point, which also includes areas such as Hout Bay, Wynberg and Claremont,” he explained.

“More importantly the areas we’ve seen a lot of increases (are) Grassy Park, Ottery, Lotus River, all the way to Seawinds, Muizenberg down to fish Hoek. These areas have seen significantly more cases than the first time around.”

He added that the increased cases have led to more hospitalizations and has since placed severe strain on the province’s health facilities. Hospitalizations reached an all-time high this week, with 2691 patients currently admitted, of which 316 are in ICU. Cloete stressed that hospital bed capacity in both the private and public sector is under severe pressure.

“The pressure is people need to go to where they are assessed, which is emergency centres. From there they’re being seen and placed into an available bed. The pressure is then on the capacity where the person must go to, once it’s been confirmed the patient needs oxygen,” he explained.

Critics meanwhile took issue with the closure of the “Hospital of Hope” at the Cape Town International Convention Centre (CTICC) during Level 3 of lockdown. The hospital, Cloete said, sought to cater to if there is “no other option than to place people in field hospitals”. This however did not take place and the contract between the department and the CTICC has since expired.

“The contract specifically stipulated that the moment the restrictions (were) lifted, the CTICC needs to go back to the work that it is designed for. When we had the first wave, we saw fewer (cases) than we expected, and the pressure was not as high across all the platforms. At any given time, we only had enough staff to open about 400 of the 860 beds,” he elaborated.

“That was before we brought online the Brakengate Centre, which has the capacity for 388 patients but in the first wave there was never more than 10-12 patients. We kept Brakengate open just in case we had a second wave, which is what happened.”

He said additional capacity was also created on the premises of Lentegeur Hospital, where up to 200 beds are expected to be brought online within the next week.

“All the beds and oxygen (from CTICC) were repurposed and distributed to the rest of the platform. Most staff actually moved to the Garden route, some had to move to other provinces.”

The provincial government has meanwhile made an urgent appeal to the public to do their bit to not get infected, pointing to immense strain faced by the healthcare sector.

“The capacity rate for metro hospitals currently stands at 105%, while in rural areas, it stands at up to 93%. Over the past month, the public sector has also been requested by the private sector to take on referrals. This demonstrates the severe strain which is also being experienced by some private sector hospitals –across the board, our hospitals are struggling,” read a statement by the Western Cape government.

The well-being of and conditions under which health care workers are operating, Cloete said, is the departments “single biggest concern”. More than 760 healthcare workers are currently actively infected with Covid-19, with five have succumbed to the virus within the past two weeks alone.

“The healthcare workers are also seeing much more deaths per shift this time around.”

Cloete said that around 400 or 600 current staff are expected to get a contract extension,  while an additional 6000 nurses from outside will be brought into the system.

“It’s a big limiting step in terms of the ability to staff the wards. It’s one thing to have the wards and beds but it’s the nursing staff required to be able to look after the patient,” he said.

“Nursing unions are very concerned about their members and rightfully so. The strain undertaken by our nursing staff during this period is tremendous- they are exhausted, they have gone through a first wave (and) thought they would get a break. Now, all of this (Covid-19 cases) is coming to them, together with alcohol-infused trauma.”

Cloete further acknowledged the uproar by those who are denied testing due to having little or no symptoms. He, however, emphasised that taking the test puts the person who requires the test most at risk, “which is the one that is really in need of oxygen in the hospital (and) needs to confirm whether they have Covid-19 to be separated from other people”. Cloete appealed for understanding around the department having to redirect resource to prioritize high risk cases and healthcare workers.

“Think of the person sitting inside the hospital waiting for the test results to come back. What happens is, if all of us go for testing then the testing system gets overloaded. Then the person waiting for their treatment has to wait two days- this cannot be. We cannot make somebody sit while waiting for oxygen.”

“Testing is available, you will (just) wait a bit. If you are under 45, have mild symptoms and are not suffering from hypertension, diabetes and don’t have breathing difficulties, there are people that need it more than you,” he added.

Cloete further urged the public to celebrate the festive season in open spaces and do so with the least number of people possible.

“From our estimation, being inside a mall is more dangerous than being in a park or outdoors. Every continuous gathering of people who are not observing social distancing and wearing of masks continues to increase the number of circulating virus and therefore increase the number of people that might need to go to hospital and require oxygen.”

“The science and evidence suggest that you are 80 times more likely to get the virus by inhaling the air exhaled by somebody else while you are in an enclosed space or indoors,” Cloete warned.

The provincial health department made the following appeals:
– Limit the amount of people you come into contact with “keep it to your own secure bubble”
– Keep (gatherings) small and keep it outside
– Avoid being in any enclosed space for longer than 20 minutes
– Avoid being in any place where there are more than 10-15 people
– Wear your mask
– Maintain social distance

VOC