I have received many questions from both the public and the media as to why the Western Cape has more deaths than other provinces. We take these questions very seriously, because our top priority is to save lives, and every single death is one too many.
Western Cape health MEC Nomafrench Mbombo convened a group of public health specialists, as well as academics, to provide an analysis of Covid-19 related deaths in our province. We have world-class clinicians and epidemiologists in the Western Cape and SA, and it is important that we leverage their insights and expertise.
Before I discuss their analysis, I want to make an important point about accurate reporting. It is essential that we accurately report and record every single death of a person who was infected with Covid-19. This sounds obvious, but it is not that simple. As we will share below, most of the people who have passed away due to Covid-19 had serious comorbidities. This includes diabetes, hypertension and chronic obstructive pulmonary disease.
The virus can cause severe pneumonia, among other ailments, which can become fatal, especially in older people and those people with underlying health conditions. It is therefore entirely possible for a death to occur in a health system, and for the cause of the death to only be noted as one of these underlying health conditions. To confirm it is Covid-19 related you would have to have tested the patient for Covid-19.
This requires well-run hospitals with the right expertise and a heightened awareness. If there is a suspicion that someone has Covid-19 it is important to confirm this, even if it happens after death. This is what we do in the Western Cape. In 11% of Covid-19 deaths we took the sample for Covid-19 on the day of death or after death because the person first presented with severe comorbidities. Our health system is on constant alert and looking for potential cases, and is referring suspect cases to the laboratory for confirmation, even if this happens post-mortem.
Why is this important? This information, like the number of infections, provides us with data on the progression of the virus, and its transmission. And this data is essential to making sure our health system is prepared to respond at the peak of the crisis. The Western Cape health department both understands this and takes this very seriously. We believe that we are accurately recording Covid-19 positive deaths in the province because of our rigorous systems and institutional expertise. It is important that this happens across the country. If it does not, data will become incomparable and the effectiveness of its analysis might be affects.
According to the analysis undertaken by our health specialists, the breakdown of deaths by comorbidities and age reflects that some patients had more than one comorbidity. Our analysis of Covid-19 related deaths in the Western Cape, done when we had 64 deaths on Tuesday, found that our death rate is at 1.8%. At this stage, this is in line with international data on the progression of the virus in other countries.
As it stands, the death rate is not higher in the Western Cape than it is elsewhere in the world, and is likely to be the same rate countrywide (accurate reporting of data assumed).
Other observations include:
- There is a clear pattern between comorbidities and death, as indicated above.
- The deaths correlate with patterns of cases. The growth in number of deaths is linked to growth in the number of cases in line with this rate.
- Our age group is slightly younger than what we are seeing internationally (significant number between 40 -60 years old). Our health teams are analysing this further, but it is likely explained by our younger population and the general spread of comorbidities such as obesity and metabolic syndrome.
- Where there is an outlier case (where the person who has died does not meet the trends), our department will undertake a thorough review to try to understand what other factors may have contributed.
I want to stress an important point here: while the information we have shared above indicates that vulnerable groups are most at risk, this does not mean that those who are younger, or those in good health, should not worry. Not only could you help spread the virus, and infect someone who is vulnerable, you could also get seriously ill. Every single person, regardless of age and health, should be part of our team effort to flatten the curve.
It is worth reiterating that we cannot avoid this virus — many of us will become infected. Our role is to slow its spread through our own personal behaviour choices, so that more people can receive treatment when they need it. Each of our actions now will determine whether our health system will cope. It is up to us all.
What is our data telling us? I have previously discussed the importance of our active-case-finding approach to testing. This approach is where we actively follow the “bush fires”, or pockets of infections, and focus our screening and testing on these clusters. We do this because we want to be as accurate as possible in recording our number of cases in the Western Cape, as well as use our resources efficiently. This allows us to monitor the progression of the virus in the Western Cape, and in turn allows us to prepare our health system through scenario planning.
The data we are collecting is telling us that the transmission of the virus between people in the Western Cape is accelerating. Community transmission is well established, and more and more people are going to get infected by Covid-19 over the coming weeks as the virus spreads. Its nature, as we have seen globally, is to grow exponentially. This is a new phase in the transmission of the virus, which the entire country will enter into at some point (and perhaps has entered into in some areas already), depending on their trajectory.
This has been made clear by both President Cyril Ramaphosa and Prof Salim Abdool Karim. The lockdown bought us time to prepare our health system for the pandemic and the peak that is still to come. It also allowed us to “flatten the curve”. It will not stop the virus, which will continue to spread.
Our focus must continue to be on preparing our health response so that we are ready for the peak, on protecting vulnerable groups of people, and on ensuring that we continue to test and confirm Covid-19 cases in our province based on epidemiological evidence.
Accurate reporting of data is also critical. We must be fully transparent and honest with the people of the Western Cape at all times, because information is power. The more data we have, the better our health response can be. The more information our residents have, the better they can help us flatten the curve by changing their behaviour. We must work as one team, together.
• Winde is premier of the Western Cape.
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