There has been much discussion over why the Covid-19 epidemic has taken root in the Western Cape so much more deeply than anywhere else in the country.
For several weeks a frustrating, polarised debate was had: those sympathetic to the Western Cape government argued that it was because more and better targeted testing was responsible as this caused more cases to be found. Those antagonistic to the Western Cape believed the epidemic was worse because the government didn’t value lives — especially those of the black poor.
As the trajectory of the epidemic continues to unfold, the biases inherent in these positions are being revealed. It is evident, as Prof Salim Abdool Karim explained at his briefing last Friday night, that the Western Cape is experiencing “a different scenario” with an epidemic that is growing rapidly. Community transmission is well established in all subdistricts in the Cape Town metro, especially in the hotspots of Khayelitsha and Tygerberg, which includes Belville South, Elsies Rivier and Delft. By the end of the May the number of infected people in the province doubled every nine days.
In Gauteng, for instance, the epidemic doubled only every 24 days and here, as well as in most other provinces, community transmission is only weakly established. The only other province where the epidemic is moving fast is the Eastern Cape, where infections double every 12 days.
It is simply not possible, says Karim, that there could be large numbers of undetected cases in other provinces without a visible increase in hospital admissions. So if more and superior testing is not the explanation, the question for Western Cape is: why?
Health officials in the province believe the large number of global travellers led to the epidemic seeding earlier in Cape Town than first realised. Climatic factors may also play a role as respiratory pathogens typically thrive in Cape Town.
Karim has added a third element. He thinks the evidence of concentrated hotspots of infection indicates several super-spreader events, which arose from clusters of employees at grocery stores. When the lockdown happened towards the end of March, clusters of retail workers — who continued to move about during the lockdown — became the super-spreaders. The same occurred at a few other sites where essential services continued operating: a pharmaceutical company, a fish factory and a bakery also experienced outbreaks.
The outbreaks made tracking and tracing more challenging. There were more contacts to reach and by early May the backlog of laboratory testing had grown so large that it was no longer effective. A month ago the province’s own modellers projected that at the time of the peak the province would need 6,200 beds. This meant a shortfall of 1,000 general care beds at the peak.
The province responded by building two new field hospitals — one at the Cape Town International Convention Centre and one in a warehouse — adding more than 1,000 beds. Four weeks later it conducted a “calibrated modelling exercise” that brought together the Western Cape modellers with the National Modelling Consortium, which is contracted by the national department of health, and the Actuarial Society of SA, which is also modelling the epidemic. The exercise found that May’s projections were too low and that 7,800 beds could be needed at the peak.
Premier Alan Winde now faces a dilemma. If the province doesn't scale up again now, it will be too late to do so later. But elsewhere in the world epidemiological models are showing their weaknesses: in the UK the 4,000-bed Nightingale Hospital, provisioned to scale up for the peak, has closed after treating only 54 patients. Overall, the UK epidemic is declining faster than was expected.
There is another big limitation on the Western Cape’s ability to scale up further. The staff complement is under strain. The convention centre alone will require another 900 staff. The province has reached its ICU limit, not because it has run out of beds — there are still 30 to spare in the public sector — but it does not have the staff to run them.
Health-care workers are tired are fearful, and many are ill. Right now 549 health-care workers are infected and off work. Another 638 have been infected and recovered. As in any other workplace, health-care workers who find they have unwittingly been in contact with an infected colleague or patient are required to monitor themselves for 14 days. If they have symptoms they are required to isolate for 14 days.
There have been numerous labour stoppages at clinics and hospitals over the level of personal protective equipment that must be provided and what measures should be taken when a health facility has possibly been infected. This is a difficult time in the Mother City — and the real crunch is still to come.
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