Gauteng Command Council said that a move to Level 2 needs to be done gradually

Gauteng Premier David Makhura hosted the weekly Gauteng Command Council briefing on 13 August to provide an update on the current Covid-19 pandemic within the province.

Makhura said, “The only way we can win this battle is if everyone is given information and the government must share that information with the public so we can share where the pandemic is going and where there are hotspots so they can take extra measures.

“We are seeing some positive results in terms of reduction but we want to still say that the road ahead is long.” He said it’s important for them to constantly adapt their plans and draw lessons from elsewhere.

Dr Mary Kawonga, a senior specialist in public health medicine, who is a part of the provincial command council said in June there was a huge spike in cases and by the end of July  the team started to see a reduction in the number of cases.

“Models have to be revised and the model in Gauteng is being revised continuously based on what we’re seeing in practice.” She highlighted that the presentations at the Gauteng briefings focus specifically on the province and on a ward level.

‘We need to be careful of the second surge’

Professor Bruce Mellado, of Wits University’s iThemba Labs, who is also a member of the Gauteng Command Council, said after careful analysis of data, there has been a downturn of hotspot activity within the province, which is as a result of the combined efforts of various stakeholders. He explained that the surge in cases was driven by hotspots, however, they were then put under control. “This is by no means the peak of the pandemic, this is the end of the first surge. Unfortunately, the fundamentals for a second surge are there so that’s what we need to be careful of.”

Melado explained that the July data contains very important information and allows them to recalibrate their modelling moving forward. “July data shows how the population reacts to non-pharmaceutical intervention. What is the level of adherence of the population to social distancing? That is what drives, to a great extent, the pandemic.”

He said the province has been able to handle the first surge well, however, they need to be cognizant of the fact that there is still a possibility of new surges. “It is our advice that non-pharmaceutical interventions need to continue. Given the success of controlling the first surge and the hotspots, we are now in a position to relax lockdown.”

New predictions for the pandemic in Gauteng

Melado explained that they have devised both an optimistic and pessimistic prediction for the pandemic.

He said in the optimistic scenario, the curve will begin to decrease by December or January.  In the pessimistic scenario, there would be a peak that is about 20 per cent higher than in the optimistic scenario, with the peak taking place around November and December. He added that even the pessimistic model is milder than they had originally modelled.

Melado explained that they have modelled what might happen if all schools were to be reopened by the end of August, devising both optimistic and pessimistic models.

“The pessimistic scenario would have the peak around November or December, with a maximun of around 100 to 120 active cases in the province. If in August we open the schools immediately, what happens is that the peak is basically brought forward.”

He added that the maximum number of cases could potentially double to around 250 to 270 cases.  “The small changes around policy and behaviour does have an impact, so we have to do everything in a safe and gradual way.”

Impact of moving to Level 2

Melado said they have also modelled what would happen if the province moved to Level 2 at the end of August or beginning of September.

“The relaxation of lockdown is a complex matter from  a mathematical standpoint  and based on the experience from other countries.

“It is very clear that whatever relaxation takes place, that needs to be performed gradually or in a phased way. Overconfidence, unfortunately, many time does not pay off.”

Lockdown and its socio-economic impacts

Gillian Maree, a senior researcher at Gauteng City-Region Observatory explained that they analysed those who are vulnerable and might not be able to maintain social distancing or preventative hygiene measures.

She said crowding within housing has contributed to the spread of infection,  especially in communities where people have shared sanitation. She said more suburban, richer suburbs had far lower risk and it was much easier to maintain social distancing. “Some of the challenges we noticed would be particular for communities in informal settlements, in peripheral areas as well as in people who live in high-density settlements within our CBD’s.”

Maree said they also analysed data of those who have experienced difficulty accessing healthcare in the past and those who have access to medical aid. “What this data tells us is that the impacts are likely to be felt unevenly and that is what we have seen unfolding in the past few months. Poorer communities are likely  to bear the brunt of not only Covid itself but also in the way that they manage the large social and economic impacts that we’ve had to bear with the lockdown.”

She highlighted that in many cases they noticed multiple cases of Covid-19 at one site. She said there was an overwhelming number of these clusters taking place in long-term care facilities (those which provide rehabilitative and ongoing medical care as well as old age homes.)

“It is worth noting that to date we have noted 232 facilities that have been identified with well over 2 000 cases within these long term care facilities.”  Maree said there have been three facilities where there have been well over 100 cases per facility.

“We may be seeing a plateau but this certainly does not mean that we can let up, we need to be as vigilant as we have been in the past.”

Maree said there have been interesting age and gender and how the virus has affected different people. “The bulk of infections that we are seeing are from people of working age, mainly between the ages of 20 to 25 to about 55. A large number of people from that group are testing positive, as well a slight uptick from the elderly.”

She said the curve shows an increasing gap between the number of females and males testing positive. “Overwhelming, we’ve seen an increase in the number of females testing positive for Covid. At the moment, it’s about 56  per cent of women who are testing positive.”

Maree explained that this might be because women are more likely to get medical help when they are sick. “One of the key reasons we think this is happening, particularly from Level 3, when people were going back to work, women are more likely to work in vulnerable, higher-contact positions such as nurses or cashiers.”

Strategic goals moving forward

Professor of paediatrics Mphelekedzeni Mulaudzi, who represents the Gauteng Clinical Governance Advisory Sub Committee, explained that they have a number of strategic goals outlined to reduce the transmission of Covid-19.

She explained that the first goal is to reduce transmission. This should happen through the reduction of transmission within communities as well as within healthcare facilities.

“As far as reduction is concerned, it is the behaviour of us as a community, that prevents continual transmission. One of the important aspects of reduction is to identify cases which become positive and identify those in close contact with them.”

She said that the second goal is to reduce the number of deaths. She said that there needs to be a multi-pronged effort to track and trace those with the virus. She said monitoring of these patients is important as some patients might become severely ill within a short period of time.

She highlighted that the third goal is to ensure there is good ‘end of life care’. She explained that this would apply in cases where a patient is likely to die from the virus. “We need to start talking about this, as difficult as it is.”

She said clinicians might provide futile care for a patient and the chances of the patient surviving are very low. “It is important that as a community, within our homes, that we start talking about our wishes. What is the wish should a person reach this stage? So that the clinicians are aware of what your wishes are for the end of life care.”

She said palliative care is often used for those with other diseases such as cancer or HIV, and it is something that needs to be strengthened with Covid-19 patients so that they can have dignity at the end of their life.

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