Western Cape intensifies war against virus to save the vulnerable

With the Western Cape firmly in grip of the Covid-19 epidemic, with the highest infections and deaths, the province is now in a race against time to save the vulnerable, the aged and those with comorbidities such as tuberculosis (TB) and diabetes from almost certain death.

The Western Cape has had 45,357 Covid-19 cases – more than 61% of the country’s total – and reported 1,200 deaths – more than 73% of the country’s total.

Explaining the reasons for the province’s spike in infections, head of provincial health department Dr Keith Cloete said it all pointed to early community transmissions, possibly from tourism.

“Towards the end of the tourism season we had quite a lot of people that visited the Western Cape. We had sporadic cases between the end of March and beginning of April, just before lockdown. It was possible at that point that we already had local transmission at that time,” he said.

According to Cloete, the testing regimen at that time was only on imported cases so people with symptoms, unless they had travelled overseas, were not tested.

“We know and have documented proof that towards the latter part of March, we started approaching the national department [of health] to say we had sporadic cases and needed to change the testing regimen to allow us to test people that did not have a travel history.

“The reason why we have so many cases now is because we had an earlier community transmission,” he said.

Cloete said their focus now was on their Covid-19 hotspot strategy, with key interventions including selective screening, focusing on the most vulnerable people, those at risk of severe Covid-19 or death from the virus.

He said this involved screening in old-age homes and contact with every positive case and their contacts.

“Because we know of people at risk, we have to actively manage them. We can identify them by address to say they have a comorbidity, contact them and check how they are, assess their condition to prevent them from becoming ill and prevent them from dying,” Cloete said.

Dr Glenda Davison, head of the biomedical sciences department at Cape Peninsula University of Technology and honorary senior lecturer at the University of Cape Town, agreed with Cloete that the early transmission was due to the tourist season.

“It seems as if we are going to peak as early as July,” she said. “However, I think that there are other reasons that should also be taken into account.

“During the first Level 5 lockdown, clusters of infections emerged in shopping centres and workplaces that were allowed to continue operating.

“This led to the virus being taken into communities, where isolation was and is very difficult, and led to the Western Cape experiencing a sudden surge in community spread.”

Davison said a combination of tourism, which was probably the initial source of the infection and then high community spread, had resulted in the Western Cape having a higher infection rate than other provinces.

She said the other factor was that the Western Cape experienced a huge backlog in testing.

Davison said test results were sometimes taking two weeks and this made tracking and tracing and accurate statistics almost impossible.

She said with high-density provinces like Gauteng, the danger of a sudden rise in infections lurked as the virus spreads through human contact and when people live closely together, there was always the chance of this.

“The most important lesson [from the Western Cape] is to avoid overcrowding and ensure that as businesses reopen, they put in place proper measures to protect their staff and clients.

“I think as a country we have moved into a phase in which each individual must take responsibility and on many occasions, people in the Western Cape have not obeyed the lockdown rules. This, of course, is very difficult in poorer communities,” Davison said.

Public health expert Professor Mary-Ann Davies said they have preliminary findings on the links between those with comorbidity factors and the virus.

“Old age and some of our common comorbidities do increase our risk of Covid-19 death and probably diabetes is the most important of this. We have been able to make the first attempt to quantify what the effect of tuberculosis and HIV might be and what we have seen is a modest, approximate doubling of the risk of death associated with these conditions,” she said.

According to Davies, these figures might be overestimated as they have not fully investigated the effect of all the risks like socioeconomic status, geographic location and being overweight.

She said people with TB/HIV tended to be younger and the overall risk of Covid-19 death among these patients was lower, in the order of around 1% or less.

– siphom@citizen.co.za

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