WCG STRATEGY TOWARDS COVID-19 - Presentation to the Covid-19 Ad-hoc Committee - Parliamentary Monitoring Group
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WCG STRATEGY TOWARDS COVID-19
Presentation to the Covid-19 Ad-hoc Committee
PREMIER AR WINDE
Videoconference DR HC MALILA 22 April 2020
Dr K CLOETE
National-provincial-local coordination
Nationally, President has established a National Command Council (NCC) that
meets three times a week. NCC led by the president is coordinating and
guiding government response to the pandemic
The NATJOINTS structure has been activated. COGTA has activated its
National Disaster Operations Centre to coordinate response to COVID-19.
COGTA Operations Centre interfaces with the NATJOINTS and PROVJOINTS
structures
All provinces have established institutional structures to coordinate their
response within their areas of jurisdiction. Metros and Districts have also
established/ activated similar institutional structures. All Disaster Management
Centres in provinces, districts and metros have been established/ activated
across the country
Other departments such as Water and Sanitation have established their own
coordinating structures or national operation centres to guide response within
their sectors. COGTA is regularly communicating with MECs, Mayors and
Traditional Leaders through video and teleconferencing
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WC Provincial Response
From 16 March – 14 April 2020 a Sub-committee of Cabinet chaired
by Minister Maynier met daily and reported into Cabinet
The meeting took the form of a briefing to the Minister from various
Clusters working on the response to Covid-19
On Wednesday 15 April the first Covid-19 Extended Cabinet
meeting was held, which includes Cabinet, PTM, the Metro and
District Mayors and MMs
The Cluster Leads now report directly into the Extended Cabinet
meeting three times per week
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WCG Covid-19 response – Workstreams
Health Response (covered in today’s presentation by Dr Keith Cloete)
Humanitarian and Social Response
Local Government and Disaster Management Response
Business and Economic Response
Safety and Security Response
Infrastructure Response
Strategy: Next Phase Data Management, Modelling and Strategic
Management / Planning Response
Finance, Administration and Institutional Support
Communication
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Covid-19 workstreams (1)
Humanitarian and Social Response
Call centre to handle requests for assistance
• Call Centre receiving =/- 10 000 calls daily – backlogs developed
• Recruited volunteers from WCG departments to respond to ‘please call me’
• Call Centre staff capacity has been doubled and will increase further to ensure all calls
answered in 2min
Food
• DSD Feeding of children taking place through ECD Centres and NGOs schools - +/-135 000
households supported
• WCED feeding +/- 100 000 learners
• The school feeding was without incident and strict behavioural protocols are being
followed but is being challenged politically and nationally
• NGOs feeding about +/- 200 000 households
Data
• Datacentre focusing on assessing need using vulnerable households data, economic sector
data and call centre data
• Datacentre focusing on mapping provision via mapping the large NGOs
Strategy
• Whole of Society strategy being developed to align all efforts
© Western Cape Government 2012 | Go to Insert > Header & Footer > Enter presentation name into footer field 6Covid-19 workstreams (2)
Local Government and Disaster Management Response
• Ensuring maintenance of basic services
• Coordinating communication, information sharing and joint planning with
municipalities (Joint District and Metro Approach)
• Management of admission to quarantine and isolation (Q&I) facilities
• Coordination of food assistance distribution with Social Development
• Determining resource requirements – application for national disaster funding
• Support to community-based screening and testing
• Assisting with repatriation of foreign nationals
• Burials management
Safety and Security Response (Prov JOC)
• Working with SAPS on enforcement of regulations
• Participating in Provincial Joints structure which reports to National Joints
• Responding to complaints against SAPS of abuse of power
• Providing information to police on schools that have been vandalised and looted
• Monitoring of criminal behaviour linked to lockdown
© Western Cape Government 2012 | Go to Insert > Header & Footer > Enter presentation name into footer field 7Covid-19 workstreams (3)
Business and Economic Response
• Assisting local businesses to access the national funding that has been made
available
• Assisting with repatriation of foreign nationals
• Identifying paid-for quarantine sites (hotels and BNBs)
• Developed specifications for PPE and developed a database of suppliers
• Developed replies with Legal Services to FAQs – clarifying the interpretation of the
Regulations
• Frequent engagements with Agriculture, Retail and other key stakeholders
Infrastructure Response
• Municipalities have provided a list of potential Q&I sites
• Moving forward with operationalisation of Q&I sites
• Identifying and procuring sites for acute beds (field hospitals)
• Provincial traffic enforcing the regulations
• Engaging transport sector on sustainability and compliance
• Indications are that some commuters are not observing physical distancing
© Western Cape Government 2012 | Go to Insert > Header & Footer > Enter presentation name into footer field 8Covid-19 workstreams (4)
Strategy: Next Phase Data Management, Modelling and Strategic Management / Planning
Response
• Department of Health leading on modelling towards a Health strategy
• Further models to be extrapolated, data analysed and scenarios developed
• Pooling of data analytic resources across departments
• Data to inform medium- and long-term planning and modelling
Finance, Administration and Institutional Support
• Established a Central Procurement Advisory Committee to assist the Joint Operations Centre
(JOC) and departments to procure rapidly and track and trace orders and payments
• Develop costing models to determine resource needs and inform major procurement
• All spheres likely to face budget cuts
• Municipalities must review their own budgets – careful cash management, revenue and
expenditure management
• Some municipalities may go into fiscal distress
Communication
• Regular communication from the leadership
• Daily stats are issued to the public in the morning and a press release in the afternoon
• Weekly media statement from the Premier
• Digital press conferences (“digicons”) and press conferences conducted by principals
• Extensive use of community radio and loudhailing
• Mass issuing of short messages (3 million mobile numbers)
© Western Cape Government 2012 | Go to Insert > Header & Footer > Enter presentation name into footer field 9Health Sector Response
Dr K CloeteContents
1. Current status of the COVID-19 epidemic in the Western Cape
2. Predictions for the future of the epidemic, and likely resource
requirements
3. Western Cape strategy underpinning our response to COVID-19Current status of the COVID-19 epidemic in the Western Cape
Global and National Context 1. Lots of information available on COVID-19 globally including the WHO website and many dashboards. 2. National Minister and Chair of MAC, Prof Abdool Karim, briefed the nation a week ago; daily updates on data from NICD. 3. The President is considering the evidence and will announce on post 30th April lockdown arrangements, most likely a phased lifting of lockdown, with many control measures remaining in place. 4. Prevention measures such as cough etiquette, social distancing, hand hygiene and the use of masks must be deepened, with a special focus on certain high-risk areas and vulnerable groups. 5. We keep abreast of national and global developments.
The three waves – Western Cape experience so far
90
SARS-CoV-2 diagnoses
Import associated
80
Imported
Local transmission
70
60
50
40
30
20
10
0
01 Mar
12 Mar
14 Mar
16 Mar
18 Mar
20 Mar
22 Mar
24 Mar
26 Mar
28 Mar
30 Mar
01 Apr
03 Apr
05 Apr
07 Apr
09 Apr
11 Apr
13 Apr
15 Apr
17 Apr
19 Apr
Mar Apr
Professor Salim Abdool Karim, address 13 April 2020 Based on 973 cases reported by 20 April 2020Tackling the bushfires
Professor Salim Abdool Karim, address 13 April 2020
-Specific clusters driving the bushfires
-Cases are however widely distributedDistribution of cases by sub district
Laboratory Testing
Number of tests per day in public and private Weekly number of public sector tests and %
sector positive
Community screening & testing
1600 3500 7,0%
3057 3047
Number of tests per day
1400
Number of tests per week
3000 6,0%
1200 5,8%
2500 5,0%
Percetn positive
5,3% 5,6% 5,4%
1000
2000 4,0%
800
3,9%
1500 3,0%
600
3,0%
1000 691 2,0%
400
360 424
200 500 94 1,0%
Case definition expanded
0 0 0,0%
3/8/2020 - 3/15/2020 3/22/2020 3/29/2020 4/5/2020 - 4/12/2020
3/14/2020 - - - 4/4/2020 4/11/2020 -
3/21/2020 3/28/2020 4/18/2020
Number of tests Percent positive
Private Public
First 2 weeks of Community Screening and Testing
Number screened Number tested Percent tested
Metro 48,901 3,678 7.5%
Rural 32,728 140 0.4%Strandfontein Camp :
CST : • 1570 Clients screened - 62 screened positive
• 81 629 screened ; and tested.
• 14 results received and all 14 COVID-19 results
• 3818 Tests negative.Clinical Outcomes
8,4%
2,9%
General ward
ICU
Not admitted
88,7%Age distribution of patients diagnosed, admitted and dying
100% 1% 4%
12%
13%
90% 19%
26%
80%
Percent of patients in each age group
23%
70% 25%
38%
60% ≥80
60-79
50%
42% 40-59
40% 20-39
65% 0-19
30%
56%
44%
20%
26%
10%
4%
0% 1% 0% 0%
All cases All Hospital ICU Died
70% of patients dying had one or more co-morbiditiesCOVID-19 in Health Workers- Public and Private sector comparison
COVID-19 in Health Workers private sector/public sector
comparison. 20 April 2020
14
13
12
12
10
10
8
6
5
4
4
3
2
1
0
Doctor Nurse Other
Public Private UnknownCategories - other
Breakdown of “other” cartegory:Covid-19 in health workers as at
20 April 2020
4,5
4
3,5
3
2,5
2
1,5
1
0,5
0Much more data to be put in the public domain
* Public-facing dashboard will differPredictions for the future of the epidemic, and likely resource requirements
Scenario Planning
1. There is a national consortium doing technical work to anticipate how COVID-19
will impact in South Africa
2. There remains uncertainty around what proportion of the population will become
infected with and without interventions, the proportion expected to be totally
asymptomatic, and the expected clinical severity in those symptomatic
3. Contextual variations between countries like:
• age structure of populations
• health system capacity
• levels of co-morbidity
• timing and impact of social distancing interventions like lockdown
• Population density and informal settlements
• Socio–economic vulnerabilities
4. Planning is based on global experience in severe clinical presentations, while
waiting for more of our own data, guidance from the NDoH, and new technical
work from epidemiologists and modellersAt peak, allowance for 6000-7000 acute beds
7 000
All beds
6 000
General acute care beds
Ideally critical care or ICU beds
5 000
4 000
3 000
2 000
1 000
0
Premised based on age-adjusted estimates for symptomatic patients
- up to 6% may require hospitalisation
- up to 2% may require more intensive careMaking up for projected shortfalls in bed availability
Field hospital beds
1000
Acute beds in current
750
ICU bedsWestern Cape strategy underpinning our response to COVID-19
Western Cape Approach
Alignment to National Strategy for COVID-19
Stage 1: Preparation
• Community education
• Establishing lab capacity
• Surveillance
Stage 2: Primary prevention
• Social distancing & handwashing
• Closing schools and reduced gatherings
• Close borders to international travel
Stage 3: Lockdown
• Intensifying curtailment of human interaction
Stage 4: Surveillance and Active case finding
• Contact tracing
• Isolation & Quarantine
Stage 5: Hotspots
• Spatial monitoring of new cases
• Outbreak response teams
Stage 6: Medical Care
• Building hospital capacity including ICU.
• Managing staff exposure and infections
Stage 7: Deaths and the Aftermath
• Expanding burial capacity
• Regulations on funerals
• Managing the psychological and social impact
Stage 8: Ongoing Vigilance
• Monitoring AB levels
• Ongoing surveillance
• Administer vaccinesSuppression and Containment
The strategy in this phase is to prevent transmission, early identification and
isolation of cases, tracing and quarantine of contacts. The effectiveness of
this strategy will determine impact on the rest of the health system, the lives
that can potentially be saved due to preventative steps and healthcare
system capacity, and the ultimate effect of COVID-19 on our society.
Thus, suppression and containment is the key to limiting this threat, and
“flattening the curve”
1. Community Prevention – Hand hygiene, cough etiquette, social distancing, masks
2. Screening and Testing – Active targeted case finding (81 629 screened, 3818 tests)
3. Hotspot identification and response – Identify cluster of cases to contain spread
4. Isolation and Quarantine – Provide designated sites for people who cannot do so at
home (546 beds in use; 929 beds contracted; 8042 + 1145 being explored)
© Western Cape Government 2012 |Triage and Testing Sites
Temporary Rented Tent for Triage and Testing (rent for three months - option to extend)
• Completed:
– Tygerberg
– Victoria
– Mitchell’s Plain Hospital
– Khayelitsha
– Kraaifontein
– Karl Bremer
– Paarl
Currently Under Construction:
– False Bay
– Red Cross
In tender evaluation stage – construction to start next week
– Eerste Rivier
– Heideveld
– Helderberg
– Wesfleur
Specification to be finalised for NSH and Groote Schuur.
George and Worcester will have a no tent solution and the projects are implemented by
the relevant workshop.
© Western Cape Government 2012 |Public Works Strategy to I&Q
• Understand the numbers from a health model perspective to guide the
operationalization of Q and I facilities.
• Have a level of disaggregation so that the number of bed required can be
facilitated.
• Use a pragmatic guideline (under development from DoH) to guide what is
needed.
• Procure a turn-key solution as the first approach in order to allow time to
activate provincial facilities and municipal facilities
• Based upon numbers projected, be able to scale up the number of beds
required from week to week.
• Understand what the triggers are where Q&I is not longer an effective
suppression strategy.
© Western Cape Government 2012 |Isolation and Quarantine
1. Q & I beds in Province contracted – 929
2. How many beds available to be used:
• Contracted - 791
• Available not contracted, i.t.o beds offered by hotels – 8042
3. How many beds are we looking to activate in provincial facilities
across the Province - 1 145
4. How many currently in use - 546 (Inclusive of National & Provincial
placement of people)
© Western Cape Government 2012 |Health Platform Response
1. Testing and Triage:
a) Create capacity to be able to increase testing and the support self-
management
b) Separate facilities at 17 designated sites (7 completed, additional 10 will
completed by first week in May)
2. PHC:
a) Strengthen PHC facilities to stream, test and triage Covid-19 cases – 146
facilities
b) Maintain essential non-Covid-19 care
3. Acute Hospitalisation:
a) Intermediate care beds for mild cases – 1300 beds being planned
b) Acute care beds for moderate cases – capacity created in existing 1697
c) ICU beds for severe cases – 150 additional capacity
4. Palliative Care:
a) In-patient care
b) Community-based care
© Western Cape Government 2012 |Supplies and Equipment
1. N95 respirators: 70 000 on hand; 2.9 million on order
2. Surgical masks: 2 million; 7 million on order
3. PPE kits: 4000 on hand; 50 000 on order
4. Ventilators: 432 ventilators; 100 on order
5. Innovations: local production capacity for masks, visors,
disinfectant booths, goggles, etc.
6. Stock on hand : R45m : stock ordered : R185m
© Western Cape Government 2012 |Recovery & Vigilance
1. Recovery:
a) Most people will recover – 222 have recovered as at 20 April 2020
2. Vigilance:
a) Monthly surveillance amongst Health Care Workers to be
implemented
b) Monthly surveillance in public transport, schools, prisons, workplaces
to be implemented
3. Adverse outcomes:
a) Protocol developed for Death Management in Hospitals and in
community settings
b) Capacity to manage burials and cremations
© Western Cape Government 2012 |Current Staff Composition in Department – April 2020
© Western Cape Government 2012 |Staff
1. Our staff need to be protected and kept safe – adequate supplies of PPE
(as part of a broader IPC strategy) is the key
2. Employee wellness capacity to provide emotional support to staff
3. A database of volunteers has been established and the call for
volunteers has been widely advertised – 1150 received to date
4. Accommodation and transport needs of staff are being addressed
through collaboration with Transport and Public Works
5. Organized labour are recognized as essential stakeholders and partners
© Western Cape Government 2012 |Conclusion
1. Our strategy towards Covid 19 needs to be agile and rapidly
adjusted as conditions change. This presentation covers our
strategic considerations at this point in time.
2. This requires unity of purpose and strong partnerships – Health
Department cannot do this alone. Mobilise all forces.
3. This calls for business unusual, sense of urgency and courageous
leadership from all of us.
4. Its also an opportunity to fast-track Health System Strengthening,
and building towards UHC and WoSA
© Western Cape Government 2012 |Thank you
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