Statement by Premier Alan Winde at his weekly Digital Press Conference

“Our hospital system is facing severe strain and our healthcare workers need us to do better right now”

Earlier this week, every district within the Western Cape exceeded the number of Covid-19 infections experienced in the first wave, suggesting that the second wave of the virus will be significantly larger than the first. While there are signs of slowing in the Garden Route, the Cape Town metro, and thereafter the other districts, are set to face unprecedented case numbers over the coming weeks.

There are now clear indications that the second wave has been exacerbated by a new variant of Covid-19, called 501.V2, which has shown to be far more infectious than the initial strain which marked the first wave. Due to this new strain, we expect our R(t) – which is the effective reproductive number of the virus (how many residents each positive person likely infects) to increase – meaning that the peak of our curve, and how quickly it goes up, are both likely to be higher.

To put it simply – over the next few weeks we expect to see our healthcare system placed under enormous strain, at a time when more beds will be needed than ever before.

It is also happening at a time when our nurses, our doctors, and our clinicians have already been working flat out, under very stressful circumstances, since March.

The fact that our second wave is taking place over the festive season – normally the most social time of year – is further cause for deep concern.

This confluence of factors means it is now more important than ever that residents of the Western Cape step up to the plate to help us contain the spread of the virus. We need to do this to protect our hospital capacity because if we continue as is, there is no guarantee of a hospital bed in either the public or private sector, for you or a loved one, if you require it. And we need to do it for our healthcare workers, because they are extremely tired, extremely strained, and need our help to get through the next few weeks.

These healthcare workers are not nameless or faceless – they are our moms and dads, our sisters and brothers, our children. They have been on the frontline for 9 months, facing the threat of infection in their job every day. They have borne witness to so many residents taking their last breath, and they have seen their own colleagues pass away from Covid-19. It is time for us to show them our respect by changing our behaviour in a dramatic way so that we avert our current infection trajectory.

The current trajectory of Covid-19 in the Western Cape, and expectations for the month ahead

Total active infections in the Western Cape currently stand at 34 694, 61% higher than the first peak. The highest single day increase in cases at the first peak was 2158 (29 June 2020), but our most recent high has been 4508, 108% higher.

Currently, 2691 patients are in hospital, and 316 patients in ICU – the highest number since Covid-19 hit us.

The capacity rate for metro hospitals currently stands at 105%, while in rural areas, it stands at up to 93%. Over the past month, the public sector has also been requested by the private sector to take on referrals, which we have done. This request demonstrates the severe strain which is also being experienced by some private sector hospitals –across the board, our hospitals are struggling.

We are currently using 32.4 tonnes of oxygen per day, 5 tonnes more than we utilised per day during the peak of the first wave. We are using 58.5% of available daily capacity of oxygen.

There are currently 761 healthcare workers actively infected with Covid-19. In the past two weeks alone, 5 healthcare workers have died as a result of the virus.

In the Garden Route, the rate of infection and hospitalisations is finally decreasing, after the district experienced a peak which was double the height of its first peak.

A similar pattern is currently emerging in the metro, which is moving rapidly now toward its second peak, which should arrive within the next two weeks to a month. If this pattern of the second peak in the metro being double the first is borne out, we can expect to see upward of 90 residents per day passing away due to the virus in this one district alone.

And we know from data collected since March that for every person that passes away, 25 residents will land up in a hospital bed, often requiring life-saving intervention to survive.

This means we are likely to need at least an additional 500 beds in the metro on top of what we currently have, and more crucially, the healthcare workers to provide care at these beds.

The situation at our healthcare facilities is further exacerbated by residents consuming more liquor over the festive season. Despite the liquor restrictions introduced by the national government in the past few weeks, we have seen a minimal levelling off of the trauma case load burden experienced at key hospitals, which means that our healthcare workers are facing this additional strain.

Later today, National Health Minister, Dr Zweli Mkhize, is visiting the Western Cape to receive an update on our current Covid-19 figures and on our healthcare platform. This data, along with the data of other provinces facing strain, will form the basis of his feedback to the National Coronavirus Command Council, which constantly reassesses whether current interventions are adequate to deal with the virus and protect our health system – and its employees - from collapsing.

We are working hard to capacitate our healthcare system to see it through the second peak

In the Western Cape, work is ongoing to ramp up both our bed capacity and the number of healthcare workers operating in our hospitals, to protect the system and our staff from severe strain.

To date, we have added 613 beds across hospitals in the Western Cape. Our focus has now shifted to the metro, where our healthcare management team is working under very tight deadlines to create an additional 500 beds, including 187 additional at Lentegeur, which we believe are needed to see us through the difficult month ahead.

Additional bed capacity will be achieved in part through the de-escalation of non-essential healthcare services. These changes include:

• Visitation by non-patients is restricted;
• Non-urgent outpatient appointments will be postponed, and patients given alternative dates;
• Non-urgent elective surgery will be postponed, and patients provided with a later date;
• Patients who are in hospital but are stable will be discharged for further management at home or at a step-down facility;
• Outreaches from District and Regional hospitals will be suspended; and
• Patients are urged to only access the Emergency Centre for emergencies. Non-emergencies to access healthcare services at nearest clinic.

Emergency services that will continue:

• Emergency surgery;
• Obstetric surgery;
• High risk obstetric clinic;
• Fracture clinic;
• Limited eyecare and eye surgery; and
• Allied health for emergency cases.

Amended services at clinics:

• Medication delivery to stable chronic patients will continue;
• Medication will be given for longer periods where possible;
• Outreaches will be postponed;
• Non-urgent appointments will be postponed and given an alternative date;
• Essential services will continue, such as TB and HIV screening and treatment, chronic care, family planning, immunisations, and antenatal and postnatal care;
• Dental services limited to emergencies only;
• Eyecare services limited to emergencies only; and
• MOU’s (midwife obstetric units) will continue to operate.

We are also working extremely hard to meet the need of the system for additional staff. In this respect, we have gone on a recruitment drive by extending our bursary programme, the early commencement of the new intake of community serve, renewing the contracts of staff members hired during the first wave, opening up new short term contracts and filling as many vacancies as possible. We are also working through our volunteer lists, but it must be noted that it has been difficult to on-board volunteers due to the obvious pressure which the role entails. We thank those residents who have been willing to volunteer in the fight against Covid-19 and do hope other residents will consider doing so too.

Crucially, while we will continue to maintain Brackengate Hospital of Hope as a field hospital for intermediate care, we are seeking to create any additional new capacity within our current facilities. We have done this because many Covid-19 patients are best assisted in the high care environment – not within an intermediate care environment such as a field hospital. It is here that the staff exist to administer these beds. In addition, any beds which are newly created within our hospitals will stay there, creating a legacy that will have a lasting positive impact on our services in years to come, post-Covid-19.

We are continuing to monitor the situation closely. The bottom line is – capacity is extremely tight in respect of both beds and staff. As our healthcare system faces its most challenging time in recent history, we are doing everything we can to see it through, but we need your help if we are to succeed.

Residents need to urgently change their behaviour to save our healthcare system from being over-burdened and to show respect for our healthcare workers

Research on how Covid-19 spreads has radically advanced since the virus was first detected almost a year ago.  We now know that the most important thing we can do, is to reduce exposure to virus particles transmitted through the air. That means we must avoid the three c’s: confined or enclosed spaces, crowded spaces and close contact.

To keep safe, we must do everything we can to limit our exposure to other people, even though we know this is extremely hard over what is normally our most social time of year.

This festive season, and especially on key days like Christmas and New Year’s Eve, we are now calling on residents to please confine their celebration, as far as possible, to their own household, which we call a family bubble. At celebrations, seek to keep these very small, such as having no more than 5 visitors, and 10 people in attendance in total (unless your own household is bigger than this), and host all events outside.

This is a precedent we have seen being regulated by law in many countries around the world which have experienced a similar growth in cases due to this new strain.

We also call on residents to please sit outdoors at restaurants, or to dine out. Sitting inside an enclosed restaurant for the duration of a meal is high risk. In this respect, municipalities should urgently seek to enable restaurants to move their tables outdoors, onto pavements, and perhaps even closed off streets. We find ourselves in a unique situation and we must respond with innovation.

We ask residents to avoid all non-essential gatherings, particularly those which are indoors. This includes gatherings at faith-based institutions, weddings, funerals, social events and political events, conferences, concerts and live performances, cinemas, theatres, bars, taverns, and shebeens. Make the right choice as a member of our community to protect our healthcare system and to show your respect for our healthcare workers.

Should you wish to drink, do not drink so much that you harm yourself or another person, and do not drink and drive. Trauma cases in our hospitals are taking up beds and diverting the attention of our healthcare workers, a scenario we can no longer afford to entertain without serious repercussions on our ability to care for patients who are ill as a result of disease or Covid-19.

On our part, we have called for urgent meetings with faith-based organisations, as well as retail, to discuss how they can strengthen safety protocols and reduce the spread in their enclosed environments. This must include sensible limits on capacity to ensure distance, sanitising, mask wearing and deterring gatherings in their spaces. We also call on residents to please only have one member of the family do the shopping to limit the spread of infection to our immediate family bubble as best as we can.

Keep it small and keep it outdoors

The Western Cape Government supports the right of residents to rather visit a well-managed beach or park – within their family bubble. Being outdoors, getting exercise and fresh air, as well as having a joyful time, is very important for residents across our province, who’ve had an extremely difficult year. Beaches and parks are also one of the very few free entertainment spaces which can be enjoyed by residents from all our communities, and to deprive our residents of this will only serve to confine them indoors, in often cramped spaces, where the spread of the virus is more likely. These are some of the arguments I made in a court case on the closure of the Garden Route’s beaches, in which I was cited as a respondent.

I made these arguments following the advice of our own health department and based on studies conducted around the world which state very clearly that being outdoors is far safer than being indoors. We expect judgment in this court case to be delivered within the next few days. Should beaches be reopened, we expect residents to comply with the safety advice given out by government to contain the spread, which includes keeping a 1.5metre distance from others and wearing a mask, as well as staying in the family bubble.

The reopening of the Garden Route’s beaches will also serve to mitigate the extremely negative impact of their closure on the Garden Route economy. Over the past week, I have seen reports that 100% of bookings have been cancelled at some accommodation establishments, and that the region has lost upward of R4 million in revenue due to cancellations. This is extremely difficult to bear considering that it does not only affect the guest house owner, but also serves to send all its staff members home without revenue from tips and hourly wages over what is usually the busiest time of year. 

In this respect, the Western Cape Government has requested the national government to extend UIF/TERS support to the Garden Route, a request which we believe is being considered with due care.

As a province, we are working proactively on vaccines

Like many citizens across the world, our residents are anxious to understand when they can expect vaccines to become available in South Africa. Noting that the roll out of vaccines has already commenced in some parts of the world, the Western Cape is eagerly and proactively working on securing vaccines for our residents. This includes the following steps:

• The formation of a group of technical experts who are conducting a formal option appraisal of all available candidate vaccines in terms of efficacy, safety, affordability etc;
• A development of a prioritisation protocol for roll out which will prioritise healthcare workers and other essential workers as well as vulnerable groups, such as the elderly and those with co-morbidities;
• Demand forecasting, including estimating the number of vaccines required per prioritised group and more generally; and
• Cost forecasting and confirmation of budget.

In short, the province is doing everything in its power to be fully prepared to pay for, receive and store, distribute and fairly roll out vaccines when they land.

What is crucial is for the vaccine to receive national approval from the South African Healthcare Products Regulatory Authority (SAHPRA) - a necessary step and one which we eagerly anticipate. When it comes, be assured that this province will be ready.

My promise to our residents and to our healthcare workers

Earlier this year, I promised you, the residents of our province, that I would do everything in my power to ensure that our healthcare system can take care of you if you get Covid-19. We have made huge interventions to guarantee this to date, and so far, we have managed. I also made a promise to our healthcare workers – that we would take care of them in their hour of need, to take heed of the strain they are facing, and to do something about it before they became overwhelmed.

What we are seeing now is unprecedented – the confluence of the peak of the second wave, taking place over the festive season, with a much more infectious strain. My team and I are continuing to work flat out to keep my promise, but, as mentioned prior, we need your help.

To show your respect for our healthcare workers, and to ensure our hospitals are not overwhelmed, please stick it this simple advice: keep it small and keep it outdoors.

We all need to play our part if we are to get through the peak of the second wave.