SA'S Covid-19 situation — April 9, 2020

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Health Minister Dr Zweli Mkhize has reported that the number of COVID-19 infections in the country had increased by almost a hundred, to 1,845. Deaths increased overnight by five to 18.

Eyewitness News reports that Mkhize was speaking after the Motsepe Foundation donated personal protective equipment to be distributed in all provinces. The minister received the donation on behalf of the government. “With the new supplies that are coming with the support from the Motsepe Foundation, the Solidarity Fund, (and) the private sector – all of this together will give us an additional six to eight weeks stock,” he said.

South Africa hopes to be building ventilators before the end of April, with a target of manufacturing 10,000 devices by the end of June, with the capacity to build up to 50,000 more if necessary, reports Business Insider.

Just how many ventilators are ultimately built is likely to depend on the needs of other countries, and the extent to which they can ramp up their own manufacturing. The report says South Africa has around 6,000 ventilators available in public and private hospitals; how many are needed for local use is likely to depend on the extent to which the national lockdown, and other measures to slow the spread of SARS-CoV-2, succeed.

The report says with global supply chains facing unprecedented demand, South Africa's National Ventilator Project (NVP) aims to build locally, using only parts and materials "that are readily available in large quantities on the commercial market or can be manufactured locally in South Africa".

Spotlight reports that it is unclear how many ventilators are available in the country currently. The Health Minister responded to questions about this by saying that they “are dealing with the situation as it stands now” and do not want future projections to create miscommunication or panic. Mkhize said “right now they are adequate” referring to the number of ventilators in the public and private sector.

Gauteng Health MEC Bandile Masuku, added that while he is confident that there are enough resources to flatten the curve, “ventilators will be a problem”. He put this down to South Africa’s economy being traditionally dependent on medical equipment imports. However, Masuku also mentioned that they have discovered ventilators in some hospital storerooms that have been bought years ago and not previously used.

The report says the responses in the private healthcare sector are similarly guarded and focused on increasing capacity ahead of time. Chief clinical officer of Mediclinic Southern Africa, Dr Stefan Smuts, said that they recognise the international challenges with ventilator shortages and that “ongoing collaboration with new and existing networks seeks to review the expansion of this capacity”.

Group medical director of Netcare, Dr Anchen Laubscher, said that they have in the past had enough respiratory equipment and have “substantial ventilator capacity”. The group said it has a “frequently rehearsed disaster management plan” and COVID-19 task team in place that is assessing equipment needs on an ongoing basis.

Dr Charl van Loggerenberg, the GM of emergency medicine at Life Healthcare also confirmed that they have had enough capacity in the past and said it has not previously been necessary for their around 1 000 adult Intensive Care Unit (ICU) beds to all have ventilators. He did say that “additional equipment has been ordered as part of our procurement processes during this time”.

The report says the Minister of Trade and Industry, Ebrahim Patel, confirmed that the department is fast-tracking the import of critical equipment and that the implementation of a state of disaster has allowed for an exemption to the Competition Act, so that hospitals are able to share equipment and personnel if needed.

Registering the import or manufacture of a ventilator usually takes up to eight weeks but is currently fast-tracked to a turnaround time of under one week. Andrea Julsing Keyter, the deputy director of medical devices at the South African Health Products Regulatory Authority (SAHPRA), said they are currently keeping up with applications.

Testing for COVID-19 in South Africa will hopefully be massively increased in the next few weeks using machine called the GeneXpert, currently used to diagnose tuberculosis (TB), reports Groundup. The report quotes Mkhize as expressing concern that not enough testing is being done. “Our testing criteria are reactive and restrictive. This means we don’t have a true picture,” he has said.

South Africa had conducted over 50,000 tests by 4 April. This compares well to, say, Brazil which has conducted about the same number of tests but has a much bigger population. But our capacity is far behind Australia (nearly 300,000 tests), South Korea (over 460,000 tests) and most European countries.

Also, in the early stages of the epidemic here it was clear who to target: people with symptoms of COVID-19 who were returning from overseas. Now it is much less obvious and we risk missing outbreaks unless we can do much more testing in many more communities.

The report says the GeneXpert, developed by US company Cepheid, is key to this. It takes 45 minutes to give a result. As of 2017, South Africa had 314 of these machines – 180 of the machines will be used for COVID-19.
Professor Bavesh Kana, director of the Centre of Excellence in Biomedical Tuberculosis Research, said the GeneXpert is a safe, fast and easy to use system. The tests can be done in some of the mobile laboratories that the health department is rolling out, though electricity is needed.

The report says beyond the GeneXpert, laboratory capacity is also being increased. Dr Kamy Chetty, CEO, of the National Health Laboratory Service (NHLS) said they currently have six laboratories where COVID-19 tests are done. By late April this will be increased to nine. The mobile laboratories will bring patient samples to these facilities. Most tests are still being done in the private sector.

Currently the country can do about 5,000 tests in 24 hours. Later this month it will increase to 15,000 and by the end of April to 36,000. At least that is the plan. The proof will be in the execution.

The report says Mkhize is also hoping that antibody tests will be usable in South Africa soon.

The view of Shabir Madhi, a professor of vaccinology at the University of the Witwatersrand is that the total number of people testing positive for the deadly coronavirus in in South Africa is “an underestimate of the burden of COVID-19". Madhi, who is also the director of the respiratory and meningeal pathogens research unit at the SA Medical Research Council, is quoted in The Times as saying that the number of confirmed cases is lower than the number of total cases “due to limited and/or restrictive testing criteria”.

This was because the majority of testing in the private sector was done “using an algorithm geared towards detecting imported cases and their contacts”. “There was an emergence of 'sporadic cases', including health-care workers, indicating community transmission.”

Madhi said that there was an urgent need for the upscaling of the testing facilities. Some of the priority areas for action that he identified included: upscaling countrywide diagnostic capacity; safety and protection of front-line health-care personnel; increasing access to mandatory flu vaccination; centralised and decentralised containment areas; systems management and logistic support for public hospitals; immediate private-public health-care partnership agreement; psychological preparedness and support for front-line health-care personnel; and community mobilisation at multiple fronts.

Amendments to the 26 March directive on electronic communications zero-rate access to all COVID-19 websites and all calls to national numbers “identified by the Department of Health” have been gazetted.

“Emergency centres” are required to ensure that, “if requested”, “calls about COVID-19” are immediately connected to one of these numbers, notes Pam Saxby for Legalbrief Policy Watch.

The amendments also require licensees with access to high-demand spectrum to “make connectivity available” at a minimum speed of 10 megabits per second (10mbs) to 152 district-based virtual classroom platforms. This is “to support virtual teaching during the COVID-19 national disaster”.

Given that, in terms of the 26 March directive, electronic communications services and digital technologies are considered essential to curbing the spread of the virus, Saxby says the amendments are expected to further improve access at a reasonable cost by facilitating the removal of any remaining obstacles.

Meanwhile, the South African Medical Association said the decision to allow minibuses and taxis to transport occupants at 70% capacity will not contain the spread of COVID-19. IoL reports that this comes transport Minister Fikile Mbalula amended regulations on how many passengers taxis can carry. Now, 15-seater taxis are only allowed to ferry 10 people at a time and minibuses with a 22-seater capacity are limited to a maximum of 15 passengers.

SAMA said this decision was not based on scientific principle. “Apart from the decision on capacity, the minister also noted that all passengers must wear either surgical masks or N95 respirators. Not only are these masks in short supply but will do very little to protect drivers and occupants from exposure. We are deeply concerned about this development, which we view as a misunderstanding of the challenges of the transmission of COVID-19,” said SAMA chair Angelique Coetzee.

“Wearing masks as a normal healthy member of the community is not called for in this instance, and N95 masks will do little in terms of any additional protection if they are not worn properly. To be effective, an N95 mask must be airtight, and this requires a special fit-test to establish. But, more importantly, these masks are in short supply and are desperately needed for protection of medical personnel who are caring for COVID-19 patients in ICU and other hospital settings,” Coetzee is quoted in the report as saying.

Full Eyewitness News report

Full Business Insider report

Full Spotlight report

Full Groundup report

Full report in The Times

Full Legalbrief Policy Watch report

Full IoL report

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