It's possible that SA could experience a second surge of coronavirus cases - Zweli Mkhize

• Health Minister Zweli Mkhize has warned the risk of a second wave of coronavirus cases remains a possibility.
• He added that the World Health Organisation would be sending 43 senior experts from across the globe to assist South Africa with the pandemic.
• Mkhize said while it was still "early days", the department had undertaken to invest in the development of a vaccine against the coronavirus.

The real risk of experiencing a "second wave" of coronavirus cases remains, so containment measures must not be abandoned, Health Minister Zweli Mkhize said on Wednesday.

Mkhize held an early-morning virtual briefing to update South Africans on the current state of affairs regarding the health department's handling of the Covid-19 pandemic.

"We are not out of the woods yet. Until we are completely safe, we will keep reviewing restrictions and, if necessary, certain restrictions will still remain in place," Mkhize said.

Mkhize said South Africa had gone beyond the half-a-million mark of confirmed Covid-19 cases. On Tuesday, night, he announced a cumulative total of 521 318 infections.

"We are happy that even with the targeted testing approach which we adopted as a department based on the Ministerial Advisory Committee [MAC] advice, our testing numbers continue to grow. To date we have tested 3 078 202. This translates to a testing rate of 51 514 per million [of the] population, which compares well to global figures," the minister said.

Home deaths to be tested for Covid-19

"The question that has been raised is whether the plateau that is observed in some provinces is due to reduced testing numbers or if indeed fewer people are becoming infected with coronavirus. To assess this, we have looked at other key indicators which are that we have seen reduced hospital admissions and persons under investigation (PUIs) presenting in health facilities; we have not breached hospital capacity; and, despite the surge, we have not seen a significant increase in deaths."

Mkhize said while the department was "cautiously optimistic", it was still too early to make definite conclusions regarding the observed decline.

"We need to continue to track all these indicators and ensure that our testing capacity reflects a realistic picture of our epidemiological status. We will therefore only know for sure when there is a consistent decline over a period.

"It is worth mentioning that, as part of improving the records of Covid-19-related deaths in response to reports on excess deaths, we now require that all the sudden deaths and those that occur at home must have specimens taken for Covid-19 before a death certificate is issued," Mkhize said.

Healthcare worker safety and PPE

"As government, we have constantly given our commitment to the public that the protection of health workers, including doctors and nurses, is of utmost importance. This workforce remains at the frontline of our battle against Covid-19 and it is in our interest as government to ensure that they are protected," Mkhize emphasised.

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He said the Department of Health noted with concern increasing allegations of healthcare workers contracting the coronavirus in the line of duty owing to lack or poor quality of personal protective equipment (PPE).

"We have even received reports that some may be dying after being infected due to the lack of sufficient PPE or due to sufficient PPE not being provided or failure or neglect by management to adhere to prescribed workplace safety protocols," Mkhize said.

"We want to outrightly state that this cannot be tolerated," the minister warned.

He said a few days ago he was made aware of reports that a doctor had died at the George Mukhari Academic Hospital, north of Pretoria, due to Covid-19. There were also allegations that this was because of a lack of sufficient supply of PPE and doctors being made to work in an unsafe environment at the facility.

"I viewed these allegations in a serious light and have decided to urgently appoint a team led by Professor Taole Mokoena – together with other medical, nursing and legal professionals – to conduct an urgent investigation and provide me with a report in 14 days from the commencement date. 

"This report will provide me with independent findings and recommendations. These will also be communicated publicly. I want to assure members of the public that if individuals entrusted with positions of power in health facilities or even at district level are found to be in dereliction of duty by not ensuring adherence with health protocols, appropriate action will be taken against them," Mkhize said.

He encouraged healthcare workers at this facility to avail themselves for this probe. "I believe that this approach of zooming into specific incidents will assist us to establish the real challenges and deficiencies occurring in the health facilities. It will also ensure accountability and promote a culture of heightened awareness of workplace safety."

Infected healthcare workers

As at 2 August, the number of infected healthcare workers was 24 104, with 181 fatalities recorded. This means that the national infection rate of healthcare workers stands at 5% of all confirmed cases.

"We have also kept track of the level of infection on healthcare workers globally: on 17 July, the World Health Organisation (WHO) reported that healthcare workers account for 10% of global infections," Mkhize said.

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The department has requested provinces to further verify and break down the data so that it can know exactly how many healthcare workers have died or recovered, as well as provide a full breakdown of categories of healthcare workers.

"While we appreciate that employees can acquire the virus both in their line of duty as well as in the community, we encourage employers in different sectors across the country to continue taking measures to minimise the chances of acquiring the coronavirus in the workplace."

Concerns by unions

Mkhize said unions have been raising their concerns about workplace safety, the availability and quality of PPE and the mental and physical well-being of their members.

"We have noted reports from unions collected through their fact-finding missions and also the ones indicating shortage of PPE in some hospitals. I have since instructed the provinces to ensure that PPE is immediately made available at those facilities highlighted and for a report to be made available," Mkhize said.

"The provinces have also been instructed to ensure that occupational health and safety (OHS) committees are established in every province, district and health facility. This is to facilitate constant communication and cooperation between unions and management.

"I have now obliged all provinces to ensure that these committees are fully formed and functional within the week and must meet at least once a week. In these OHS meetings, staff and unions must ventilate all issues and if resolution is not satisfactory, the complaints must be escalated to the relevant MECs."

Mental well-being of healthcare workers

The mental well-being of healthcare workers is equally important, Mkhize said, more so during high-pressure periods such as the Covid-19 surge.

"I have requested that in all provinces work must be done at provincial, district and facility level to promote psychosocial counselling to deal with the trauma experienced by healthcare workers, ensuring that they get support and manage the problems of fatigue and irritability and any indications of burnout."

Mkhize said:

Bed and oxygen capacity

"We continuously assess the availability of beds, oxygen and staff complement. While there have been constraints, work has been done to ensure vacancies are filled, but we can also confirm that we have not breached our bed capacity and many of our field hospitals are not filled to capacity and we continue to monitor this as we manage the surge.

"We have no doubt experienced challenges and glitches. This is in no way unique to our country. I therefore want to submit, with all humility, that up to now our government has displayed its readiness and has thus far coped with the surge. We remain committed to taking all the measures necessary to protect our people," Mkhize said.

"It appears we may have benefitted from treatment developments as we were experiencing our surge. Our indications are that there has already been an improvement in the survival rate from ICU [intensive care unit], where the mortality has been reduced demonstrably: one study shows ICU mortality has been reduced by about 25% since the introduction of dexamethasone on 16 June.

"In another study undertaken by MRC [South African Medical Research Council], ICU survival rates showed dramatic improvement at 30% to 40%, whereas the ICU mortality rate at the beginning of the pandemic was around 80%."

Notwithstanding these encouraging scenarios, the department has directed all provinces to enter into service level agreements with private health facilities to ensure that when bed shortages are experienced, alternatives can be explored.

Update on vaccines

Mkhize said while it was still "early days", the department had undertaken to invest in the development of a vaccine against the novel coronavirus.

"Currently we are participating in the ChAdOx-1 study and in the COVAX project to be part of the global research initiatives as well as the access to vaccines programme. We also wish to pursue the possibility of manufacturing vaccines locally."

WHO team arriving in South Africa

Mkhize announced that the WHO had agreed to government's request for reinforcements.

"As we know, South Africa is now in the top five globally in terms of the number of infections. I want to pause and acknowledge the WHO director general, Dr Tedros Adhanom Ghebreyesus, for his continuous support and counsel. We know that he and his team have had to carry the global burden in the battle against Covid-19.

"Today we announce that the WHO will be sending 43 senior experts from across the globe, including renowned specialists such as Dr David Heymann, who is a seasoned infectious disease epidemiologist and public health expert. I'm also pleased that Dr Mike Ryan will be leading a team from Geneva and will now be focusing on South Africa and providing us with constant advice while analysing our strategies, including the decisions we have taken as the Department of Health in our Covid-19 response."

Mkhize said this was a great opportunity, not only to improve South Africa's health strategies during the pandemic, but also to accelerate its path toward healthcare reform.

The first 17 experts will touch down in South African on Wednesday and will complete a period of quarantine and initiation before being deployed within the department and across various provinces.

Don't become complacent

"We can never overemphasise the importance of good human behaviour and the impact it can have on flattening the curve," Mkhize warned. "The containment measures being implemented are assisting; however, we must not be complacent. The real risk of experiencing the 'second wave' of the pandemic remains, so containment measures must never be abandoned.

"Until we are completely safe, we will keep reviewing restrictions and, if necessary, certain restrictions will still remain in place."

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