Covid-19

Covid-19: Household screenings begin as experts warn about false picture of crisis

05 April 2020 - 00:05 By GRAEME HOSKEN, LWANDILE BHENGU and QAANITAH HUNTER
Health workers arrive to disinfect Madala hostel in Alexandra, Johannesburg. This week SA will pass the halfway mark of its 21-day lockdown introduced in an effort to slow the spread of the coronavirus. Now, say experts, urgent attention must be given to mass testing to give the country a fighting chance of tackling the crisis.
Health workers arrive to disinfect Madala hostel in Alexandra, Johannesburg. This week SA will pass the halfway mark of its 21-day lockdown introduced in an effort to slow the spread of the coronavirus. Now, say experts, urgent attention must be given to mass testing to give the country a fighting chance of tackling the crisis.
Image: Alon Skuy

Brace yourselves, SA.

Halfway through a 21-day lockdown, the country is fixated on daily new infection levels as it prepares for a possible Covid-19 spike that many fear could overwhelm the country's health services.

House-to-house screening and testing kicked off yesterday with a pilot programme involving more than 200 households in Umlazi, Durban, but health experts warned about SA's slow start to testing and a shortage of key protective equipment.

The warnings come after health minister Zweli Mkhize said this week that the lower levels of infections reported over the past several days could be the lull before the storm, and that hundreds of thousands of tests need to be conducted.

Also this week, the government was finalising a plan to move thousands of people out of high-density areas, and health workers' union Nehawu launched a court action against the health department to compel it to provide sufficient protective gear for health workers.

This follows news that the US recorded about 1,300 new coronavirus deaths between Thursday and Friday - the highest single-day death toll reported by any country.

With 1,505 infections and nine deaths, South Africans have been warned not to let down their guard, as the virus takes hold in overcrowded townships, where social distancing and lockdown regulations are difficult to enforce.

In Umlazi Q section, KwaZulu-Natal health MEC Nomagugu Simelane-Zulu and a team of health officials were out in full force on a screening drive yesterday.

Seven groups of screening teams and testers were sent to households to screen families. Simelane-Zulu said that the target was for each group to visit 30 homes by the end of the day.

"Today we decided to bring out our screening teams and tracer teams in order to pilot the mass screening and understand what needs to be done. I must indicate that it is not everybody that is going to be tested. Everybody is going to be screened and the screening is going to determine who needs to be tested, " she said.

Simelane-Zulu said premier Sihle Zikalala would launch the province's home screening and testing drive this week.

A health department community screening and testing programme is set to be rolled out nationally, with the launch of mobile units fitted with specialised equipment used for TB testing.

But Medical Research Council vaccinologist professor Shabir Madhi warned that this TB testing equipment is no "magic bullet" that will save SA from a Covid-19 crisis.

Madhi said the National Health Laboratory Services (NHLS) rather needed to explain why only 11 of its more than 230 labs are being used for Covid-19 testing and what it is doing to secure supplies to ramp up mass testing of 35,000 people a day.

"I fear, because of testing kit and material shortages, SA will be on a similar or worse infection trajectory as Spain and Italy.

"Urgent mass community testing is needed but cannot happen because SA is woefully incapacitated by a lack of test kits and materials, "which now take 10 days to import".

"For us to detect who is infected and isolate them and quarantine their contacts, at least 30,000 daily tests must be conducted. Government cannot properly implement its isolation and quarantine strategies without knowing who's actually infected, which is critical to this fight."

He said the NHLS should have properly planned for Covid-19 infection testing when the National Institute for Communicable Diseases (NICD) started surveillance of the virus in January.

Madhi said even though the health department is scaling up testing, mass testing is only likely to happen in May, which "is too late as the country will be dealing with the worst part of the pandemic".

He suggested university laboratories be used to increase daily testing capacity.

"These labs could easily do 5,000 daily tests collectively."

Professor Mosa Moshabela, dean of the University of KwaZulu-Natal's School of Nursing and Public Health, said its labs were ready to assist. He said that with the virus now in townships it has moved into new populations and communities.

"From modelling we believe that while only 1,505 people are known to be infected, the actual number is 4,000. It's estimated that by May 6 there will be over 100,000 infections."

He said the evolution of the Covid-19 spread would change the dynamics of how cases are detected.

I fear, because of testing kit and material shortages, SA will be on a similar or worse infection trajectory as Spain and Italy
Medical Research Council vaccinologist professor Shabir Madhi

"The moment it spreads to people who cannot access health care, the detection rate dramatically slows down."

The head of the NHLS, Dr Kamy Chetty, said it is not SA's fault that new tests for Covid-19 have not been rolled out yet.

She has set up a "war room situation" to negotiate with suppliers, fast-track the delivery of essential items and assist smaller suppliers in SA, to ramp up testing.

"We order test kits and then it doesn't come in. It gets postponed. The flight gets cancelled. It is a huge challenge. The other challenge is the fact that the whole world is competing for the same products.

"We are dealing with suppliers throughout the world. It is very difficult. The team sits here in a war room-style situation phoning suppliers. We have to find creative ways [to deal with the crises]," she said.

"From an operational point of view, the NHLS has had to work extremely fast to capacitate itself," Chetty said.

She said the fact that the NHLS is in a stable financial situation, moving from a R1.4bn deficit in 2017 to a R1.8bn excess in 2020, made it easier to respond to crises.

Mkhize said that of 50,219 tests conducted, the NHLS has done about 6,000, with private laboratories conducting the rest.

The government is pinning much of its hopes on a TB testing machine, which can be used to detect Covid-19.

Mohammed Majam, Wits University's health consortium's Ezintsha division medical technologies head, said SA is better geared than most countries to test for Covid-19 because of the country's HIV/TB problems.

"SA has about 2,000 GeneXpert machines, used for TB testing, which can be used for Covid-19 testing. While the current Covid-19 tests take 48 hours, the GeneXpert can reduce this to 45 minutes.

"But, the big issue now is obtaining the testing materials to conduct the tests. Hopefully they will arrive in the next few weeks."

Two weeks ago the US Food and Drug Administration (FDA) approved the global use of GeneXperts to test for Covid-19.

Madhi stressed that the slowing in positive results was not because the Covid-19 war is being won, but because of test shortages, movement restrictions stopping people from getting tested and the obsolete requirements of who can be tested.

"Until now only people who had travelled to high-risk countries and their contacts got tested. Now there are only local transmissions."

NHLS spokesperson Mzi Gcukumane said of its more than 233 laboratories, 11 are being used to conduct Covid-19 tests, and 28 of its 67 new mobile units are to be fitted with the GeneXpert machines to conduct widespread community testing.

The NHLS has 325 GeneXpert machines in 176 laboratories. In addition, "laboratories have been equipped with brand new equipment for Covid-19 ... the NHLS initially could do 5,000 tests in 24 hours and with the addition of other instruments, we will be able to process approximately 15,000 tests in 24 hours."

He was unable to say how many daily tests were currently being done.

He admitted there are challenges around limited supplies. "SA has to compete for these global supplies. Flights have also been cancelled, which has delayed stock coming into the country."

He said when the GeneXpert test kit was approved by US's FDA two weeks ago, SA immediately placed orders. "Test kits will be arriving next week. We are assured SA is a priority."

Gcukumane said each district and metro will receive a mobile unit.

"Thus far, seven vehicles have been deployed across the country, with five distributed over the weekend and 12 to be distributed on Monday."

• Meanwhile, a senior government insider told the Sunday Times this week that government had created software that will help healthcare workers trace vulnerable citizens in all 4,000 wards across the country.

Using a vulnerability map, created with the assistance of the Council for Scientific and Industrial Research and the University of Pretoria, government officials will be able to pick which areas are under greatest threat from the virus.

Using a realtime map, the technology looks at the density of the area and how far the houses are from each other.

It is also able to show the nearest hospitals to the affected areas, and the capacity of the facilities.

The system shows that six of the top 10 most vulnerable wards are in Gauteng.

The source said the idea was to close the vulnerable area as soon as an infection has been picked up, and then conduct widespread testing.

This is in addition to the use of cellphone technology to track people who tested positive and those who have been in contact with them.

The cellphone technology, which is usually used to solve criminal cases, is able to trace where the infected person has been and who was at least two metres from them at a particular area. This technology works even when cellphones are switched off.

"We are able to go to everyone you have met. If you visit someone we are able to say he was within two metres from you," the insider said.

The CSIR said it had been commissioned by the health department to work on the app, and therefore could not comment.


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