Shift to 'targeted management' as 4 provinces account for 96% of Covid-19 deaths

The Covid-19 pandemic in SA has become a tale of two countries.

The Western Cape is home to two-thirds of active cases, the Eastern Cape, Gauteng and KwaZulu-Natal account for 32%, and the other five provinces have just 1.2% between them.

The four worst-hit provinces account for 96% of deaths, and health minister Zweli Mkhize said on Friday that the national focus would now shift towards "targeted management ... in hot spots, where large numbers of people become infected at the same time".

This is the approach followed in the Western Cape since Covid-19 "clusters" began to emerge in supermarkets and workplaces several weeks ago, but premier Alan Winde said the province was now changing gear again to adopt a "ruthlessly efficient targeted hot-spot plan".

In some areas this would be rolled out at street level, and where people screened positive they would be tested selectively, with an emphasis on protecting the vulnerable.

Winde said all eight health sub-districts in Cape Town, as well as Witzenberg (Ceres) municipality, had hot spots that had been linked to "specific workplace clusters" responsible for about 800 cases.

Western Cape health spokesperson Mark van der Heever said: "A blunt, one-size-fits-all approach for the entire province - when some regions have few cases and others have high transmission - is neither sustainable nor effective.

"Our screening and testing teams are deployed based on data, which actively identifies and follows the 'bush fires' - the pockets of infections within communities."

Van der Heever said this approach had propelled the number of confirmed cases in the province upwards, and would continue to do so.

Mkhize's change of emphasis could change the way screening and testing are done in Gauteng, where the approach so far has been fairly targeted but not as intensive as in the Western Cape.

According to a presentation by the Gauteng command council this week, there were "clear signs of emerging hot spots in townships - Soweto, Orange Farm, Alexandra, Kathorus [Katlehong, Thokoza, Vosloorus], KwaThema, Tembisa, Ivory Park, Soshanguve and Ennerdale".

Gauteng health spokesperson Kwara Kekana said it was testing "health workers in particular. Additionally, there is a focus on the testing of vulnerable groups. Screening is also conducted at health facilities, and there is also rapid-response work being done in densely populated areas."

Screening was guided by "heat maps" generated by surveillance that identified "concentrations of cases". From there, "mobile testing and screening sites are set up, and in some cases there is also a door-to-door campaign", said Kekana.

In Eastern Cape, Nelson Mandela Bay and Buffalo City metros have recorded the highest number of infections, and attendances at funerals have spread the virus to rural areas.

Provincial health spokesperson Sizwe Kupelo said screening and testing had mainly targeted the two metros and the OR Tambo and Chris Hani districts. About one in seven of the province's 6.7-million people had been screened.

About 800 nurses had been hired to do community screening and 200 more were being recruited. Kupelo said the volume of testing meant the province was waiting an average of 72 hours for results.

Limpopo has not identified any hot spots after screening 3.4-million people and testing 4,595, said health spokesman Neil Shikwambana. "We had hoped that the mass screening would identify hot spots and, fortunately for us, we had none," he said.

As early as February, the province began screening people at its two major border posts. "When SA recorded its first case on March 5, we strengthened our screening, not only at border posts but also of everyone in the province who had travelled overseas.

"When we recorded our first case on March 16, we screened all contacts, tested all close contacts and quarantined all close contacts, even though they tested negative."

Shikwambana said the province launched the mass screening and testing during lockdown without being selective, visiting more than 900,000 households.

At least 10 community health workers were sent to each village. "The idea was to cover as much of the community as possible . there was also an opportunity for mop up later on when all the villages were covered."

Five individuals were being trained to screen colleagues in every workplace. Potential risk areas, such as mines, would be targeted for intensive screening, said Shikwambana.

By Thursday more than 3,000 people had been tested in the Northern Cape, out of 844,000 screened, but health MEC Mase Manopole said they were shifting now towards targeted testing.

Two out of five districts in the province, which has 1.27-million inhabitants, remain virus-free and Manopole said the Northern Cape's vast open spaces might have slowed transmission. "One professor was joking that the Northern Cape already has social distancing."

Manopole said an outbreak in the mines would be alarming - one mine employed 12,000 workers, for example - but so far everyone had tested negative.

In North West, where there have been fewer than 60 cases and only one death, health spokesperson Tebogo Lekgethwane said: "Hot spots are a priority but are not the only focus for screening, [which is done] ward by ward, door to door, and district to district."

The health departments in KwaZulu-Natal, the Free State and Mpumalanga did not respond to Sunday Times queries.