Lockdown: Cabinet won't reimpose stringent rules despite coming Covid-19 spike

Despite senior ministers and premiers advocating for the government to reconsider the relaxation of lockdown regulations, there appears to be no appetite from the Union Buildings to reimpose stringent rules.

This comes as some health experts raise concerns over whether SA's health system is ready for the approaching onslaught of Covid-19 infections. By Friday, 1,354 people had died - 2.2% of the country's 61,927 infections.

Minister in the presidency Jackson Mthembu told the Sunday Times that the cabinet's decision to relax lockdown rules, including lifting the ban on alcohol sales, is "not up for reviewal".

Despite Eastern Cape premier Oscar Mabuyane, Gauteng premier David Makhura and police minister Bheki Cele saying they support the alcohol ban's reinstatement, Mthembu said the cabinet had not discussed reversing the relaxation of regulations.

"The decision of cabinet stands. It is not up for reviewal ... we have not discussed the reviewal of those measures. Not at all. All we have said is let's have discussions with the experts and see how they look at measures that we have taken so that we are advised," said Mthembu.

President Cyril Ramaphosa's National Coronavirus Command Council (NCCC) is set to receive an assessment report from the health ministerial advisory council (MAC) on Tuesday. A cabinet meeting will follow on Wednesday, where a decision will be taken on the lockdown regulations.

Mthembu said the last cabinet meeting did not conclude what measures were needed after regulations were relaxed to level 3. He said any talk about specific regulations by any cabinet member was "ill-discipline".

"I am a member of cabinet. I speak to what cabinet has agreed ... I'm not part of the ill-disciplined crew," he said.

Mthembu said the MAC is expected to advise the NCCC about the impact the relaxed regulations have had on the health of citizens and hospitals. It is also expected to advise on the impact of the tobacco ban and whether the government can open the economy further - including allowing seated patrons at restaurants, and hotels and B&Bs to operate.

The MAC is also expected to advise if a "differentiated" approach is needed, imposing more stringent regulations in hot-spot areas.

Wits University Clinical Research Unit professor and MAC member, Ian Sanne - not speaking for MAC - said he believed the health department's response was in step with the medical services' scale-up requirements needed to manage the pandemic.

"With the pandemic's evolution being monitored, there is lots of ongoing work which will predict where surge capacity is needed," Sanne said.

"From where I sit, we are doing the right thing at the right time. The Western Cape and Eastern Cape infection rates were anticipated and follow global trends. Gauteng and KwaZulu-Natal are just a few weeks behind them. What we now want to see is expanded testing capabilities. Surge capacity plans need to be executed to meet the increasing demand for patient care."

Sanne warned that while strong attention was being paid to scaling up medical services, it remained to be seen whether the pace could be maintained.

"Big negotiations are under way between the health ministry and the private sector. One area of big concern is the recruitment of health-care workers," he said.

"The predictions are that the field hospitals are likely to be needed. The scale-up of these and the procurement of equipment and human resources are in step with the escalating pandemic."

However, fellow MAC member, vaccinology professor Shabir Madhi, who said he was not speaking for MAC, but from his position at the Medical Research Council, said SA was "nowhere near ready" for the coming spike.

"It's impossible to tell where the additional health-care workers will come from. What we see now in the Eastern and Western Cape, in terms of deaths and infections, is where Gauteng and KwaZulu-Natal will be within three weeks," he said.

"The doubling times of infections is shrinking. It was 14 days under hard lockdown, it's now 12 days. The situation in the Western and Eastern Cape, which are still in relatively early stages of the outbreak, will get worse. Cape Town and Nelson Mandela Bay will be three times worse off compared to where they are now within weeks. It's the same for the other metros."

Madhi said multiple issues compounded SA's health-care problem, including testing and backlogs. He questioned the benefit of conducting tests four days after samples were collected.

"When you test in hospital, results must be obtained quickly to prevent the virus spreading among health-care workers and patients," he said.

National Health Laboratory Services (NHLS) spokesperson Mzimasi Gcukumana said an international shortage meant all provinces were short of testing kits, the procurement of which has been centralised to avoid competition for supplies between laboratories. He added that by Wednesday, 63,244 tests had not been processed.

"The NHLS has capacity to conduct 36,000 tests per day. Last week, NHLS processed 105,023 tests [15,003 a day]. The volumes are increasing as test kits arrive."

In May, the government said it needed to create between 20,000 and 35,000 intensive care unit (ICU) beds by November. This means at least 20,000 extra ICU nurses are needed for a patient-to-nurse ratio of one-to-one.

The health department revealed there are now 2,739 ICU and 1,335 high-care government nurses. The Netcare and Life Healthcare hospital groups have 2,850 and 1,200 ICU nurses respectively.

Health department spokesperson Popo Maja said SA had 1,940 public hospital ICU and high-care unit beds.

Western Cape health spokesperson Mark van der Heever said they needed 5,272 extra medical staff, including 1,708 nurses [696 high-care unit and 378 ICU] and 220 doctors [91 high-care unit and 44 ICU], and have asked other provinces for help.

Van der Heever said infections among medical staff was increasing, with an expected 20% absenteeism rate. The province's hospitals were due to hit capacity by the beginning of July, he said.