Western Cape heading into covid surge, yet should move to Level 3.

Over half of SA’s confirmed active covid cases are in the Western Cape, where the virus is more established than in other parts of the country and is now moving into the phase of rapid growth ahead of the peak. Yet the province has done what it can to prepare for the peak, and should move to level 3. Leading experts predict that many provinces will catch up to the Western Cape’s trajectory in the coming months. They should not be returned to level 4 or 5, regardless of readiness.

As of 23 May, the Western Cape had 6 146 active cases – people currently known to be infected – out of a total of 11 239 active cases in South Africa. Case numbers are expected to peak in June/July, a couple of months before other provinces, where numbers are expected to peak between August and October.

Why has the Western Cape’s infection curve been ahead of South Africa’s? One reason is that Cape Town is Africa’s most popular tourist region, and thus welcomed the most visitors from the hardest-hit regions in the world, including China, Europe and the United States while the epidemic was progressing. Many of the country’s first cases were reported in the Western Cape, and it is likely that the province has had the highest number of infections all along.

Secondly, the Western Cape has been testing more of its population than any other province. So far, it has tested 1350 people per 100 000 of population, while other provinces have tested between 140 and 850 per 100 000 of population. The more tests conducted; the more cases will be recorded.

Thirdly, in contrast to other provinces, the province’s testing strategy is focused on testing in ‘hotspots’ – places where the infections are concentrated – as opposed to general testing of the population. This means the ratio of positive tests to all tests will be higher, because of testing being focused in places where the virus is suspected, or more likely, to be present.

And fourthly, the Western Cape is performing post-mortem testing. This means patients who were not tested for covid before they died have a greater chance of still being picked up. If someone is not tested for covid before or after they die, their death will not be recorded as a covid-related death. This shows the impact of testing on the reported covid death rate.

Yet, despite the growing numbers, the DA and Premier Alan Winde are adamant that the province should move to level 3, and is probably more ready to open than any other province. Why?

The dual purpose of the lockdown was to buy government time to: 1. increase the capacity of the health care system (“raise the line”) and 2. ramp up more targeted measures to slow the spread of the virus (“flatten the curve”), in particular testing to trace and quarantine infected individuals. The Western Cape has used the time effectively and has been transparent about the increased health and testing capacity that has been achieved:

  • R725.5 million has been committed to covid-related expenditure across the Western Cape Government.
  • The conversion of the CTICC into a temporary hospital facility that will provide 850 additional beds at the peak of the pandemic, set to open 8 June.
  •  Additional temporary hospitals along the R300 in the Metro, in Khayelitsha, and in the Cape Winelands that collectively provide an additional 616 beds, to open soon.
  • 18 testing and triage centres (12 are already operational) to provide additional support at these facilities.
  • 3888 Community Health Workers are operating across the province, with a further 464 due to start work soon
  •  The number of tests have increased from 7 975 on 1 April to 94 275 on 18 May. This is an increase of 1182%.

Some in government believe the Western Cape should be held at level 4. This would be a mistake, just as it will be a mistake to return other provinces to level 4 in the months to come, whether or not they have used the lockdown time to prepare their health systems.

Extended hard lockdown creates more problems than it solves. It presents a greater risk to people than does the virus itself, and will ultimately result in more human misery. It too threatens lives. There is a strong link between economic devastation and increased mortality. The ability of the public health system to treat those with diseases and potentially fatal injuries requires resources which come from tax revenues. Without these resources lives will be lost.

Lockdown has a direct impact on government social and health spending. Aside from the impact on the fiscus, economic decline will lead to job losses (National Treasury estimates between 3 and 7 million for South Africa) and loss of income, which in turn means starvation and malnutrition for millions of people. Poor nutrition and low incomes are further directly linked to compromised immune systems reducing quality of life and years lived and also making people more susceptible to contracting covid.

Government’s worst-case mortality projections of 45 000 covid deaths this year, while grim, reflect that the covid response has been grossly out of proportion to the threat. We need to bear in mind that more than 400 000 South Africans die from natural causes each year, including around 37 000 from tuberculosis and 32 000 from diabetes, as well as 15 000 in road accidents and 21 000 from murder. (In the US, between 1 February and 16 May this year, across all ages, more people died of pneumonia than covid.)

None of these threats to human life lead us to mothball our economy and stay indoors, and for good reason. While every death is a human tragedy, we cannot avoid all deaths, nor sacrifice society’s other competing needs, such as food and mobility.