Minister of Health Zweli Mkhize has ordered that Covid-19 tests be done in all cases of sudden death to improve the department’s death records but said they were observing a noticeable downward trend in new infections daily.

The minister was providing an update on the outbreak of coronavirus infections in the country.

“We now require that all the sudden deaths and those that occur at home must have specimens taken for Covid-19 [testing] before a death certificate is issued,” Mkhize said.

The latest numbers of excess deaths in South Africa are due for release tonight (5 August). In their latest available update the Medical Research Council stated that the all-cause national number of deaths for people older than one per week has risen to 16,223 and is 63% higher than the predicted number based on historical data in the week ending 21 July 2020.

“When compared with the predicted numbers, there was an excess of 6,256 deaths in the latest week,” their findings state. The number of deaths from natural causes is also significantly higher than the predicted number. According to MRC statistics in the period 6 May – 21 July 2020, there has been an excess of 22,279 deaths from natural causes.

Mkhize said that there are now 521,318 confirmed cases of coronavirus infections in South Africa but added that it looks like the country might be over the peak of the outbreak by the end of August.

He said his department’s recommendations will be tabled at the sitting of the National Command Council but warned that restrictions will remain in place to prevent a second surge.

Mkhize said the country could expect “more guidance” from the National Command Council by next week.

He announced the arrival of the first 17 experts who are part of the World Health Organisation‘s Surge Team in South Africa on Wednesday.

“The WHO has agreed to our request for their re-enforcement as we continue to implement our national Covid-19 response. As we know, South Africa is now in the top five [countries] globally in terms of the number of infections … 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 the team from Geneva and will now be focusing on South Africa and providing us with constant advice whilst analysing our strategies, including the decisions we have taken as the department of Health in our Covid-19 response,” he said.

“We see this as a great opportunity, not only to improve our health strategies during this pandemic but also to accelerate our path towards healthcare reform.

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

“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 less people are becoming infected with coronavirus,” he said. Mkhize said that at the same time there has been a reduced number of hospital admissions and patients under investigation presenting at health facilities. “We have not breached hospital capacity.” He added that despite the surge, there has not been a significant increase in deaths.

Mkhize said they are now concerned about KwaZulu-Natal as an area “where real pressure will be felt”.

He said the province has seen an increase of up to 3,000 new infections a day but while this number is slowly tapering off, he remained worried.

He said in the Western Cape there has been a reduction in the number of daily new cases since 7 June and the current infection figures for this province were much lower than initially expected. The number of new infections in the Eastern Cape started tapering on 12 July, he explained, with a drop in the number of new cases being recorded for the past three weeks.

Mkhize said Gauteng moved rapidly upwards in July with up to 6,000 new infections being recorded per day but have also shown a decline in the number of new cases for the past three weeks. He added that his team has investigated reports that Gauteng’s hospitals were full and found that the admissions areas were filled up but not the hospitals and also that the Nasrec Field Hospital was not full.

“But we are not out of the woods yet with Gauteng,” he said.

“Whilst we are cautiously optimistic, it is still too early for us 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.”

He said it was becoming clear that the hard lockdown in March and April had delayed the rising number everywhere but in the Western Cape and that an increased reopening of the economy when the country moved to Level 3 caused an increase in cases.

“We will need another two to three weeks to confirm the downward trend,” he said. “But containment measures are working… our biggest challenge now will be to sustain this by sticking to hand washing, the wearing of masks, personal distancing and limiting funerals to 50 people,” Mkhize said.

He added that indications are that South Africa will be over the peak by [the end of] August but said he feared a second surge that will be much bigger, as has happened in the United States.

Addressing problems that have been raised about health workers receiving substandard or insufficient personal protective equipment, Mkhize said he was concerned about “increasing allegations of healthcare workers contracting the coronavirus in the line of duty due to lack or poor quality of personal protective equipment. 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 and failure or neglect by management to adhere to prescribed workplace safety protocols.

“We want to outrightly state that this cannot be tolerated,” he said.

He said that after receiving information that problems with PPE had led to a doctor dying at the George Mukhari Academic Hospital in Garankuwa he had appointed a team to conduct an urgent investigation.

“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… 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 the latest numbers available show that 24,104 health workers have been infected and 181 have died.

“This means that the national infection rate of healthcare workers stands at 5% of all confirmed cases,” Mkhize said, adding that at the moment the World Health Organisation is reporting that health workers account for 10% of global infections.

“We have also kept track of the level of infection on health workers globally: on 17 July 2020 the WHO reported that health workers account for 10% of global infections.

“As part of continuous monitoring, we have requested provinces to further verify and break down this data so that we know exactly how many health workers have demised, recovered, the full breakdown of categories of healthcare workers,” he 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 also recognise the critical role played by labour unions in representing their members’ views and concerns at the workplace during this period.”

He added that he has noted reports by labour unions highlighting where there are problems with PPE and has instructed provinces to ensure that these facilities immediately receive stock.

Provinces have also been instructed to ensure that the Occupational Health and Safety Committees are established in every province, district and health facility within a week, Mkhize added. He said if the committees cannot resolve problems at facility level it must be escalated to the relevant MEC.

“The mental well-being of our healthcare workers is equally as important, more so during high pressure periods like the one we are going through now with 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 the country had not breached its bed capacity and many field hospitals were not filled to capacity but service level agreements with the private sector were being kept in place.

He added that there has been a significant improvement in the survival rate of patients in the country’s ICUs.

“It appears we may have benefited 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 where the mortality has been reduced demonstrably: one study shows ICU mortality has been reduced by about 25% since the introduction of dexamethasone on June 16. In another study undertaken by MRC, ICU survival rates showed dramatic improvement at 30-40% whereas the ICU mortality rate at the beginning of the pandemic was around 80%,” he said.

He added that a number of non-intrusive ventilators will be distributed to hospitals in the country including small rural hospitals. “We want people who go to rural hospitals to be given a chance to survive,” he added.

Mkhize confirmed the country’s participation in global research initiatives and vaccine programmes. “We also wish to pursue the possibility of manufacturing vaccines locally.”

Mkhize once again stressed that “good human behaviour” and lockdown measures were important in reducing the number of infections in the country, but warned against complacency.

“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.” DM/MC