COVID-19

28 May 2020

Over a month ago, the Western Cape Government provided an update to the media on its scenario planning for the Covid-19 pandemic, projecting on the number of hospitalisations expected during the course of the pandemic and therefore what would be required by our healthcare system to respond at the peak.

This update was done on the best available evidence at the time, mainly drawing on international data and experiences to better understand the trajectory of the virus in our context. As we mentioned at the briefing, this would be updated continuously as the situation changes and more evidence becomes available – both in South Africa and globally.

Our initial projections based on this data regarding bed shortfalls were as follows:

• We would have a shortfall of 1000 general care beds at the peak.
• We would have a shortfall of 750 ICU beds at the peak.

With more evidence available to us, especially with respect to hospitalisations and deaths, we can now provide a further update. This is part of our continued efforts to be open and transparent with the people of the Western Cape as we navigate this uncertain time together. Our government views every person as a partner, with the ability to help make a difference.

Over the course of the last few weeks, we have also taken several steps to ensure our modelling and projections are of the highest possible standard. Fortunately, South Africa has many top scientists and we have sought to leverage these great minds. We therefore have been engaging with both the Actuarial Society of South Africa (ASSA) and the National Covid-19 Modelling Consortium, to compare our assumptions and projections for the peak of the pandemic in the Western Cape.

The findings of these two modelling exercises have been different:

• The ASSA model is projecting a notably higher peak in the province than the Western Cape’s initial projection (based on the available data a month ago).
• The National Consortium model’s peak is lower than the ASSA model’s projection, but it is still higher than the Western Cape’s initial projection (based on the available data a month ago).

It is important to keep in mind that modelling is based on a number of assumptions, which are not certain at this time. This includes various factors such length of stay in a hospital facility and the percentage of symptomatic versus asymptomatic cases in the population.

These uncertainties must be kept in mind and new data must always be factored in as the pandemic progresses.

We have been tracking our own initial projections against the current deaths and hospitalisations at this moment in time:

• Our initial provisioning scenario is tracking the actual number of deaths and hospitalisations in the province consistently to date. Currently the number of deaths is slightly lower than our initial model projected, but this might be explained by reporting lags.
• This scenario was a conservative one to ensure adequate provisioning, and the fact that we are close to this level of demand on our platform requires us to consider if further provisioning is necessary.

It is important to note that both the ASSA model and the National Consortium model projections are consistent with our initial projections at this stage of the curve. To put it differently, all three of our curves are at similar points at this stage of the pandemic, but they diverge as they approach their respective peaks.

This leaves our government in a very difficult position. We have taken significant steps to make sure we are prepared for the peak based on the best available evidence and modelling, but it is difficult to know exactly how pronounced the peak will be at this stage.

To try and create more certainty, we have since worked with the National Consortium to calibrate our models based on new data now available on Covid-19 in the Western Cape, including hospitalisations and deaths. This was done because their modelling is also being used by the National Government.

The calibrated modelling exercise has therefore projected the following:

• A peak towards the end of June, beginning of July 2020.
• There will be a requirement of approximately 7800 beds at the peak of the pandemic. We had previously worked on a 6200-bed requirement.
• Cumulative deaths of approximately 9300 people in the Western Cape.

Based on the original scenario plan we presented to you before, the Western Cape Government intervened quickly to ensure we prepared additional facilities for the peak we might be expecting, including the 850 intermediate care beds at the CTICC temporary hospital and the 300 intermediate care beds at the Brackengate warehouse. However, this collaborated modelling points to the need for additional capacity.

My cabinet will now meet to consider these new projections, and together with the National Government, including the National Treasury, we will consider both whether, and then when and how, to bring online additional bed capacity.

There are other risks that must be factored in, however:

• We recognise that the ideal scenario would be to wait until we are closer to the projected divergence point in the models to see if this additional investment will be required. Unfortunately, a wait-and-see approach will not be possible because the different modelling projections have curves that are largely similar up until a very distinct point, at which they quickly move away from each other. This will leave us with no time to take a different course – we must choose our course soon. Put differently, there isn’t a noticeable “trigger” point to bring additional beds online.
• Additional beds require additional doctors and healthcare staff. The CTICC temporary hospital will have more than 900 staff. Finding additional staff is most probably the most difficult part of any additional scale-up. We must also factor in the fact that some healthcare workers will get infected with Covid-19 and they will not be able to work.
• The private sector has additional capacity, but it is costly. This would require significant additional resources.

We will provide further updates on our modelling, projections and further interventions taken following a number of important engagements over the next week. Our priority remains being fully open and transparent with you during this difficult time.

As we communicated to you last week, we have already adjusted our health strategy that will focus on protecting high-risk individuals, including those who are older than 55 and those with underlying conditions. It is these individuals who are more likely to be hospitalised and get seriously sick. Our targeted hotspots interventions, including community screening and testing, have already been repurposed to meet this imperative. Our focus is now on saving lives.

But I want to be very honest with you now, we simply cannot fight this pandemic alone. We need each and every person to help us. When you keep yourself safe, you keep your loved ones safe too. When you follow the golden rules of good hygiene, wear a cloth mask, and keep a distance, you prevent someone who might need to be hospitalised from getting the virus. You can help us flatten the curve, and your behaviour will save lives.

So I am calling on you today. If you have not taken this seriously yet, take it seriously now. Its going to get much worse before it gets better. We need you to slow the spread of this virus to protect the ones you love.

How can you help?

• Stay home as much as possible.
• If you are an employer, make sure that your workplace is strictly adhering to all guidelines to ensure cloth mask usage, hygiene and distancing.
• If you should not leave your home unless absolutely necessary if you are in a high-risk group category, particularly with underlying health conditions.
• Always wear a clean cloth mask when in public. Keep it over both your nose and mouth and don’t touch it.
• Keep your distance. Always. There is nothing more respectful, and caring, to do right now than to tell someone to keep away from you.
• Always follow the golden rules of hygiene, by washing your hands, sneezing into a tissue, and not touching your face.
• If you do get sick, stay home and call our hotline on 021 928 4102 for advice. You don’t want to pass the virus onto any person.
• But if you get very sick, and you are battling to breathe, seek urgent healthcare.

If every single one of us takes up this responsibility now, the worst-case scenario peak can be avoided, and we can save lives.

Please keep safe. Keep your loved ones safe. Save lives.