WCG STRATEGY TOWARDS COVID-19 - PMG€¦ · •Recruited volunteers from WCG departments to respond to ‘please call me’ •Call Centre staff capacity has been doubled and will

Presentation to the Covid-19 Ad-hoc Committee

VideoconferencePREMIER AR WINDE

DR HC MALILA

Dr K CLOETE

WCG STRATEGY TOWARDS COVID-19

22 April 2020

© Western Cape Government 2012 |

National-provincial-local coordination

Nationally, President has established a National Command Council (NCC) that meets three times a week. NCC led by the president is coordinating and guiding government response to the pandemic

The NATJOINTS structure has been activated. COGTA has activated its National Disaster Operations Centre to coordinate response to COVID-19. COGTA Operations Centre interfaces with the NATJOINTS and PROVJOINTS structures

All provinces have established institutional structures to coordinate their response within their areas of jurisdiction. Metros and Districts have also established/ activated similar institutional structures. All Disaster Management Centres in provinces, districts and metros have been established/ activated across the country

Other departments such as Water and Sanitation have established their own coordinating structures or national operation centres to guide response within their sectors. COGTA is regularly communicating with MECs, Mayors and Traditional Leaders through video and teleconferencing

Go to Insert > Header & Footer > Enter presentation name into footer field 2

© Western Cape Government 2012 | Go to Insert > Header & Footer > Enter presentation name into footer field 3


WC Provincial Response

From 16 March – 14 April 2020 a Sub-committee of Cabinet chaired

by Minister Maynier met daily and reported into Cabinet

The meeting took the form of a briefing to the Minister from various

Clusters working on the response to Covid-19

On Wednesday 15 April the first Covid-19 Extended Cabinet meeting was held, which includes Cabinet, PTM, the Metro and

District Mayors and MMs

The Cluster Leads now report directly into the Extended Cabinet meeting three times per week



WCG Covid-19 response – Workstreams

Health Response (covered in today’s presentation by Dr Keith Cloete)

Humanitarian and Social Response

Local Government and Disaster Management Response

Business and Economic Response

Safety and Security Response

Infrastructure Response

Strategy: Next Phase Data Management, Modelling and Strategic Management / Planning Response

Finance, Administration and Institutional Support

Communication



Covid-19 workstreams (1)

Humanitarian and Social Response

Call centre to handle requests for assistance• Call Centre receiving =/- 10 000 calls daily – backlogs developed• Recruited volunteers from WCG departments to respond to ‘please call me’• Call Centre staff capacity has been doubled and will increase further to ensure all calls

answered in 2min

Food• DSD Feeding of children taking place through ECD Centres and NGOs schools - +/-135 000

households supported• WCED feeding +/- 100 000 learners• The school feeding was without incident and strict behavioural protocols are being

followed but is being challenged politically and nationally• NGOs feeding about +/- 200 000 households

Data• Datacentre focusing on assessing need using vulnerable households data, economic sector

data and call centre data• Datacentre focusing on mapping provision via mapping the large NGOs

Strategy• Whole of Society strategy being developed to align all efforts




Local Government and Disaster Management Response

• Ensuring maintenance of basic services

• Coordinating communication, information sharing and joint planning with municipalities (Joint District and Metro Approach)

• Management of admission to quarantine and isolation (Q&I) facilities

• Coordination of food assistance distribution with Social Development

• Determining resource requirements – application for national disaster funding

• Support to community-based screening and testing

• Assisting with repatriation of foreign nationals

• Burials management

Safety and Security Response (Prov JOC)

• Working with SAPS on enforcement of regulations

• Participating in Provincial Joints structure which reports to National Joints

• Responding to complaints against SAPS of abuse of power

• Providing information to police on schools that have been vandalised and looted

• Monitoring of criminal behaviour linked to lockdown




Business and Economic Response

• Assisting local businesses to access the national funding that has been made available

• Assisting with repatriation of foreign nationals

• Identifying paid-for quarantine sites (hotels and BNBs)

• Developed specifications for PPE and developed a database of suppliers

• Developed replies with Legal Services to FAQs – clarifying the interpretation of the Regulations

• Frequent engagements with Agriculture, Retail and other key stakeholders

Infrastructure Response

• Municipalities have provided a list of potential Q&I sites

• Moving forward with operationalisation of Q&I sites

• Identifying and procuring sites for acute beds (field hospitals)

• Provincial traffic enforcing the regulations

• Engaging transport sector on sustainability and compliance

• Indications are that some commuters are not observing physical distancing




Strategy: Next Phase Data Management, Modelling and Strategic Management / Planning Response• Department of Health leading on modelling towards a Health strategy• Further models to be extrapolated, data analysed and scenarios developed• Pooling of data analytic resources across departments• Data to inform medium- and long-term planning and modelling

Finance, Administration and Institutional Support• Established a Central Procurement Advisory Committee to assist the Joint Operations Centre

(JOC) and departments to procure rapidly and track and trace orders and payments• Develop costing models to determine resource needs and inform major procurement• All spheres likely to face budget cuts • Municipalities must review their own budgets – careful cash management, revenue and

expenditure management• Some municipalities may go into fiscal distress

Communication• Regular communication from the leadership• Daily stats are issued to the public in the morning and a press release in the afternoon• Weekly media statement from the Premier • Digital press conferences (“digicons”) and press conferences conducted by principals• Extensive use of community radio and loudhailing• Mass issuing of short messages (3 million mobile numbers)


Health Sector Response

Dr K Cloete

Contents

1. Current status of the COVID-19 epidemic in the Western Cape

2. Predictions for the future of the epidemic, and likely resource

requirements

3. Western Cape strategy underpinning our response to COVID-19

Current status of the COVID-19 epidemic in the Western Cape

Global and National Context

1. Lots of information available on COVID-19 globally including the WHO website and many dashboards.

2. National Minister and Chair of MAC, Prof Abdool Karim, briefed the nation a week ago; daily updates on data from NICD.

3. The President is considering the evidence and will announce on post 30th April lockdown arrangements, most likely a phased lifting of lockdown, with many control measures remaining in place.

4. Prevention measures such as cough etiquette, social distancing, hand hygiene and the use of masks must be deepened, with a special focus on certain high-risk areas and vulnerable groups.

5. We keep abreast of national and global developments.

The three waves – Western Cape experience so far

Professor Salim Abdool Karim, address 13 April 2020

0

10

20

30

40

50

60

70

80

90

01

Mar

12

Mar

14

Mar

16

Mar

18

Mar

20

Mar

22

Mar

24

Mar

26

Mar

28

Mar

30

Mar

01

Ap

r

03

Ap

r

05

Ap

r

07

Ap

r

09

Ap

r

11

Ap

r

13

Ap

r

15

Ap

r

17

Ap

r

19

Ap

r

Mar Apr

SAR

S-C

oV

-2 d

iagn

ose

s

Import associated

Imported

Local transmission

Based on 973 cases reported by 20 April 2020

Tackling the bushfires

-Specific clusters driving the bushfires

-Cases are however widely distributed

Professor Salim Abdool Karim, address 13 April 2020

Distribution of cases by sub district

0

200

400

600

800

1000

1200

1400

1600

Nu

mb

er o

f te

sts

per

day

Number of tests per day in public and private sector

Private Public

94360 424

691

3057 3047

5,3% 5,6% 5,4%5,8%

3,9%

3,0%

0,0%

1,0%

2,0%

3,0%

4,0%

5,0%

6,0%

7,0%

0

500

1000

1500

2000

2500

3000

3500

3/8/2020 -3/14/2020

3/15/2020-

3/21/2020

3/22/2020-

3/28/2020

3/29/2020- 4/4/2020

4/5/2020 -4/11/2020

4/12/2020-

4/18/2020

Per

cetn

po

siti

ve

Nu

mb

er o

f te

sts

per

wee

k

Weekly number of public sector tests and % positive

Number of tests Percent positive

Case definition expanded

Community screening & testing

Laboratory Testing

Number screened Number tested Percent tested

Metro 48,901 3,678 7.5%

Rural 32,728 140 0.4%

First 2 weeks of Community Screening and Testing

CST :

• 81 629 screened ;

• 3818 Tests

Strandfontein Camp :

• 1570 Clients screened - 62 screened positive

and tested.

• 14 results received and all 14 COVID-19 results

negative.

8,4%

2,9%

88,7%

General ward

ICU

Not admitted

Clinical Outcomes

4%1% 0% 0%

44%

26%

0% 0%

38%

42%

65%

56%

13%

26%

23%

25%

1% 4%

12%19%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All cases All Hospital ICU Died

Perc

ent

of

pat

ien

ts in

eac

h a

ge g

rou

p

≥80

60-79

40-59

20-39

0-19

Age distribution of patients diagnosed, admitted and dying

70% of patients dying had one or more co-morbidities

3

4

13

5

12

10

1

0

2

4

6

8

10

12

14

Doctor Nurse Other

COVID-19 in Health Workers private sector/public sector

comparison. 20 April 2020

Public Private Unknown

COVID-19 in Health Workers- Public and Private sector comparison

Categories - other

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

Breakdown of “other” cartegory:Covid-19 in health workers as at

20 April 2020

Much more data to be put in the public domain

* Public-facing dashboard will differ

Predictions for the future of the epidemic, and likely resource requirements

Scenario Planning

1. There is a national consortium doing technical work to anticipate how COVID-19 will impact in South Africa

2. There remains uncertainty around what proportion of the population will become

infected with and without interventions, the proportion expected to be totally

asymptomatic, and the expected clinical severity in those symptomatic

3. Contextual variations between countries like:

• age structure of populations

• health system capacity

• levels of co-morbidity

• timing and impact of social distancing interventions like lockdown

• Population density and informal settlements

• Socio–economic vulnerabilities

4. Planning is based on global experience in severe clinical presentations, while

waiting for more of our own data, guidance from the NDoH, and new technical

work from epidemiologists and modellers

At peak, allowance for 6000-7000 acute beds

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

Ideally critical care or ICU beds

General acute care beds

All beds

Premised based on age-adjusted estimates for symptomatic patients

- up to 6% may require hospitalisation

- up to 2% may require more intensive care

Making up for projected shortfalls in bed availability

750

1000

Acute beds in current

ICU beds

Field hospital beds

Western Cape strategy underpinning our response to COVID-19

Western Cape

Approach

Stage 1: Preparation

• Community education

• Establishing lab capacity

• Surveillance

Stage 2: Primary prevention

• Social distancing & handwashing

• Closing schools and reduced gatherings

• Close borders to international travel

Stage 3: Lockdown

• Intensifying curtailment of human interaction

Stage 4: Surveillance and Active case finding

• Contact tracing

• Isolation & Quarantine

Stage 5: Hotspots

• Spatial monitoring of new cases

• Outbreak response teams

Stage 6: Medical Care

• Building hospital capacity including ICU.

• Managing staff exposure and infections

Stage 8: Ongoing Vigilance

• Monitoring AB levels

• Ongoing surveillance

• Administer vaccines

Stage 7: Deaths and the Aftermath

• Expanding burial capacity

• Regulations on funerals

• Managing the psychological and social impact

Alignment to National Strategy for COVID-19


Suppression and Containment

1. Community Prevention – Hand hygiene, cough etiquette, social distancing, masks

2. Screening and Testing – Active targeted case finding (81 629 screened, 3818 tests)

3. Hotspot identification and response – Identify cluster of cases to contain spread

4. Isolation and Quarantine – Provide designated sites for people who cannot do so at

home (546 beds in use; 929 beds contracted; 8042 + 1145 being explored)

The strategy in this phase is to prevent transmission, early identification and

isolation of cases, tracing and quarantine of contacts. The effectiveness of

this strategy will determine impact on the rest of the health system, the lives

that can potentially be saved due to preventative steps and healthcare

system capacity, and the ultimate effect of COVID-19 on our society.

Thus, suppression and containment is the key to limiting this threat, and

“flattening the curve”


Triage and Testing Sites

Temporary Rented Tent for Triage and Testing (rent for three months - option to extend)• Completed:

– Tygerberg– Victoria– Mitchell’s Plain Hospital – Khayelitsha– Kraaifontein– Karl Bremer– Paarl

Currently Under Construction:– False Bay– Red Cross

In tender evaluation stage – construction to start next week– Eerste Rivier– Heideveld– Helderberg– Wesfleur

Specification to be finalised for NSH and Groote Schuur.

George and Worcester will have a no tent solution and the projects are implemented by the relevant workshop.


Public Works Strategy to I&Q

• Understand the numbers from a health model perspective to guide the operationalization of Q and I facilities.

• Have a level of disaggregation so that the number of bed required can be facilitated.

• Use a pragmatic guideline (under development from DoH) to guide what is needed.

• Procure a turn-key solution as the first approach in order to allow time to activate provincial facilities and municipal facilities

• Based upon numbers projected, be able to scale up the number of beds required from week to week.

• Understand what the triggers are where Q&I is not longer an effective suppression strategy.


Isolation and Quarantine

1. Q & I beds in Province contracted – 929

2. How many beds available to be used:

• Contracted - 791

• Available not contracted, i.t.o beds offered by hotels – 8042

3. How many beds are we looking to activate in provincial facilities across the Province - 1 145

4. How many currently in use - 546 (Inclusive of National & Provincial

placement of people)


Health Platform Response

1. Testing and Triage:

a) Create capacity to be able to increase testing and the support self-

management

b) Separate facilities at 17 designated sites (7 completed, additional 10 will

completed by first week in May)

2. PHC:

a) Strengthen PHC facilities to stream, test and triage Covid-19 cases – 146

facilities

b) Maintain essential non-Covid-19 care

3. Acute Hospitalisation:

a) Intermediate care beds for mild cases – 1300 beds being planned

b) Acute care beds for moderate cases – capacity created in existing 1697

c) ICU beds for severe cases – 150 additional capacity

4. Palliative Care:

a) In-patient care

b) Community-based care


Supplies and Equipment

1. N95 respirators: 70 000 on hand; 2.9 million on order

2. Surgical masks: 2 million; 7 million on order

3. PPE kits: 4000 on hand; 50 000 on order

4. Ventilators: 432 ventilators; 100 on order

5. Innovations: local production capacity for masks, visors,

disinfectant booths, goggles, etc.

6. Stock on hand : R45m : stock ordered : R185m


Recovery & Vigilance

1. Recovery:

a) Most people will recover – 222 have recovered as at 20 April 2020

2. Vigilance:

a) Monthly surveillance amongst Health Care Workers to be

implemented

b) Monthly surveillance in public transport, schools, prisons, workplaces

to be implemented

3. Adverse outcomes:

a) Protocol developed for Death Management in Hospitals and in

community settings

b) Capacity to manage burials and cremations


Current Staff Composition in Department – April 2020


Staff

1. Our staff need to be protected and kept safe – adequate supplies of PPE

(as part of a broader IPC strategy) is the key

2. Employee wellness capacity to provide emotional support to staff

3. A database of volunteers has been established and the call for

volunteers has been widely advertised – 1150 received to date

4. Accommodation and transport needs of staff are being addressed

through collaboration with Transport and Public Works

5. Organized labour are recognized as essential stakeholders and partners


Conclusion

1. Our strategy towards Covid 19 needs to be agile and rapidly

adjusted as conditions change. This presentation covers our

strategic considerations at this point in time.

2. This requires unity of purpose and strong partnerships – Health

Department cannot do this alone. Mobilise all forces.

3. This calls for business unusual, sense of urgency and courageous

leadership from all of us.

4. Its also an opportunity to fast-track Health System Strengthening,

and building towards UHC and WoSA

Thank you

Documents

WCG STRATEGY TOWARDS COVID-19 - PMG€¦ · •Recruited volunteers from WCG departments to respond to ‘please call me’ •Call Centre staff capacity has been doubled and will