With the number of Covid-19 infections rising by the day, Western Cape health facilities are preparing for all eventualities.With the announcement made by president Cyril Ramaphosa on Sunday 15 March in an attempt to curb the spread of the virus, a ban on gatherings of more than 100 people was implemented, with further measures expected to be announced on Sunday 22 March. The address was postponed to last night (Monday 23 March) and People’s Post had already gone to print by the time of his address. For anyone who has visited a local public health facility for appointments or medication, long waits see thousands of patients gather at facilities, posing greater risk for spread. However, the hundreds of medical facilities run by the Western Cape government and City of Cape Town have already started implementing measures to mitigate these risks.Maret Lesch, Western Cape department of health spokesperson, says the province runs 457 primary health care service points and 33 district hospitals, five regional hospitals, six tuberculosis hospitals, four psychiatric hospitals, two central hospitals, and one tertiary hospital. The City of Cape Town runs 104 facilities with close to 250 000 patients expected to visit its facilities over the winter and autumn periods.Mayco member for health, Zahid Badroodien says the daily services includes immunisation, treatments of reproductive health and sexually transmitted diseases, nutrition, mental health, tuberculosis, mental health, maternal health and chronic care among others.Lesch says: “The average number of people per facility depends on the type of facility and how many hours it operate per day. Our day clinics are open for eight hours per day, we also have 12-hour and 24-hour facilities. Most of our facilities offer a comprehensive service package, ranging from chronic care to acute medical care. In 2018/2019 we saw 14.1 million patients in our primary health care (clinic) facilities,” she says.To ensure that long queues are avoided at the provincial facilities, Lesch says the department is calling on patients to arrive on time for their appointments.“We ask that patients do not arrive hours before their appointment times so that we can limit the number of people in the waiting area. Chronic medication can be collected at our off-site (clinical decision unit) CDU, which also reduces the number of people waiting at the clinic. We ask that people waiting to be seen follow proper hygiene protocol by washing their hands and covering their cough or sneeze with the bend of their arm or a tissue. Discard the tissue immediately after use and wash hands,” says Lesch. City clinics have further implemented a contingency measure that will decongest the facilities.“These will include providing medication for two months or more, appointment systems and staggering clinic visits. Each clinic will have a different approach, based on their specific client load,” says Badroodien.Some of the other measures being put in place include postponements of elective surgeries, discharging of patients in stable condition for further management at home. “All clinics are following strict hand hygiene protocol. Patients are also screened via a questionnaire before entering the facility to ensure they do not match the case definition for Covid-19. We have also adjusted our visitation policy at all government hospitals to limit the number of visitors per patient in line with social distancing guidelines as a measure to reduce the possible risk of spreading Covid-19,” says Lesch.Badroodien adds: “Clinics already have very strict hygiene procedures in place called ‘infection control procedures’ as we are used to dealing with infectious diseases such as TB. These include excellent hand hygiene, sterilisation of equipment and correct removal of hazardous waste. Simple actions such as good ventilation and positioning of patients in waiting rooms are also key.”Anyone infected by Covid-19 has flu-like symptoms and those most at risk have travelled to an area where the virus is spreading from person-to-person in the community or if someone has had close contact with a confirmed or suspected case of Covid-19.“If you suspect you meet the description and case definition for Covid-19 you should isolate yourself at home for 14 days. Call the National Institute for Communicable Diseases (NICD) hotline on 0800 029 999, Provincial Hotline on 021 928 4102, or your doctor and explain your symptoms. They will advise you on the next steps. Should you be referred to go for testing, do not go directly to a health facility – call ahead and alert them that you are coming so they can prepare for your arrival to prevent further spread of the virus. Only people matching the case definition for Covid-19 will be tested,” says Lesch. Currently, primary care clinics are not testing clients for Covid-19, says Badroodien.“Training is under way to increase this capacity. Anyone who presents at a facility is screened and appropriately referred if need be. In the meantime, however, we ask that residents first call one of the hotlines that have been established to assist persons who have reason to believe that they may have contracted the virus,” he says.City health has also implemented the identification of rapid response teams, in association with the metro district health service, to do contact tracing and collect samples, ensuring facilities are prepared to deal with the outbreak, if required, ensuring all staff members are trained to respond to any patient in the event of a suspected case, acquiring personal protective equipment for staff and information posters to display in waiting rooms and other public facilities“The City’s environmental health practitioners have also ramped up their health promotion awareness and education sessions, around good hygiene practices to avoid contracting and or spreading the virus,” says Badroodien. With the number of Covid-19 infections rising by the day, Western Cape health facilities are preparing for all eventualities.