Free State Health MEC, Montseng Tsiu, considers having to deal with Covid-19- infected individuals who remain asymptomatic as among the main challenges facing the province in its response to the coronavirus pandemic.
By 19 May the Free State had conducted 19 834 tests and recorded 165 confirmed cases, 118 recoveries and six deaths. “[The issue of] people that don’t show signs and symptoms is challenging,” Tsiu said. “There are others who would not only screen but also test and the results [would] come out negative, and then within 14 days when they test again, the results come out positive. We’re dealing with something that is new. We’re still learning.”
In mid-March the Free State recorded its first Covid-19 case when a medical technologist who worked at various hospitals in Bloemfontein, tested positive.
Tsiu told Spotlight after the province announced its first positive case, the department made sure they traced all contacts. “We screened and tested them. We also went to the school her children attended [and we] screened the teachers, learners as well as their families.”
Many of the province’s first infections were in people who attended a three-day-long church gathering early in March. This outbreak prompted a visit by Health Minister Dr Zweli Mkhize. Since then a large screening initiative and tracing of various individuals who attended the church conference were conducted.
“We immediately went to the church, to make sure we covered [traced] each and every one who was part of the gathering. We screened everyone and tested those who needed testing. That following day, after some who attended [the church gathering] tested positive; we quarantined them. We also went as far as asking cell phone companies to assist us in checking [tracing] the movements of those who attended the church gathering and their contacts,” Tsiu said.
One death too many
At 141 positive Covid-19 cases, Mangaung Metropolitan Municipality has the most cases in the province. Free State Premier Sisi Ntombela said this week that the city may remain at level 4 when some areas move to level 3 by end of the month. So far, those who have died from Covid-19 in the province are all men from Bloemfontein between the ages of 51 and 86 years.
Among those who died is a 77-year-old man who was confirmed positive after the virus was detected through a swab of his remains. This prompted the department to swab the remains of all deceased persons across the province, to ensure they know for certain if anyone died of Covid-19. The department will then trace all the contacts of the deceased for testing. “Most of those who have tested positive have recovered,” Tsiu said. “We only have a few that we have lost, which is something that is bothering us as one death is one too many.
"We have lost six people [to date] due to Covid-19 and we know that they had underlying diseases. To us it’s a concern. We would not want any person to lose their life to this illness.” The head of the Free State Health Department, Dr David Motau, told Spotlight of the six deaths that the province recorded, two had multiple morbidities, two had hypertension and the other two had no known co-morbidities. “The dead were swabbed, and some had cardio-respiratory illnesses such as pneumonia. We’re confident that we should be able to deal with this. We have a situation where we have finite resources for infinite healthcare demands. Those are some factors contributing to the challenges we have,” Motau said.
Upscaling screening and testing efforts
According to Tsiu, the provincial department’s “determination to flatten the curve and curb transmissions has been a combination of tracing contacts, screening and testing”.
“We don’t just initially test,” Tsiu said. “We conduct testing after we have received results from the screening. Our soldiers on the ground, who are the community health workers, are dealing with the community transmission. They conduct door-to-door screenings and educate people about the virus. We go to different communities, erect a tent and our nurses stay there during the day, screening, testing and educating people.”
Compared to other provinces such as the Western Cape and Gauteng, however, the latest statistics from the National Institute for Communicable Diseases (NICD) show the Free State by early May had done only 597 tests per 100 000 people whereas Gauteng did 736 tests per 100 000 and the Western Cape 1 023 per 100 000 people.
On Tuesday Motau said the province had done a total of 19 834 tests so far. Spotlight asked him about these testing figures.
“You would know that Western Cape and Gauteng are accounting for more than 70% of the cases in the country, so ordinarily it would make sense that they do a lot of tests,” he said. “However, as the Free State we also need to make sure that we test. [Now] we will be doing targeted testing in our vulnerable areas. While the demand is getting higher, you would know that the country as a whole does not have enough test kits, and the national department is working hard at making sure that we get those test kits. We are also in collaboration with private labs and have agreed that we use private labs to do some of our tests that would have come from some of these targeted areas that we’re talking about,” Motau said.
In March, two mobile Covid-19 screening buses provided by the National Health Laboratory Services for screening and testing were stationed at Pelonomi Hospital and Universitas Academic Hospital, respectively. That same month the department collaborated with private health facilities to increase the number of ICU beds to 320 in the province. Tsiu said the province employed about 500 enrolled nurses to increase screening capacity and deployed 40 tracers from the humanitarian organisation Red Cross in the province. Mangaung Metropolitan Municipality in Bloemfontein has 25 tracer teams of 125 tracers per team. These teams include volunteers, CHWs and nurses.
To quarantine or not to quarantine
Tsiu told Spotlight what “helped” was that the provincial authorities do not allow people to self-quarantine. “We have seen that when people say they have self-quarantined, they still get out of their houses and move around. Sometimes they would move carelessly without the masks, so we make sure that you are where we can monitor you on a daily basis,” she said.
Quarantine is when people may have contracted the disease but are asymptomatic. It is dealing with these asymptomatic people Tsiu describes as the province’s biggest challenge. Isolation refers to separating sick people from others. The guidelines of the NICD provide that where it is safe to do so, people can self-isolate at home. In terms of the Regulations to the Disaster Management Act, however, provinces can force people to isolate in state facilities.
When asked about quarantine and the legal and public health concerns underlying it, Motau clarified that although the MEC has given a “political direction that her wish is for the department to be able to deal with the pandemic, they need to admit everyone and there are still some [people] allowed to self-quarantine”.
Motau said they had some successes with self-quarantine. “But the MEC has said she doesn’t want to take chances, and these people must be quarantined. You now look at how you balance the resources in terms of the available quarantine sites together with the number of patients you have,” Motau said.
Doing exceptionally well
According to Tsiu, there are about 1 078 quarantine beds and 449 isolation beds in the province. This includes 881 quarantine beds in Mangaung, 40 beds in Fezile Dabi District, 36 beds in Thabo Mofutsanyana, 55 beds in Lejweleputswa and 66 beds in Xhariep, she said. Tsiu said there are 14 quarantine sites across the province that include eight sites in Mangaung, two in Xhariep, one in Fezile Dabi, one in Thabo Mofutsanyana and two in Lejweleputswa.
The MEC said she is satisfied with the work that is being done. “I think that is what we are doing exceptionally good. Once you test positive, we make sure we remove you from the community and quarantine you at places where we have provided beds for isolation. Those [individuals] who are not yet confirmed, we move them to places [stationed] for them alone, until we get the results and until the 14 days of the incubation period pass. After that, if you’re cleared and did not contract the virus, we let you go.”
But what about concerns that removing people to quarantine sites can contribute to rising levels of stigma around Covid-19 and may derail the response by making people less likely to test? Motau acknowledged the issues of stigma are concerning. “This is a worrying factor that has been discussed at the provincial command centre with the DG [Director-General]. We’re in agreement that if we don’t deal with stigma, we will have a serious problem. So, I think we need to invest a lot to educate our communities and making sure that they know this issue around Covid-19,” he said.
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