Open letter to Health MEC and the Premier

MEC Sindiswa Gomba, Member of the Executive Council
Honourable Oscar Mabuyane, Premier of the Eastern Cape
Dr Thobile Mbengashe, Superintendent General, The Eastern Cape Department of Health

Dear Leaders of the Province,

RE: COVID-19 RESPONSE IN THE EASTERN CAPE

On 16 April 2020 the Daily Dispatch published an article about the Eastern Cape’s first COVID-19-related death, at Frere Hospital. The National Department of Health has attempted to keep the country updated on such vital information as the daily number of total infections, the number of recoveries and deaths, and its strategy to combat the coronavirus pandemic. Unfortunately, not a great deal of similar information has been made available regarding the Eastern Cape Province. Further, there is seldom an outline of the specific districts confirmed positive cases in the Eastern Cape.

Bearing in mind that the Eastern Cape is the fourth most populous and the second most destitute Province in South Africa, it is of grave concern that the provincial government appears inadequately prepared to deal with the coronavirus pandemic. While reading the Dispatch article about the first death in the Eastern Cape, I thought about the information gap outlining the Province’s detailed response to the pandemic. The information gap along with the shortage of personal protective gear (PPE), the lack of sufficient ICU beds, and the continued movement of people between districts amidst rising COVID-19 cases are of particular concern.

The importance of information:
During a pandemic, it is important that citizens have access to readily available and sufficiently organised and locally relevant information, in order for them to remain informed, as well as engaged with their government. Credible information, which is frequently updated is required for purposes of transparency, accountability and to ensure that the public is aware of the implications of the pandemic so that they too may take personal responsibility in ‘flattening the curve’. The Constitution guarantees our citizens the right of access to information.

Giving effect to the right fosters a culture in which citizens have access to information which in turn enables them to fully exercise and protect their rights, in this context, the right to life and bodily integrity. Human health during this time depends on access to healthcare when needed and credible, relevant, extensive and updated information. It is also important that where people are met with technological and economical challenges, the State also ensure that such information is available through more accessible formats.

The Disaster Management Act
The Disaster Management Act (the Act) calls for the establishment and implementation of a framework for disaster management along with a centre for provincial disaster management.

According to the Act, the centre has certain powers and duties. The primary focus of the centre would be to specialise in issues pertaining to disaster management at a provincial level. It would be responsible for coordinating an integrated approach to disaster management, with special emphasis on prevention and mitigation by all the relevant stakeholders. The centre should also act as a repository of and conduit for information concerning disasters, impeding disasters and disaster management in the Province.

While the Act calls for the creation of a centre for provincial disaster management there has been no indication (that we are aware of) from the Province whether this centre is functioning, where it is located and who is tasked with its running. Furthermore, there has been no communication (that we are aware of) from the Province regarding the platform created by the centre for purposes of information dissemination regarding steps taken by the Province to manage the disaster.

Lessons from the ground
It is my opinion that the Province’s ability to deal with the pandemic will be complicated by such factors as rurality, the geographical structure, health facilities, infrastructure, unequal distribution of healthcare personnel and the healthcare system capacitation. For many in the Province, access to healthcare means walking 5km and more to get to a clinic. Health facilities in the Eastern Cape are in disrepair. The facilities are small, aged and rundown which leads to overcrowding, lack of dignity and lack of privacy. At times, the facilities lack electricity and experience water shortages.

Health workers are at increased risk, due to dealing with patients, on a daily basis, who come in and out of health facilities. Personal Protective equipment (PPE) is necessary to keep them safe from the risks associated with exposure to potentially ill and or infected persons. Furthermore, they are also faced with long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. In the Province, healthcare workers have gone on strike due to the absence of PPE. It is commendable that the Province is looking internally for persons to assist with the manufacturing of protective gear. However, the Province does not appear to have any short-term measures in place to deal with the present shortages.

The Province’s response has been negatively impacted by the shortage and uneven distribution of health personnel. The Premier’s subsequent deployment of 2000 nurses and 1000 nursing assistants in order to combat the spread of the virus and to deal with patients in the facilities is noted and welcomed, as is the proposal for temporary appointment of unemployed nurses.

It is also commendable that community health workers (CHWs) have been appointed to conduct mass-screenings, as well as referrals of suspected COVID-19 cases. Unfortunately, CHWs across the country have expressed their concern at potential exposure and infection due to lack of sufficient supplies of PPE, among other concerns.

Critical communication needed
On 20 April 2020, citizens of the Province were encouraged to present themselves for testing. Unfortunately, without sufficient information about testing, it is very difficult to for anyone to do so.

The PSAM would like to therefore address the following questions to the provincial leadership:

Testing sites:

How many private and public testing sites (clinics, hospitals and community health centres) are there in the Eastern Cape and where are they located?
What is the screening schedule for the Province as a whole and – where available:
– Itinerary per district?
– Itinerary per ward?
How will those persons who have been screened and need to be tested get to a testing facility? Has this information been disseminated to the public to increase awareness and prevent misinformation relating to screening procedure?
How many isolation facilities have been identified throughout the province and where are they situated?

The Clinical Management of Suspected or Confirmed COVID-19 Disease dated 27 March 2020 outlines steps to be taken to manage persons under investigation (PUI) and persons who fulfil the criteria of suspected COVID-19 case. However, it is silent on what steps are to be taken to get the patient from the clinic to a designated isolation facility. What means are to be employed to transport the patient?

Is it contemplated that emergency medical services and medical personnel will need to be set aside and designated specifically for this purpose?

Healthcare personnel:

How many healthcare personnel have been employed to date in response to the COVID-19 outbreak?
How many of those employed personnel have received training?
Are there procedures in place to ensure that healthcare personnel, including CHWs, are themselves screened and tested for COVID-19? In addition, if this is so, how frequently?
What steps have been taken to deal with the current shortages of personal protective equipment for healthcare personnel, in light of the nation- and worldwide, shortages?

Funerals:

What measures, beyond the National Disaster Management Regulations and their amendments10 are being considered/taken to address the transmission of the virus through the attendance of funerals?
What measures have been taken to identify and trace all those who have attended funerals in cases where those who have tested positive have been directly linked to funerals in the Province? How many individuals have been traced to date?
What measures are being taken to restrict cross-district travels?

While the National Disaster Management Regulations and their amendments outline steps that must be taken for purposes of funeral attendance and cross-district travels, individuals attending funerals in the province have failed to abide by the regulations, which has resulted in suspected and confirmed cases emanating from funerals
attended.

It is important that there be clear communication with the public regarding COVID-19 in order to enhance access to testing, transparency and accountability and dispel uncertainty to bolster the Province’s response to the pandemic.