A hospital worker puts on gloves as part of her Personal Protective Equipment (PPE) in the COVID-19 ward at the Somerset Hospital in Cape Town, on July 2, 2020. Picture: RODGER BOSCH / AFP
A hospital worker puts on gloves as part of her Personal Protective Equipment (PPE) in the COVID-19 ward at the Somerset Hospital in Cape Town, on July 2, 2020. Picture: RODGER BOSCH / AFP

At the start of the Covid-19 pandemic in the Western Cape, I made clear that our province’s Covid-19 response would be evidence-based and data-led.

In an unprecedented crisis of this magnitude it was critical that we consider potential scenarios, and that we make provision for them so that every person can receive medical care should they need it.

In doing so, we have always opted for the most “pessimistic” outlook. A caring, responsible government needs to do this, so that we are never caught wanting. You plan for the worst but intervene to get the best possible outcome.

In April, I revealed our very first scenario planning projections to the public. These projections could not be based on real data in the province, as there simply were not enough cases in the Western Cape and SA at the time. It therefore looked at international trends, our population size, and factored in reasonable epidemiological assumptions.

Once the number of cases climbed in the province, and we had more data available to us, we again looked at our provisioning scenarios and checked whether it was still reasonable to follow these original projections.

Because we wanted this to be as credible as possible, we partnered with two expert associations — the Actuarial Society of SA (Assa), and the National Covid-19 Modelling Consortium and recalibrated the provisioning scenario using the new data available.

To recap, the National Covid-19 Epi-Model (NCEM) calibrated to the Western Cape data, projected at the end of May:

• A peak towards the end of June, beginning of July 2020, that was notably steeper than our original provisioning scenario. This peak, however, was not as steep as the Assa model.

As a result, there was a requirement of approximately 7,800 beds at the peak of the pandemic. We had previously worked on a 6200-bed requirement.

Cumulative deaths of about 9,300 people in the Western Cape (over the entire curve)

At the time, our original provisioning scenario was still tracking the number of deaths and hospitalisations reasonably accurately. But the new modelling projected that at a point in time the two scenarios would diverge — and the Western Cape could see a surge of hospitalisations and deaths in line with this steeper curve.

We have been tracking our daily deaths and hospitalisations — which remain the most robust measurements available to us — against this new provisioning scenario and we can confirm that the significant surge that was projected as a realistic possibility did not take place to the degree that was anticipated during June.

Our hospitals (both public and private) of patients with confirmed Covid-19 have been tracking about 1,700-2,000 hospitalisations consistently for the last two weeks, and the estimated number of deaths is tracking about 60-70 deaths a day, accounting for anticipated delays and under-reporting.

At this point, I need to make an important point about modelling. During a novel Covid-19 pandemic, it is not a perfect science.

Models are projections, using available data and based on assumptions. They help us explore what might transpire, but the outputs should be treated with caution and full understanding of the inherent assumptions, limitations and uncertainty.

It is very important to remember that Covid-19 is a new virus and that we don’t have natural history to underpin these assumptions. Also, our behaviour every single day does makes a real difference. Certainty is therefore not possible during this challenging time.

This makes it difficult for a government to plan. Do we build more field hospitals, or do we have enough beds with the existing interventions?

With more data available, we have again worked with the National Consortium and the Assa to recalibrate our provisioning scenario.

The NCEM calibration has been completed, and the latest provisioning scenario has the following conclusions:

The peak in the Western Cape seems to be later than was originally projected and is likely to take place from end of July to beginning of August.

This peak is also flatter than was originally projected. This means that we will not have as many hospitalisations and deaths at the peak as we originally thought.

As a result, it is projected that 5,450 beds will be needed at the “peak” should this scenario hold. This is lower than both the original provisioning scenario from April (6,304), and the previous NCEM calibration from May (7,800).

However, this flatter trajectory would last for longer. This means potentially more cumulative deaths of about 10,000 people during the pandemic.

The virus is could be with us for longer than we thought, with this first peak only ending towards the end of November.

So, what does this all mean for the Western Cape government’s provisioning?

Given this latest projection and given that we have not seen the expected surge in hospitalisations, we will not proceed with a CTICC 2 Hospital of Hope expansion at this stage. Our existing platform, with the operational field hospitals, and private sector capacity, means we have capacity at this stage to manage the expected burden.

However, we have done extensive planning for such an expansion and it remains “on the table” should the data suggest it will be needed.

Indeed, these latest projections can change given the unprecedented nature of this pandemic, and so we will continually analyse the data to make the best possible decisions in this uncertain time.

The Western Cape government cabinet has also approved a plan to purchase additional beds in private facilities for public sector patients. The advantages of the plan are multifold:

• The infrastructure and capacity (they are fully equipped and staffed) exists in place and can be accessed anytime when available.

 We have done the preparatory work and have signed off with the major private hospital groups and is in the process to sign independent practitioners.

Several engagements, processes and mechanisms have been put in place to manage the interface between the public sector and private sector including referral, governance, billing and information management through an intermediary, ethics committee, evidence-led clinical guidelines.

This also adds capacity in rural areas, that do not have access to existing field hospitals in the Cape Metro.

The Western Cape government is fortunate to have some of the best and brightest minds working in our department of health. These top scientists are not yet clear on what has caused our curve to be flatter and pushed out. We are dealing with an unprecedented scenario, and we are learning about this virus every day.

Some of the factors posited is that the virus is peaking in different places in the city at different times. Another scenario is that the virus does not infect everyone in the same way. Behaviour change interventions, such as wearing a mask, and keeping a distance can also make a real difference.

As more data becomes available and as we learn more about the pandemic in the Western Cape and SA, we will be able to be clearer on the reasons for these changes. I will share this information as soon as I have it. I can also assure the people of the Western Cape that we are constantly analysing our data so that we make the best possible decisions.

For now, I want people to know one certainty during this time: we have the power to change this curve again. Changing the way we behave by wearing a mask, keeping a distance, and following good hygiene, will interrupt the spread of the virus. This will flatten the curve further. This will keep our loved ones safe. This will save lives.

I know this pandemic is overwhelming and we are “told” by government do so many things. I want people to know that they really can make a difference by making these simple behaviour changes in their lives. I am so grateful for everyone who has done this already, and I urge every person who hasn’t yet to join us in our effort to beat Covid-19 in the Western Cape.

• Winde is Western Cape premier.

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