GEORGE NEWS - The Covid-19 infection and death rate in the Western Cape which significantly exceeds the rate in the other provinces, could be ascribed to differences in the recording of data in different provinces.

In a media briefing on Thursday afternoon, 7 May, Western Cape Health Department head Dr Keith Cloete said their data confirmed that "community transmission is more established" in the Western Cape than in other provinces. 

At the time he said it would be speculative to give the reasons why this is so. "In a sense we are earlier in the uptake of transmission than other provinces."

Following on this, Premier Alan Winde issued a statement on Friday 8 May explaining that the Western Cape Government believes its health department is accurately recording Covid-19 positive deaths in the province because of its rigorous systems and institutional expertise. 

"It is important that this happens across the country. If it does not, data will become incomparable and the effectiveness of its analysis might be impacted."

He said it is "entirely" possible for a cause of death to be noted only as one of the underlying health conditions (such as diabetes, hypertension and chronic obstructive pulmonary disease) present in most of the people who have passed away due to Covid-19. 

"The virus can cause severe pneumonia, amongst other ailments, which can become fatal, especially in older persons and these people with the underlying health conditions. To confirm it is Covid-19 related, you would have to have tested the patient for Covid-19. 

"This requires well-run hospitals with the right expertise and a heightened awareness."

If it is suspected that someone has Covid-19 it is important to confirm this, even if the testing happens after death. "This is essential because this information, like the number of infections, provides us with data on the progression of the virus, and its transmission. And this data is essential to making sure our health system is prepared to respond at the peak of the crisis."

Western Cape samples cause bottleneck at labs
According to Cloete, the high number of swab samples being collected in the Western Cape has been the cause of a bottleneck in testing at the laboratories of the National Health Laboratory Services (NHLS). This led to results taking as long as seven days to be released. 

"When we did the analysis with the NHLS, it confirmed that the scale-up of testing in the Western Cape over the last two weeks was so steep that it exceeded the capacity of the NHLS to keep up with the increase in the demand," said Winde.

Shortage of kits
There is also a shortage of reagents and test kits, which need to be imported from overseas. Policy decisions, such as that a person must test negative before being allowed to return to work and government departments requesting testing for their staff members, further compound the problem. 

"We have requested that the President urgently intervene to support the NHLS and obtain the reagents and test kits required, and to address issues in the policy space," Winde said.

As a short-term solution, the Western Cape government has approached the private sector to access any additional available capacity, but these labs are also under severe pressure and do not offer any realistic short-term relief.

Testing classified in five streams
In an effort to handle the situation, Cloete's department has established a management system that categorises tests in five different streams. "The first and most important (test) is for someone under investigation in an acute hospital setting who can't wait for the results for three or four days to hear whether they've got Covid, because they need to be managed in the hospital." He said the laboratories have helped the department to prioritise these tests.

The second most important stream is health care workers whose results cannot be delayed because of the many knock-on effects it would have. The third is the person from the public who feels ill and presents himself for testing, the fourth stream is tests resulting from community screening, and the fifth stream is clusters of cases in the workplace where the Western Cape has also so far done extensive screening.

George Herald is awaiting comment from the NHLS.

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