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Provinces with the most COVID-19 cases: What are they doing about it?

Eyewitness News looks at key provinces where the numbers are steadily rising - and how those in charge are preparing for worst-case scenarios.

South Africa has had the luxury of time to learn from other countries' responses – even earning praise from the likes of the World Health Organization. Picture: Sethembiso Zulu/Eyewitness News

JOHANNESBURG/CAPE TOWN/DURBAN - South Africa has entered stage four of the national COVID-19 lockdown, and while this has come with some loosened restrictions, there are warnings that if not properly managed, there could be a sudden surge in coronavirus infections.

From Iran to Italy to the United States, the world has witnessed the catastrophic effects of poor planning.

South Africa, however, has had the luxury of time to learn from other countries' responses – even earning praise from the likes of the World Health Organization.

But it’s still early days and no one knows when exactly the country will reach its peak in infections.

Eyewitness News looks at key provinces where the numbers are steadily rising - and how those in charge are preparing for worst-case scenarios.

GAUTENG

The first confirmed coronavirus case in South Africa in March may have come out of KwaZulu-Natal but it didn’t take long for Gauteng to become the epicentre of coronavirus in the country.

The Western Cape may hold the dubious honour these days, but that does not mean the country’s economic hub is getting complacent - at least according to the powers that be.

Health MEC Bandile Masuku said mass tracing, screening and testing remained a big part of the province’s strategy.

And with the government estimating that thousands of COVID-19 patients in Gauteng may need ICU care at the peak of the virus in the next few months, Masuku said the province was ramping up resources - including acquiring between 3,000 and 6,000 more beds.

“Construction is due to start in the coming weeks where we’re hoping to put 800 beds in our facilities like the Chris Hani Baragwanath Hospital, Kopanong Hospital in the Vaal, Jubilee Hospital and the Dr George Mokhari also in Tshwane.”

Masuku said frontline staff were also being equipped with personal protective equipment – but they needed more for the future.

“We’re looking at empowering local and small businesses that have been able to play in that space.”

The beds will be distributed to various public and private facilities that have been earmarked to deal with the COVID-19 outbreak.

Gauteng is also in dire need of more medical equipment to handle the load if coronavirus cases spike - or reach the peak in the next few months as has been projected.

At the peak of coronavirus infections, it’s expected that thousands of patients in Gauteng will need high medical care.

Masuku said that’s why the province was planning ahead as much as possible.

He’s confident the supply of extra beds, which would be used at hospitals, quarantine sites and other facilities would be a welcome relief.

A quarantine facility at the Nasrec Expo Centre in Johannesburg is expected to accommodate more than 2,000 patients.

Another facility being prepared is an old mining hospital in Carletonville - west of the city - which will be revamped to admit more than 200 people.

The lockdown has helped slow infections in Gauteng - while allowing for more tracing, screening and testing.

Masuku said recovery rates were also encouraging at over 65%.

The Gauteng Department of Health is still determining how many ventilators will be needed at the height of ICU cases.

Contact tracing will continue to form a big part of Gauteng’s strategy to curb the spread of the coronavirus.

Health officials will also prioritise the elderly, pregnant women and healthcare workers with the ambitious target of five million screenings in May, June and July - as well as ramped up testing.

There are currently 9,000 community healthcare workers and trained volunteers who are tasked with identifying people who’ve been in contact with those who’ve tested positive for coronavirus.

Contact tracing is important as it helps the authorities to identify the movement of the virus, pressure points and how best to respond.

Masuku said it was encouraging to see more people coming forward to volunteer their services.

“The capacity as we speak is continuously being built and we’re training individuals and volunteers every day, but our tracing has been on point.”

He said once a contact had been identified, they needed to be reached within 24 hours, but in some cases this had not been possible.

“We had an incident of a family that went to a private hospital and refused to be swabbed and we had to dispatch a team of tracers with law enforcers.”

While giving an update last week, Gauteng Premier David Makhura said more than 8,000 people had been found to have had contact with 1,400 infected people.

They were monitored while in isolation and while the majority of them have now been cleared, more than 2,500 are still being monitored

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WESTERN CAPE

The Western Cape currently holds the title of coronavirus epicentre in South Africa.

And with the province’s cases spiking by more than 100 in one day last week, authorities are facing a mounting challenge to flatten the curve.

Despite concerns, provincial health head Dr Keith Cloete said they were doing something right.

Cloete said the Western Cape government had adopted a much more rigorous approach toward actively locating cases.

“There’s a very deliberate strategy in this province; identifying hotspots is part of that strategy.”

This means tracking and tracing contacts and conducting targeted screening and testing in identified clusters.

Epidemiological evidence indicates where the cluster transmissions are taking place.

This is where resources are deployed extensively. One such area healthcare workers are focusing on is the Witzenberg Municipality.

It has 102 confirmed cases and has the highest number outside of Cape Town.

It is this approach that has led to a higher success rate in locating COVID-19 cases.

The provincial health department is hoping R47 million spent to turn the Cape Town International Convention Centre (CTICC) into a hospital will help plug the shortfall of beds as a rise in COVID-19 cases is expected.

The CTICC will provide government with around 800 beds to treat the most critical.

The Western Cape’s peak is expected later this year where on average an estimated 80,000 people will be infected, with around 10% of these needing hospitalisation.

Premier Alan Winde said the province was planning ahead as much as possible.

Winde was confident the extra beds and other facilities at the CTICC would help provide some relief when the virus hit the hardest.

“As the numbers start to push, we will be interacting with our epidemiologists again to see if we’re below or above the line. We’re concerned with our numbers climbing and so we have to have those discussions. They told us in the beginning that it should be testing, testing and more testing. We had over 4,000 tests just on Saturday and over 250,000 screenings.”

The lockdown has helped slow infections across the country, but the sudden spike in the number of cases has been concerning, even for Winde.

However, he said the recoveries, currently at just over 800, were encouraging.

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EASTERN CAPE

Eastern Cape premier Oscar Mabuyane has given the assurance that COVID-19 contact tracing teams were out in full force to identify possible coronavirus infections.

Mabuyane provided an update on the province's COVID-19 containment and management strategy on Sunday.

Three hundred and ninety-five active COVID-19 cases were recorded in the region, while more than 370 people have recovered after contracting the disease.

The province, and in particular Health MEC Sindisiwa Gomba, have come under fire for the management of the COVID-19 outbreak in the region.

Health Minister Zweli Mkhize last month deployed a team of experts to help provincial officials rein in the spread of the disease.

Mabuyane said it was challenging to manage the pandemic, but gave the assurance that tracing teams were following up on every possible contact to curb the spread of the disease.

"Yes, we are trailing behind in Buffalo City and Nelson Mandela Bay in terms of completing the list of contacts that we have, that's a reason why we have said let's work 24 hours to get contacts, isolate contacts, quarantine them, immediately when we see a contact, test it, quarantine the contact while waiting for results."

Mabuyane also come out in support of his MEC Gomba.

"She's doing fine, she's able to meet deadlines, targets... that's why we have been consistent in picking up issues, following up, raising them. Yes, just like any other province."

The Nelson Mandela Bay, Buffalo City and Chris Hani districts have the highest number of confirmed COVID-19 cases in the province.

Meanwhile, an old Volkswagen component plant will be converted into a temporary COVID-19 field hospital in Port Elizabeth.

The unit will be converted into a 4,000-bed healthcare facility for patients requiring oxygenation as part of their therapy.

To date, 814 people in the Eastern Cape have tested positive for COVID-19, of which 341 have recovered.

At least 376 people in the Nelson Mandela Bay metro have contracted COVID-19.

Funding from the German government has enabled Volkswagen South Africa to repurpose its old component plant into a temporary medical facility in PE.

Eastern Cape public works officials said there were also quarantine sites in every town in the province.

In the public sector, 1,800 beds are available and more than 3,000 in the private sector, which are on standby to assist government institutions should the need arise.

A field hospital is also under construction at the Nelson Mandela Bay Stadium.

Provincial Health superintendent-general Dr Thobile Mbengashe said about 10,000 coronavirus tests could be conducted in the province per day.

"The biggest constraints in the testing component is really the reagent... the reagents are critical components of the machines that we use to test and these are highly demanded quantities and we don't have the capacities to develop them in the country, so all these reagents are coming from other countries."

Mbengashe said the issue with regard to reagent shortages would be resolved in the weeks to come.

KWAZULU-NATAL

KwaZulu-Natal has not publicly shared its COVID-19 response plans for the coming months - drawing the criticism of opposition parties who accuse the provincial government of not being transparent.

The province registered the country’s first ever coronavirus case exactly two months ago - and now ranks third with the number of infections after the Western Cape and Gauteng.

There are concerns that the infections could rise exponentially if stricter measures are not implemented to curb the spread of the virus.

The provincial government is adamant it has used the past five weeks of the lockdown to prepare local facilities for possible peak

Eyewitness News understands that KwaZulu-Natal currently has 809 beds dedicated to COVID-19 patients at public facilities.

One hundred and three of them are for ICU admissions, while 16 are reserved for high care patients.

It’s understood plans are also under way to secure more than 7,000 quarantine and isolation beds, but concerns have been raised that if more people get sick from the virus, the load could prove difficult to manage with limited resources.

Opposition parties, including the Inkatha Freedom Party, believe the province is ill-prepared for the worst-case scenario.

The party’s provincial leader Thami Ntuli said: “In terms of the infrastructure that will be used for people who are quarantined or isolated, that is where we’re actually lurking especially in the rural areas.”

DA provincial leader Zwakele Mncwango said instead of being open with the public, the provincial government was actively withholding information that was valuable to the public – including a breakdown of cases in its regions.

“Our call is simple, give the public a breakdown from the district to the local municipality and township level so they can make their own judgments in terms on their movements.”

The provincial health department has not yet responded to questions sent by EWN last week.

Meanwhile, President Cyril Ramaphosa is expected to visit KwaZulu-Natal on Tuesday to assess the province’s response to COVID-19 as it battles an increasing number of infections.

The province is on the radar of health authorities after the recent outbreaks at private healthcare facilities.

The arrest of hundreds of people accused of flouting lockdown regulations has raised further concerns about just how prepared the province will be if the coronavirus infections spiral out of control.

It’s hoped more details will be shared when the president lands in the province.

In the meantime, Premier Sihle Zikalala said authorities had done what they could to prepare health facilities to cope with treatment demands.

Mass education campaigns, screenings, testing and monitoring are continuing - and a number of hotspots have been identified.

One of these is the eThekwini Municipality, which accounts for 60% of all infections in the province.