Ministers
Members of the Media
Fellow South Africans

 

Last night the President addressed the nation to outline our national response to the increasing spread of Coronavirus across the coun-try. As health, we have now come to give clarity on matters that were announced or that the public has asking about.

Firstly, we want to assure you that in all the decisions that have been taken, there has been extensive consultations. As the Presi-dent indicated, we continue to receive advice from experts but we also ensure that we consult provinces. As Health, we have a struc-ture called the National Health Council Chaired by the Minister of Health and is attended by all Health MECs and HODs.

At National Department of Health level, we receive daily reports that give us the latest status update of what is happening in each prov-ince, that includes the cases, deaths, recoveries and the most im-portantly the interventions at provincial level to respond to this pan-demic. These reports assist us to immediately heighten our ap-proach and interventions in provinces where we see the dynamics and management of COVID-19 changing.

Yesterday the President announced that further restrictions were being imposed under Level 3. And we must accept that these are added measures for us to contain the spread of this virus.

 

Taxi Regulations

The Minister of Transport will deal with the various dynamics sur-rounding these regulations. These are the health issues that had to be considered:

  • Studies from South Korea and China showed that the virus spreads very quickly between people sitting in a confined space for more than 20 minutes
  • they also showed that the the use of air conditioners circulates the virus such that it spreads beyond a meter
  • The issue of the emerging evidence of the virus being potentially airborne was also a concern
  • the virus can survive for several days on metal surfaces- it is a well known fact that there is a lot of bare metal in taxis that people can come into contact with
  • ventilation of the environment with natural air moving through the space and exiting into open air reduces the concentration of virus in ambient air substantially
  • it must be noted that people most at risk are those spending the most time in the taxi- drivers and conductors

 

That is why we have recommended as Health that with the taxis, being permitted to carry 100% for local and 70% for long distance, the following measures must be observed:

  1. Drivers and conductors should complete a daily symptom check before being allowed to drive a taxi.
  2. Drivers, conductors and passengers should at all times wear a mask.
  3. Drivers and conductors should practice physical distanc-ing when out of their taxis, especially at taxi ranks.
  4. The drivers, conductors and passengers windows should be opened sufficiently to allow substantial airflow across the front seats of the taxi. (recognise that its COLD- but the don’t have to be opened all the way
  5. The taxi interior and surfaces, such as door handles, should be wiped down at least once each day.
  6. Drivers should ensure that passesngers are kept at 1 me-tre apart in queues at the rank while waiting to aboard their transport.

 

Alcohol Restrictions:

We realize that South Africans were taken by surprise by the imme-diate imposition of the alcohol ban last night, however, I would like to express my heartfelt gratitude for the overwhelming support for this intervention.

 

We would like to assure South Africans that the alcohol restriction is very much evidence based. Studies have revealed that we unfortu-nately, do not have a healthy relationship with alcohol:

  • According to the World Health Organisation’s Global Status Re-port on Alcohol and Health 2018, only 31.0% of South Africans 15 years and older are current drinkers (i.e. have consumed alcohol in the past 12 months)
  • However, despite the low proportion of South African adults who drink, we are one of the countries that drink the most in the WHO AFRO region at 64.6 g of Absolute Alcohol per capita per day-that is about 5 and 6 standard drinks of 12 g absolute alcohol (or 15 ml) per day (the average for countries in the WHO Afro region is 40.0 g/drinker/day and the global average i s32.8 g/drinker/day)
  • Almost 6 out of 10 (59.0%) of drinkers over the age of 15 in South Africa are reported to engage in High Episodic Drinking- better know as “binge-drinking”
  • In 2016 alcohol attributed trauma deaths exceeded deaths at-tributable to alcohol related liver cirrhosis and alcohol related can-cers respectively.
  • The level of alcohol-related mortality for South Africa is substan-tially greater for men than for women and for persons from lower socio-economic status (SES) levels than for those from higher SES levels.
  • A Professor working in intensive care at the Steve Biko complex in Pretoria also pointed out that, typically, alcohol related trauma patients are usually young fit individuals who would not otherwise need hospitalization.
  • During level four and five of lockdown, a study by Parry et al showed that there was a 60- 70% reduction in trauma admissions.
  • Conversely when alcohol restrictions were lifted during level three, facilities reported up to 60% increase in trauma emergency centre admissions and up to 200% increase in ICU trauma ad-missions.
  • Some modeling was done to predict the impact of an alcohol ban: in these models it was demonstrated that the re-introdution of an alcohol ban could result in 20% reduction of all trauma and 40% reduction of all alcohol related trauma by the third week.

 

Each trauma case does not just take up a bed- it takes up staff, oxygen, medicines and other critical resources necessary for the management of COVID-19.

At a time like this, when every bed, every health care worker, every ounce of oxygen is needed, it would be unforgivable to identify a clear burden on the health care system and do nothing about it.

There are many who postulate that there will be home brewing and illicit alcohol trade that would hamper on this intervention. However, these phenomena were said to exist during level five and four of lockdown and yet there is still compelling evidence that despite this there was a clear benefit to restricting the commercial sale of alco-hol.

 

Curfew:

The imposition of the curfew is also strongly related to nocturnal ac-tivities and alcohol use. This has more to do with inherent activities in people’s free time at night that makes it more difficult to adhere to the regulations

This also related to trauma not necessarily caused by alcohol but that tends to take place at night- such as interpersonal violence and motor vehicle accidents. As we have demonstrated overall trauma and alcohol related injury drastically reduced during level 5 and four of lockdown, where there was a curfew imposed.

Additionally, curfews are also a measure cited by WHO to limit non essential movement, thereby limiting spread of the virus- this unre-lated to alcohol or substance misuse.

 

Targeted Testing Approach

There are also issues relating to our new targeted testing approach and I would like to take this opportunity to clarify for our citizens.

We have moved from a mass testing approach to a more targeted approach. This ensures that our limited resources are used effec-tively.

As such we have introduced new testing criteria which focus on identifying the following broad patient groups:

  • Senior Citizens
  • Patients with co-morbidities
  • Patients who need hospitalization
  • Health care workers

Ultimately the decision to test or not to test rests with the attending health care worker and so we make a plea to all clients that the de-cision of the health care practitioner should be respected and that any concerns should be addressed by constantly communicating so that should things change the attending health practitioner is able to make informed decisions.

 

 

Quarantine and Isolation

Quarantine and Isolation remain one of our biggest challenges due to the reluctance of affected individuals to volunteer to quarantine in a facility.

We have had frank engagements with community members about quarantine and isolation and have been told of the following rea-sons that makes individuals reluctant to quarantine:

  • fear of safety of their homes
  • people who look after the elderly or young ones and do not have alternative options
  • perception that quarantine site feels like a prison
  • unable to see girlfriends, boyfriend, wives and husbands etc.
  • unable to drink alcohol or smoke

We cannot stress enough that this is a critical strategy to break the chain of transmission. Government has made quarantine sites available so that there is no excuse for not taking the necessary steps to protect your loved ones.

If you have been tested for COVID-19 or have a confirmed positive result, it is absolutely crucial that you quarantine or isolate in a place where you do not interact with other people.

We are engaging social partners to assist in these instances be-cause it is vital that we make every effort to curb community spread of the virus.

We encourage all citizens to engage with the support structures though your community, such as the COVID-19 forums that have been set up in districts so that community members can band to-gether to protect each other’s properties and to lend a helping hand should a community member need to be away to isolate.

 

Non-COVID Issues

We have picked up on social media that there is a fear that we have neglected non COVID issues. This could not be further from the truth- indeed COVID-19 epidemiology demands that we pay full at-tention to non-COVID issues.

COVID-19 found our health care system already managing the triple burden of HIV, TB and non-communicable diseases

We know that the most vulnerable are those who suffer from these co-morbidities, the main non-communicable ones being hyperten-sion, diabetes and cardiovascular disease.

We already have a major burden of these pathologies: close to 8 million people live with HIV in this country, 4 million people live with diabetes and one in 3 South Africans suffers from hypertension.

It is therefore extremely important for all those who live with these conditions to remain compliant on their treatment regiments and on their medication.

All chronic patients must keep their appointments scheduled with health care workers- these appointments are made to optimize con-trol of chronic illness by intermittent direct observation.

We have encouraged prolonging repeat scripts for the duration of the State of Disaster to minimise exposure in facilities. Please take your medication religiously even if you will only be seeing your doc-tor in six months.

Patients who are attending facilities for non-COVID related issues should not fear going to a facility. We have prepared our facilities such that patients with flu like symptoms never mix with patients who present with other clinical features. Patients must never delay seeking medical attention for fear of contracting COVID-19 at facili-ties.

 

 

Focus on Gauteng

  • Concerted effort to recruit nurses through agencies and open calls- first cohort of these newly recruited nurses allocated today and allocated
  • Oxygen was distributed by Afrox over the weekend and we thank them for public reassurance that we will not run out
  • Continued efforts to increase beds and ensure that field hospital beds are equipped with hospital reticulation
  • Sufficient quarantine beds appeal to GP citizens to seek facilities if not able to safely quarantine at home

 

Behavioural Change

Last night, the Honourable President expressed his deep concern about our inability to adhere to and sustain simple interventions that ultimately saves lives.

We have seen that people do not wear masks or wear them incor-rectly, not covering the nose or mouth. In the beginning, everywhere one went one would see people rubbing hands together as they wash their hands- one does not see this so much any more. In some parts of our country, especially in densely populated town-ships, there is no or very little social distancing. These are the things that have directly caused the numbers of infected people, and those who succumb to COVID-19, to rise.

As a reminder, wearing of masks is about you protecting others more than it is about preventing yourself from catching the virus.

We know that the virus passes from person to person and that the amongst the most vulnerable population groups are

 

  1. Diabetics
  1. Hypertensives
  1. Cardiovascular
  1. Chronic or Acute Lung Disease
  1. Cancer
  1. HIV

And more broadly the elderly over 60 years of age.

We all have to protect those who are vulnerable.

We have to avoid situations where we congregate or where we ex-ceed the permitted number of people, for instance, in funerals. We are extremely concerned about funerals- there are too many people attending funerals at the same time, over and above this there is the phenomenon of “after-tears” where people have parties after the funeral leading to behaviour that is not commensurate with efforts to curb the spread of the virus. We make an appeal to our people to attend funerals and leave as soon as possible and not to exceed 50 persons attending.

We have no vaccine, no cure. Yes we are participating in trials for both but the process can take

Any months, even years, to mature and for the medicines to be available.

We have no other way. We must all play our part and make tough, conscious decisions every minute of every day. We have to be able to count on each other as we weather the storm together.