Spike in COVID-19 cases points to gaps in South Africa’s response
- Laetitia Rispel
Preventing new infections and containing the pandemic protects health systems from getting close to collapse.
The numbers of COVID-19 cases and deaths in South Africa have increased exponentially over the past 12 months. At the beginning of the country had 168,000 cases of COVID-19 and 2,844 deaths. A year later, at the start of , there were over two million confirmed cases and more than 61,000 deaths. These numbers are only a snapshot of the kind of pressure South Africa鈥檚 healthcare system is under. On the one hand, the country needs to drastically increase the number of frontline health workers. And on the other hand, there鈥檚 , according to acting health minister Mmamoloko Kubayi, to employ medical interns, or even extra medical staff. Laetitia Rispel chaired the ministerial task team responsible for the development of the . She spoke to The Conversation Africa鈥檚 Ina Skosana about the country鈥檚 COVID-19 response.
How is South Africa coping with the current wave?
The country is not coping. I think the could have been avoided. There鈥檚 been a lot of focus on the . Although vaccination is important, you can鈥檛 look at the vaccination programme in isolation from the overall response to the pandemic.
Things could have been done differently.
First of all, the government COVID-19 a national disaster in March 2020. That was an opportunity for the National Department of Health to provide strong leadership for the entire health system. But the national department has either remained quiet, or played a supportive role to the pandemic response in the nine provinces. Consequently, the COVID-19 response has varied across the country. In a crisis like the pandemic, you need strong central leadership and management.
Second, there鈥檚 been a lot of attention on the ability of hospitals to cope. The first step of any public health response must be prevention. Preventing new infections and community transmission, and containing the pandemic protects health systems from being overwhelmed or getting close to collapse.
By the time hospitals are overwhelmed by people who need admission, it is almost too late. Gauteng is the epicentre of the current surge. The province鈥檚 early warning system increasing numbers weeks ahead of the surge. Yet very little was done to contain those infections, or prevent a rapid increase.
There has been insufficient involvement of civil society and ordinary community members.
There鈥檚 a certain degree of COVID-19 fatigue. But many people still don鈥檛 understand why non-pharmaceutical interventions 鈥 social distancing, hand washing, wearing masks 鈥 are important.
What are your biggest concerns?
There鈥檚 a chronic under-investment in the 鈥 the pandemic has exposed and amplified this. This is apparent in the especially to deal with the people who are seriously ill and need to be admitted.
You can have as many hospital beds as you want. But if you don鈥檛 have the skilled staff to look after patients, then people won鈥檛 receive quality care or care at all.
There鈥檚 also been a failure to deal with the concerns and fears of frontline health workers. I don鈥檛 think there鈥檚 been sufficient attention to the psychosocial and emotional impact of the pandemic on these workers. The potential consequences are physical and mental exhaustion, stress, anxiety, and burnout. This could lead to medical errors, lower productivity, increased absenteeism and higher turnover, thus creating a vicious cycle.
What鈥檚 been working?
There are areas of innovation that we should recognise. For example government and South Africans were able to put together, at relatively short notice, significant . Digital innovation included the , the early warning system of hotspots or clusters of infections and the ability to get daily updates on COVID-19 infections and deaths.
One of the positive aspects was the 鈥渨hole-of-government鈥 approach and inter-governmental structures that were set up. These enabled different government departments and entities to work together, rather than in silos.
The other thing we have to acknowledge is the visible . There was very decisive leadership from the president at the early stages of the pandemic.
Hospital and district managers, as well as frontline staff, rescued the day. They went way beyond the call of duty. For instance, frontline nurses and doctors had creative ways of keeping communication going with family members who were not allowed to visit patients. There was a public appreciation for frontline nurses and doctors.
I think the institutionalisation of public health measures is an amazing achievement. Wearing masks, handwashing and sanitising were adopted quite quickly. Compliance and enforcement, however, are still key issues.
What should be done?
The first thing is to strengthen and stabilise leadership and management. If people are in they are less likely to take risks and make tough decisions. Given the speed with which the pandemic is growing, it鈥檚 important to have rapid decision-making.
The second thing is to engage with and involve ordinary people. This can be done through existing community structures. South Africa can build on the experience of managing the HIV epidemic to get public buy-in. People must understand that it鈥檚 only through working together that we鈥檒l be able to prevent new infections, contain the spread of infections, and save lives and protect our future.
The third point is the importance of investment in the health workforce. Without health workers it鈥檚 not possible to fight a pandemic, or have a functional health system.
Finally, it鈥檚 important to act on the data generated by information systems. What is the point of investing in health information systems when you don鈥檛 respond to the message? The government needs to take swift action at the first signs of hotspots and not wait for infections to spread.
, Professor of Public Health and DST/NRF Research Chair, . This article is republished from under a Creative Commons license. Read the .