Covid-19 Update and Vaccine plan: KZN & Limpopo

Meeting report

The Chairperson asked for a moment of silence to reflect the loss of lives of the South African Health Services. All healthcare workers and families who have lost loved ones were thought of. Certain people do not have a choice to miss work. He gave the example of nurses who could not avoid work even if they were fearful of Covid. The Committee was receiving figures from all over the country of healthcare workers who had died. He asked that everyone reflect on the loss of lives due to Covid-19 and to hold a moment’s silence. He said may the souls of those who have departed in South Africa and in the world, as a result of Covid-19, rest in peace.

KwaZulu-Natal Department of Health (KDoH) on Covid-19 challenges
Ms Nomagugu Simelane-Zulu, KZN Health MEC, said that the first wave of Covid-19 infections did not affect the province as badly as the second wave. The second wave has had a serious impact in the province. At the beginning of December the KZN Executive Council decided to stop big events because these events had the likelihood of becoming super-spreader events. The province decided not to host any big events as it would normally do during the festive season. The province noted that funerals were super-spreader events. Some were not adhering to the protocols and were not following the regulations for funerals about timing and the number of people allowed. The province had to bring in the security cluster to implement the regulations. In certain areas there was a reluctance to stop night vigils. That has been where the province has been challenged mostly. The province was talking to their people and people were beginning to realise that there were other non-traditional ways of sending condolences.

KZN had challenges of oxygen supply but has not run out of oxygen entirely. Afrox does not have enough stock and as a result in certain health facilities were not able to get the number of oxygen cylinders that were ordered. The province engaged with Afrox to find way to work around that. The province ensured that transport was arranged to those places where Afrox was not able to deliver those oxygen cylinders. The province has looked at other role-players in the market. Even though the amount of oxygen others could provide was not enough for what was required, it may reduce the burden on Afrox. The province was having continual engagements with them. It was necessary to meet once a day with Afrox just to ensure that all facilities were provided with enough oxygen.

On the vaccine rollout, KZN was inundated with misinformation about the vaccine and what causes people to fall sick and die. Some of the ‘fake news’ was the infection was not as a result of Covid-19 but rather as a result of 5G being installed in the province. People were told not to allow 5G towers to be put up as that was causing people to get sick. The Office of the Premier had been dealing with the 5G misinformation. The Department of Health had led the charge in combating the misinformation about the vaccine as there had been a lot circulating in the province about that. People were beginning to understand that the Covid-19 vaccine was like any other vaccine that had previously been taken. The Department was working on a plan to roll out the vaccines in the province as soon as the National Department of Health (NDOH) had distributed them. The plan for vaccine rollout was led by NDOH. What was required from the province was to ensure that infrastructure and systems on the ground were ready as soon as NDOH had received the vaccines. The province was aware that healthcare workers would receive the vaccines first. The province was happy with that decision because it would help in reducing the number of infections amongst their own healthcare workers. The province had put systems in place so that once NDOH was ready to distribute the vaccines, the province would be one of the first to receive them.

Dr Sandile Tshabalala, KZN Health Head of Department, presented the KZN Covid-19 update. The presentation discussed the epidemic curve between 5 March 2020 and 12 January 2021. The province recorded an average of 5062 cases per day over the past seven days. Ethekwini Municipality consistently recorded the highest number of new cases daily. The current peak was larger than the first wave. The cumulative total of KZN Covid-19 cases was 259100; recoveries were 189201; active cases were 64167 and number of deaths was 5732. It was noted with concern that all KZN districts had an incidence risk of more than 100 cases per 100000 population. The presentation noted bed availability and bed occupancy per district and the creation of field hospitals. The province was implementing a resurgence plan that targeted areas such as governance, leadership, medical supplies, epidemiology response, infection prevention and human resources for health. A total of 10564 public sector healthcare workers had had Covid-19 and 107 succumbed to the disease. The majority of the infected healthcare workers were nurses which totalled 55% of healthcare workers infected.

Operational challenges
Some of the challenges facing the province included:
• Inability to increase Critical Care / High Care beds due to specialist nurses / doctors shortage.
• Inadequate supply of oxygen due to limited capacity for bulk storage, inadequate supply of oxygen cylinders and facility infrastructure.
• Prolonged turn around for results despite use of the Antigen Rapid Test in hospitals.
• Increased morbidity / mortality due to delay in seeking medical care by Covid positive patients.
• Increased demand for contact tracing and testing in hotspot districts.
• Increasing healthcare worker infections resulting in shortage of staff in health facilities.
• Increased bed demand and patient transfer to public hospitals by private healthcare facilities.

Conclusion
Despite these challenges, the HOD stated KZN was continuing to provide quality care through:
• Transportation of sick individuals to healthcare facilities by Emergency Medical Services.
• Providing access to medical care and hospitalisation to all individuals requiring admission to hospital through continuous repurposing of existing beds and commissioning of field hospitals.
• Ensuring patients receive quality care through continued clinical capacity building and equitable resource mobilisation and distribution.

Discussion
Mr P Van Staden (FF+) said that there were a few critical cases which stood out for him. His head started to spin when he heard ‘Coastland Hotel’ in Durban. He did not understand why the KZN Health Department wanted to recommission that place. Last year the Coastland Hotel was a quarantine facility under the Department of Public Works and there were a lot of problems. The NDOH health and safety standards were not adhered to and it was not fit for humans. Why was this hotel being recommissioned? It was a big problem last year and opposition parties had to intervene to get people out of that dreadful facility to quarantine at other places.

He then referred to Wentworth Hospital in Durban where staff were seen in the media not responding to a patient screaming for oxygen and other patients were lying on the floor. This week that same patient passed away. What interventions had the MEC put in place on this matter? How soon could the Committee receive a report on this? What were the shortages of doctors, nurses and healthcare workers per hospital? What was the status for new interns for 2021? What was the status of PPE in each hospital?

Ms H Ismail (DA) asked what was the recovery rate of Covid-19 patients with comorbidities in the province? Could the Committee receive a full report on the public hospital morgues and how they are coping? There had been various reports of bodies waiting and the presentation did not touch on that. There has been reports of patients' valuables stolen by nurses in private hospitals. What was KDoH doing to ensure that this does not happen at a public hospital in the province? Has KDoH considered approaching retired staff to assist with the shortage of healthcare workers? How many interns have been placed? While the province was waiting for vaccines, could KDoH provide a comprehensive plan for the vaccine rollout broken down into timeframes and number of vaccinations per day? It was known that everyone was waiting for the National Department but by now the province should have some sort of plan for the rollout of these vaccines. This was what the Committee wanted to know. It was easy to see that there were challenges with Emergency Medical Services (EMS) so what was being done to address these challenges?

Ms N Chirwa (EFF) said that the last time KDoH appeared before the Committee there was an issue of ART medication not reaching those who needed it. The Committee had asked that this be resolved as soon as possible. She wanted an update and if it was still a problem. If it is, how many people still do not collect their medication? How was the HIV programme still being affected by the pandemic at this point? There was no justifiable reason now why people with HIV were not receiving their medication or that the province was not implementing HIV programmes due to the pandemic. KZN should, by this time, have made proper arrangements to respond to this.

How and where are the Solidarity Fund-donated ventilators being distributed in the province? Why has KDoH not distributed all the ventilators according to the presentation? The possibility of a second wave was known for some time now. In KwaZulu-Natal, infrastructure was still a big concern. What has been done to prepare infrastructure for the second wave in public facilities? How were these efforts better than the first wave? She was asking because it was known that the second wave was going to be worse.

Lastly, what has the province done at ground level to respond to fake news in the community? She recommended that the province start using community radio stations more than billboards. Integrate already-organised institutions and communities into these programmes for community radio engagements. Community radio stations provide an opportunity to engage. Education was a key principle in ensuring primary healthcare was successful. If the province failed to educate people on vaccines, like the province has challenges getting people on HIV treatment and testing, then the province will have a challenge with rolling out the vaccine programme successfully.

Ms S Gwarube (DA) noted the disturbing images coming out of Wentworth Hospital. She had seen media reports of the MEC and HOD both committing that an investigation would be done. Looking at the facts in the video and media reports, it was very clear that what happened in that hospital was a criminal matter. That was a denial of somebody’s constitutional right to health. It was important that this was not just taken on as yet another matter to be investigated and then a report will surface months from now. Somebody lost their life and KDoH had the videographic evidence in its possession. It was important that it give an update to the Committee about what steps had been taken to get to the bottom of this. Who was going to be held accountable? It was important that when patients were treated in this manner that those responsible were held accountable.

The Committee understood that there were massive service pressures in hospitals with staff shortages and staff being stretched to their limits was a huge problem. However, with this challenge, KDoH needed to balance the wellbeing of the healthcare workers with the right of people to healthcare. KDoH needed to protect the right of people not to lose their lives while in hospital and lying on the floor. She asked the MEC and HOD to provide a detailed response.

An issue not covered in the presentation was the dispute about the 27000 active cases. There was a report by KDoH that claimed that the active cases dropped by 27000. There had been a lot of speculation about what this means and it was unclear. At the beginning of the presentation it stated that KwaZulu-Natal accounted for 20% of the cases in the country. Was there a stemming of cases? Where did the 27000 figure come from? Was it possible to have that sharp decline in the space of days? Was this misreporting? She wanted KDoH to clarify this. If it was true then it was great news. There had been much speculation and dispute about this figure. It was important that the integrity of the reporting was kept to standard.

KZN was the third province that spoke of Afrox being the sole oxygen provider as Western Cape and Eastern Cape flagged the same problem. She understood that the provinces were dealing with a sole supplier that had the capacity to deal with high demand. She dreaded to think of a situation where Afrox is unable to supply the demand across the country. Was there a consideration to diversify the supplier base as Afrox is battling? If so, what interventions was KDoH pursuing? If all nine provinces were depending on this company for oxygen supply it would be catastrophic if they were to run into massive problems.

On the vaccine rollout plan, the Committee had seen different levels of readiness from the provinces this week. She was not pleased with the level of detail in the report about how KZN was readying itself for the rollout. Plans about who was prioritised in the Phase 1, 2 and 3 of the rollout was ‘bargain basement’ because that was a protocol that needed to be followed anyway. Other details were needed. What about storage, distribution and allocation of the vaccine? How was KDoH going to ensure that even the most rural of districts were getting the vaccine as soon as possible? How was KDoH going to guard the integrity of the distribution process? That kind of detail was missing from the presentation. She asked the MEC and HOD to provide more detail. At this late stage, KZN should have concrete plans to roll out the vaccine as soon as it was ready.

Dr K Jacobs (ANC) said that the country needed to be sure of where it was heading with the second wave. Everyone needed to be wary of a third and fourth wave. What was the country’s preparedness for anything that would be coming in the future? What the country was doing should be used as permanent measures for anything else that happened in the future – the changes being made to infrastructure, oxygen supply, beds, wards, staffing and ambulances. That would ready the government to provide universal healthcare when this pandemic passes. His question was would the medium and longer-term improvements being done would result in being permanent improvements to the infrastructure. He noted oxygen supply is the mainstay of treatment. Every patient who comes to a facility should be able to access oxygen. If facilities where patients can come to access oxygen immediately were not created then more lives would be lost going forward.

He highlighted the need for oxygen production, transport, bulk storage, reticulation and the machines that assist the patient with breathing to improve the rate of fatalities. It was clear that ambulances were not equipped for this type of oxygen emergency. He asked KDoH to elaborate on that. As it commissions wards and beds are put in place, it needs to ensure that those beds stay within those facilities post-Covid.

Ms E Wilson (DA) raised the state of the mortuaries. The Committee heard that cold trucks usually used for moving cold freight, were being moved to mortuaries to assist with the holding of bodies as the mortuaries were full. She wanted more information on that. It was common knowledge that the KZN EMS system was not good at all. In some areas ambulances were required to cover up to 20000 sq kilometres which indicated the restraints on the EMS system. Ambulances were queuing up at hospitals with patients waiting for them to be screened. This created a problem because there were seriously ill patients in those ambulances needing oxygen.

Those ambulances needed to be kept mobile at all times as with the current situation ambulances were being called out every couple of minutes. While they were queuing at hospitals they were unable to service other calls. This became a problem because people desperately needing care were not able to get an ambulance and get onto oxygen. She noted a media article that stated a hospital had prescribed Ivermectin as a Covid treatment and that it was under investigation. This was a heated debate about this for several weeks. She asked for an update on what investigation was done for patients who received the drug and the results.

Mr A Shaik Emam (NFP) said from reports today compared to a few weeks ago, there appeared to be a vast improvement in some of the hospital facilities. He commended Dr Moji for the role that he was playing with the Muslim community in setting up community health centres. A few years ago when the Minister of Health was Mr Aaron Motsoaledi, it was agreed that all community healthcare workers will be made permanent as some had been working for 30 to 40 years and were earning R1200 a month with no benefits. This was agreed and was implemented in KZN and the Eastern Cape. He asked for an update on that. He noted that there was a laboratory that used to take 48 hours until a new system was put in place where KDoH can get a result after 15 minutes.

There appears to be some experts questioning the accuracy of the PCR test. He was informed that this matter was being discussed extensively. Some countries that did research found up to 97 out of 100 tests were false positives. He wondered if this had anything to do with the high positivity rate that was coming from the testing being done? There were concerns raised that when people who tested negative went to hospital most of them tested positive after visiting the hospital. He asked if there was a reason for concern?

He said extensive research was being done internationally on Ivermectin and there was fantastic success with that drug. There was however no comment from the Health Department on this. He was told that Ivermectin appeared in the Register of the Medicine and Related Substances Act for human use as a Schedule 3 drug in South Africa and there was some evidence that it was registered previously for human consumption. SAHPRA agreed that it has been used but with special permission. There was extensive data on Ivermectin and NDOH and the provincial departments should be at the forefront of this. The reason he was asking was that it might end up in court shortly. The advice he was given was that this must be discussed with the different provinces. If this drug could save lives in South Africa and the health departments have done very little, or nothing, about it then should they not be held criminally liable for the loss of lives to Covid-19? This drug was proven to be successful worldwide. He wanted KDoH to comment on the matter. What was it doing to ensure there was some research on this?

The presentation made a statement about 5G and it may be correct but it might be incorrect. Can KDoH tell the Committee what extensive research it has done to ensure the rollout of 5G was safe for communities? Some research evidence was sent to him which suggested that 5G was problematic. He was not an expert on health and was asking KDoH to look into the matter to see if there was any truth to it.

He asked about the state of mortuaries. Government and NDOH froze many posts for doctors and healthcare workers in South Africa. How was that impacting the province’s ability to ensure that it has sufficient healthcare workers to provide a satisfactory service? Many of the hospitals were saying that doctors and nurses were being put off because of being infected and some died. Those positions were not being replaced.

He addressed the MEC and said he had difficulty, from a parliamentary level, communicating with the KZN Health Department because of all the red tape. One example was the community wanted to put up heath care centres and provide oxygen for free. The Provincial Department did not give adequate support to these local communities. There were a lot of problems as a result of the local authorities not being happy to allow these facilities. There was so much red tape in licensing them. The district and municipalities had to come in and he urged the province to get involved so that more of these healthcare facilities could be rolled out. This would lessen the burden on hospitals in the province. He pleaded with KDoH to create some communication so that it makes it easier for members of the public to assist it.

Mr Shaik Emam highlighted that it was not only the funerals that were super-spreader events. Any Post Office, Home Affairs or streets in Durban were super-spreaders because there was no compliance. Law enforcement authorities were doing nothing. How was KDoH working with the Provincial Command Centre to ensure there were measures put in place to help these people waiting for their grants? He helped feed over 120 people waiting at the Greyville Post Office last night. Those people were sitting there for three days using the same masks. There was no social distancing as they were waiting for their grants.

The Chairperson recalled the discussion with the Minister about Ivermectin. He did not want the opinions of the MECs and provinces when it was known that the process was at the level of SAHPRA and the Minister. No matter how urgently the Committee wanted Ivermectin to come into use, it was agreed that SAHPRA would appear before the Portfolio Committee. Until the registration was properly done, it could not be used. He asked that the matter not be discussed until the Committee received a response from the Minister.

Ms A Gela (ANC) appreciated the presentation and congratulated KDoH for the good work in the province. It was good that KDoH had a plan for alternative oxygen suppliers. She raised a concern about communication on the rolling out of 5G. KDoH would be engaging with the community on the topic ‘Does 5G cause Covid-19?’. That was a very interesting topic and Members of Parliament would be listening in on that discussion. KDoH was very transparent. When the Committee met with the Western Cape Health Department yesterday they did not provide their list of challenges. Today, the Committee had received the challenges faced by the KZN Health Department.

The Portfolio Committee needed to intervene and assist KZN to address these challenges. NDOH could assist and intervene with challenges one and six as shortage of staff needed to be addressed. Healthcare workers were exhausted and Covid-19 was affecting them because they were dealing directly with the patients in the hospitals. She referred to the number of health worker infections and asked for the recovery rate. So far under the leadership of MEC Simelane-Zulu the province was doing very well despite the challenges. The Committee needed to monitor the progress and make follow-ups on the challenges raised today by KDoH.

Ms M Hlengwa (IFP) welcomed the comprehensive report. Was there sufficient capacity at the hospitals and clinics? The health facilities needed to be capacitated so that Covid-19 patients could be well handled. Were rural KZN clinics sufficiently equipped in particular to assist Covid-19 patients? She was an eyewitness where a patient had to stop at the clinic gates because the nurses said that no Covid cases were allowed. The clinic did not even allow the patient inside to be diagnosed. That happened at her clinic in Dumezulu. She noted that a clinic did not open for 24 hours and it was the reason two members were lost in one family. She trusted that KDoH would assist the community in this regard. She referred to media campaigns and awareness as many KZN people lived in rural areas, depended on radio and did not speak much English. Most of the people spoke Zulu.

Dr S Thembekwayo (EFF) said that the overcrowding and what happened at Wentworth Hospital indicates the fatigue experienced by healthcare workers. There was a high level of fatigue irrespective of the psychological support to healthcare workers. How did KDoH address the problem of fatigued health workers? How was it coping with the rurality of the province in testing, screening and the providing services in the midst of Covid-19? She highlighted the need for communication in those rural communities where there was no electricity. How would important information be shared with those who do not have access to televisions or social media?

KDoH did not have a clear vaccine rollout programme and it was not clearly stipulated to the Committee. The reason it was present was to explain explicitly how the vaccine rollout programme would be done in the province. That has definitely not been done. She referred to the critical stakeholder meetings. During this time those meetings could not be held on a monthly or fortnightly basis. This was a period of crisis. She encouraged KDoH to have a weekly meeting with its main stakeholders. In 2017 KDoH funded four groups of orthotists and prosthetists. Only two groups were placed in Wentworth Hospital in 2018. The other two groups have not been placed yet irrespective of a number of meetings held. She wanted an explanation on this matter. When were they going to be placed within the province?

Ms M Sukers (ACDP) appreciated the presentation and extended her condolences to the families of the healthcare workers who lost their lives. A step was missed by not rolling out a comprehensive communication plan that focused not only on prevention but also on home based care and how to manage Covid-19 at home. In the last few weeks there had been a shift with the focus on rigorous vaccine rollout. The Committee needed to insist that the province was prepared for the optimal care of patients to save lives and get people returned to their families. Yesterday, with the Western Cape Health Department, she had given examples of what she had experienced there in her constituency where optimal care was not given. Due to that, lives were being lost needlessly. Did KDoH have a comprehensive community care plan that not only focused on prevention but enabled communities to take care of the moderately ill? Could it give an indication of its oxygen capacity? What did it learn from the current wave that will assist in the third and fourth wave that is anticipated? How many patients died on ventilators? She wanted a breakdown of deaths in district hospitals versus tertiary hospitals. How many deaths at district level occurred with patients on ventilators? She said KDoH could provide a written reply.

The Chairperson said that if the Committee could not get its questions answered in the meeting, KDoH would provide written responses. He asked for concise responses as there was still another presentation. A workshop would be led by the Premier tomorrow on the rollout of 5G. He had seen a poster where the province was cautioning South Africans on Covid-19. How widely was this information spread over community radios and other platforms? Were the Cuban doctors adding value by their presence in the province? The chaplaincy programme noted in the presentation was commendable. How possible was it for KDoH to support funeral undertakers? He had met some undertakers in KZN who were stressed and struggling to counsel families who had lost loved ones. Did it have a plan to provide psychological support to the funeral parlours? The reasoning KDoH gave for decommissioning Charles James TB Hospital was understandable because it seemed to do well in managing TB patients outside of formal hospital premises. However, it should consider that they were overwhelmed at the Prince Mshiyeni Hospital and they did need a facility in the south. Before KZN built another facility could they not commission and make use of Charles James Hospital to take the spillover from Prince Mshiyeni Hospital? That was just a suggestion.

He raised the challenges of the EMS. The presentation said that there was a limited number of advanced trained EMS staff. Why was it limited when there was a reasonable pool of those at intermediate level? Was it due to capacity at the college to take them to an advanced level? Or were there other resources restraining KDoH from having enough advanced EMS personnel?

KDoH response
Health MEC Simelane-Zulu said KDoH would take into consideration the comments made about the Charles James Hospital. She said Ivermectin was being discussed at a national level. The province would be guided by NDOH and therefore the province would not comment on that. Those questions which required statistics, the responses would be provided later to the Committee in writing. KDoH received a daily breakdown of the PPE per facility that it would submit to the Committee. It will indicate the PPE numbers, sizes and types at every hospital, facility and district. KDoH no longer had a challenge with PPE. Should there be a challenge it was able to move PPE from one facility to another.

The Health Department had received the video of the distressed patient at Wentworth Hospital a couple of days after the incident took place and sent a Deputy Director General to the hospital to find out what was happening. It was discovered that when the video was taken the facility was under immense pressure. On that particular day 11 of its doctors were in isolation because they had tested positive for Covid; 17 nurses were either in isolation or quarantine. That day the facility was under immense pressure. The DDG and her team was able to assist the facility to relook at the patient flow in the facility. New beds had been added as well.

KDoH was investigating the matter. A team had been sent there with senior management to ensure that the matter was investigated. Unfortunately, the investigation only started on Monday and at this point KDoH did not have a conclusive result yet. The facility had an acting CEO for a couple of months. As of yesterday, a permanent CEO was appointed. KDoH hoped that would help in the running of the facility going forward. As soon as KDoH received the report it would provide that report to the Committee. It did not want to pre-empt the outcome of the investigation and get into trouble.

KDoH did have a plan for the vaccine rollout. The Head of Department would elaborate. The Health Department already had a committee in place that was preparing for that. It identified areas where it would be keeping the vaccine and modes of transport to the rest of the province. This took into account that the province was rural with pockets of urban areas. The majority of the planning was towards those rural areas as that was the largest area the Health Department was serving.

On the availability of HIV medication. A plan was put in place during the first wave. In some areas there were challenges where people were not able to access their medication during the first wave. KDoH had made sure that everyone had access to their medication particularly the HIV treatment. Everyone who was on chronic medication had access to it now. One of the strategies it implemented was to ensure people on chronic medication were given for three months so the number of patients travelling to the facilities was reduced. That was one of the ways patients received their treatment on time. KDoH did not stop HIV/AIDS programmes. If it did that it would be affecting its own population and setting themselves back. Towards the peak of the first wave it started working on Covid-19 precautions together with HIV precautions.

On infrastructure, during its planning in the first Covid-19 wave, one of the decisions KDoH took was to invest in its own facilities. While the decision was taken to put up field hospitals, the focus was to upgrade existing facilities. It ensured that every district had at least one facility that has been upgraded. An Ethekwini hospital had been completely upgraded. With the upgrades and changes to Clairwood Hospital, the Department was going to recommission it as either a district or regional hospital. That part of Ethekwini was in great need for another hospital to assist Prince Mshiyeni Hospital. She provided examples of hospitals that were repurposed: Richmond Hospital was a TB hospital but not many patients were being admitted so it was repurposed and it has close to 200 beds. After Covid it would be recommissioned as a district hospital to serve the people of Richmond. In Harry Gwala district, it had repurposed a number of beds. KDoH had been investing in its own facilities. In Zululand, it converted St Francis Hospital which was not being utilised to its full capacity. It had put new beds in that hospital and it will be recommissioned as a proper hospital. KDoH has utilised Covid as an opportunity to upgrade its facilities. All of these facilities were going to be ready to assist if there was a third or a fourth wave of infections.

They took the decision to put up four field hospitals linked to already-established hospitals. In King Cetshwayo District, there was a field hospital within Ngwelezana Hospital. In ILembe District, there was a field hospital within General Gizenga Hospital which had about 113 beds. In eThekwini there were two field hospitals put together with about 220 beds in that facility. The reason was so that they could use the skills that were within its own facilities. They were able to ventilate patients in those field hospitals. The field hospitals were put up within the existing facilities so that KDoH did not need to take them down in the next couple of months. This has helped during the second wave because as the second wave started, it already had the additional beds. It had to commission the Royal Showgrounds as a field hospital. The facilities at the Royal Showgrounds were easily convertible and it was able to utilise it. The only challenge with commissioning community facilities was that KDoH was not able to get into a contract for one to two months for these facilities. The contracts needed to be for three to six months. It was forced to use it even though it was not within its own facilities.

KDoH had been doing quite a lot of work in the province challenging fake news not just through commercial radio stations and television. It was using community radio stations as well. The province had its own platform called ‘The Lunchtime Chat’ where they were able to access all the community radios in the province. It was a platform where the province was able to talk to its people in isiZulu so they were able to understand the information. Tomorrow the Premier was hosting a webinar to discuss 5G and Covid-19. On Friday, the Health Department would have an engagement in isiZulu on the community radio stations on the vaccine and why it was important to be vaccinated. Yesterday, it had a webinar on the same topic where it explained to the community that fake news should not be listened to. A professional was brought in to explain in detail the issues surrounding Covid-19. Posters were being put up on social media. Perhaps the posters on social media should be put in newspapers.

She discussed the question of the 27000 recoveries. It was not a crisis and she explained why there were a lot of recoveries happening in a short space of time. When the second wave started KZN experienced a surge of infections in a period of four or five days. The first large number recorded was 4200 infections in one day. The following day there was over 4000 infections. This went on for a few days up until it reached 6700 infections which was the highest number experienced in one day. That was about two weeks ago. If all those patients were put in the system in one day, it went without saying that the recoveries were going to happen just as quickly. Therefore, the figure of 27000 was not a scientific issue. It was because the province had a period of four or five days where there were a lot of infections and when the patients were out of the system, there would be a spike in recoveries.

KDoH had reticulated beds that had not been reticulated previously. It added more oxygen in areas that did not have oxygen. On the supply of oxygen, it had started looking at other players in the market even though some of them were quite small. Some of the smaller ones actually buy the oxygen from Afrox so it might be a bit of a challenge but they were working on that.

At this point there was no huge challenge of lack of shelf space at mortuaries. Hospitals were maximising their shelf space and if needed, they would use the Forensic Pathology Service (FSP) facilities. For example if Prince Mshiyeni Hospital runs out of shelf space, it would use a nearby FSP department. At no point has the Health Department run out of shelf space. Last week it gave a breakdown of mortuary space where it still had a lot of space. If the Committee wanted that information, it would be able to provide it to them.

KDoH has been accepting assistance from the public. It had received a lot of PPE and machines from donors and these had been utilised. It had been approached by Gift of the Givers who wanted to put up a field hospital. The only challenge that the Department had with some of the assistance offered was that some donors wanted it go to a hospital of their choice even if there was a need elsewhere. The Department had tried to engage them to explain where the pressures were and where the assistance was needed. It had been approached by the Islamic Society offering assistance.

If the Committee needed more information she was available to be engaged directly by the Members. The Department was available to be engaged directly by any Member of Parliament. They appreciated the issues raised by Ms Hlengwa. Not all facilities were supposed to be open 24 hours, particularly the clinics. Some provided a 24-hour service and some an eight-hour service. That matter was being reviewed and the Department would look into whether there was a clinic that could be converted into a 24-hour service clinic. The only challenge would be that it would have to add more staff and ensure there was accommodation available for the health workers. It was a matter that it was working on.

Dr Tshabalala replied that the Cuban doctors were providing value in the province. They were distributed in the districts and the Department was receiving great value from their presence. He explained why the province had a shortage of advanced life support personnel. The Council for Higher Education has not allowed the Department to train for advanced life support in the college. It was still dependent on Durban University of Technology (DUT) and was therefore partnering with them to do training. HIV patients were not suffering in the province which had more than 500000 registered chronic care patients on ARVs. KZN had more than 1.4 million people registered on Centralised Chronic Medicines Dispensing and Distribution (CCMDD) with more than 800000 active. It was using that to ensure people on HIV treatment and other chronic medications do receive their medication so that nobody was suffering due to the focus on Covid-19.

KDoH had started the process of distributing doctors to clinics so people can be seen as early as possible in clinics. It was working on adding ward-based teams to ensure primary healthcare is more advanced than what it currently was so that nobody suffers. It was training the EMS staff in the utilisation of CPAP machines and high nasal flow so that the transportation of patients was still happening even if there were no ventilators in the ambulances. There were CPAP machines in the ambulances. There were always oxygen cylinders in ambulances so there was no challenge in moving patients.

Dr Tshabalala confirmed there were people wanting to erect oxygen supply in other areas. Those people needed to come to KDoH and it would be able to guide them on how and where this should be done. Those people who wanted to assist needed to work with the Health Department so that the resources could be used effectively. Those questions not covered would be put into a report and sent to the Committee.

Dr Thembekwayo said it was important that her question is answered in person and not in writing.

Dr Teboho Moji, Acting Deputy Director General: District Health Services, replied that there was one major centre in KZN that dealt with orthotic and prosthetic items situated in Wentworth. The province was in the process of decentralising those services and was currently involved with infrastructure at three sites. One was the expansion of the site at King Edward Hospital. Then there was the construction of new sites at Madadeni and Ngwelezane. The training to increase capacity with orthotic and prosthetic technicians was based on the understanding there would be expansion and new sites. However, there was a larger context. As a rule KDoH would annually give a lot of bursaries, not only to orthotic and prosthetic technicians but also to nurses, physiotherapists and all sorts of health workers. People were given bursaries on the understanding that when they complete their studies they would be contractually obligated to work for it. Those who do not want to serve in KZN have to pay back the money. In the past few years, and this was not just in Kwazulu-Natal, there have been challenges with finances and it was very difficult for KDoH to retain all the bursary holders that have been trained. In the majority of cases now, KDoH trains these people and releases them at the end of training because of lack of funding for salaries to be able to absorb these people. KDoH was looking at a 16% cut.

The Chairperson said that the Committee was really constrained for time and that the details should be provided in writing. Infrastructure was still a problem in the province and it did not allow for the rolling out of technicians. The province not being able to absorb graduates due to lack of resources was a challenge the Committee needed to take up with the National Department for additional support to be given to the provinces.

MEC Simelane-Zulu said all the answered questions would be provided in writing.

Mr Van Staden noted he had asked for a report on Wentworth Hospital and Coastland Hotel. When would the MEC report back to the Committee on this matter?

The Chairperson said that would be a detailed report which KDoH would provide to the Committee.

Mr Shaik Emam wanted clarity on Ivermectin. Was Health not a provincial mandate, given there were challenges in KZN on how they had dealt with Ivermectin? He had sent correspondence that the Committee should invite SAHPRA to appear before it. He had not received a response on the matter and wanted the Chairperson to provide guidance on the matter.

The Chairperson said he would respond when SAHPRA gives the Committee a meeting date. The Committee had written to SAHPRA and made a request. He wanted SAHPRA to account before the Committee so the matter could be dealt with. No province would independently deal with Ivermectin until NDOH has given guidance on the matter.

Limpopo Department of Health (LDoH) on Covid-19 challenges
Dr Abey Lekoloana, LDoH Acting Deputy Director General: Healthcare Services, reported the total number of Covid-19 cases in Limpopo was 40364. The number of recoveries was 29525. The recovery rate was 73%. The number of active cases was 10137. The number of deaths was 702. The presentation detailed the number of cases per district. The district with the most number of cumulative cases, active cases and deaths was Capricorn. The Department had a Covid-19 surge response plan that included planning and coordination, facility preparedness, epidemiology and surveillance, case management and risk communication and community engagement. The total number of healthcare workers infected was 1782 with 16 deaths. The second wave was estimated to be five times higher than the first wave. That meant additional resources were required with restricted financial resources. The bed occupancy was already under pressure at 76% and was being monitored daily. The limited financial resources made it difficult to plan effectively. NDOH was responsible for the procurement of vaccines, allocation and distribution to the provinces. The logistics of planning for the phased vaccination approach and for 70% population coverage needed for herd immunity was proving to be a challenge.

Discussion
Ms Ismail asked the percentage of vacant posts currently in state hospitals in Limpopo? Has LDoH reached out to NGOs for assistance to source more oxygen and PPE? The presentation outlined a shortage of oxygen and PPE. What was the recovery rate of Covid-19 patients with comorbidities in Limpopo? Have the Lebombo Border Gate and mining companies affected Limpopo’s Covid-19 infection rate? Excess deaths were raised as a serious concern. What was being done to ensure that every death was documented accurately? Could LDoH provide a breakdown of hospitalisations and ICU cases in Limpopo? How was it going to address field hospitals?

Mr Van Staden said that it was always good to plan for the worst-case scenario. He hoped that when the time came for plans to be executed it could be done in an orderly way. Was it possible for LDoH to provide the Committee with details of bed capacity per hospital for high care ICU and general wards? What was the capacity per mortuary in Limpopo? What was the plan of action for field hospitals? Did it still have the field hospitals erected last year? If yes, was it still in operation? If not, why not? Did Limpopo have a challenge with the issuing of death certificates at hospitals? What was the shortage of doctors, nurses and healthcare workers per hospital in Limpopo? Did Limpopo have backlogs with laboratory testing? If yes, how many days was Limpopo behind?

Ms G Tseke (ANC) acknowledged the work that Limpopo was doing. According to the presentation it looked as if there was no crisis with resources especially PPE and beds. The Committee would be watching Limpopo. It would provide support to Limpopo to ensure it executes its mandate. She acknowledged the work being done by the Limpopo political leadership, especially the MEC, Ms Phophi Ramathuba. Those who did not know the MEC now know her. Ms Ramathuba was all over Limpopo conveying the message of government in taking care of this virus. She acknowledged the work done by Ms Ramathuba and her team in saving the lives of people in Limpopo. The posters made by the MEC were used to caution communities and implement the government protocols.

She noted that the cases in Polokwane were very high. What was the cause for this? She noted the closing of the borders. Did Beitbridge border post contribute to the high number of infections in Limpopo and around the Polokwane area? The presentation noted that the contracts for community service professionals were coming to an end on 31 January. What was going to happen from February to May? Was LDoH not going to encounter a challenge with that? Who exactly were the community service professionals? Were they doctors or nurses? She asked for details. Can LDoH engage with KZN Treasury to extend the contracts of the community service professionals up to May? The province was projecting a high number of cases around February and it might run short of staff.

Ms Tseke noted how the enforcement of the current restrictions were a challenge. Were Limpopo’s law enforcement agencies assisting or was Health Department at the forefront of the awareness programme? The province needed law enforcement at the forefront to ensure that people adhered to the restrictions as elaborated by the President. Shopping malls have become super-spreaders. Did LDoH have awareness and screening programmes in shopping malls as they have become super-spreaders?

Ms Wilson said that the presentation was one of the most honest presentations that the Committee had seen although the news received was not good. The Limpopo Department of Health was virtually bankrupt but it was honest. There was no money. The Department cannot even begin to tell the Committee how it would do a vaccine rollout because it was not in a position to do so. That kind of honesty was appreciated. What it does reflect is that it was in very serious trouble. In light of the pandemic, this province was going to hit a potential nightmare. She had looked at the situational analysis report presented yesterday to the Limpopo legislature and some statistics were very alarming. In that analysis it said 50% of all tests done at the moment were positive. It went from 23.3% to 49.3% positive tests. Those were alarmingly high figures.

What was more concerning in that report yesterday was that the total number of tests done in the public sector was 1301 and the private sector was 1807. She was not sure from what date to when but 1301 tests was an alarming low figure given the population of Limpopo. It was indicative that the Health Department was not testing sufficiently or the system was not managed effectively. What was quite concerning was the difference between healthcare workers testing positive in the private sector (195) versus public sector (1522). Obviously there were more people employed in the public sector so the infection rate would be higher. However, the public healthcare workers needed proper equipment and proper training so that the figures could start coming down. There was a circular circulating that Limpopo hospitals had pooled all of their beds. If you arrived at one hospital and no bed was available, the health workers would see where the next available bed was and then the patient was transported to that hospital. Given the size of Limpopo that was quite concerning because the distance between some of the hospitals could be up to 400kms. This created a backlog and a bottleneck particularly in the EMS system. It was known that Limpopo had a shortage of ambulances despite the new procurement. The ambulances were still required to cover up to 14000 square kms which was absolutely massive particularly in rural areas. EMS services were queuing up outside hospitals because people were unable to be admitted as the hospitals were quite full. They then had to be transferred to the next available hospital. During that time the ambulance crew was out of circulation and unable to attend to other emergencies.

Ms Wilson did question the capacity and available beds because she lived in Limpopo and received calls on a daily basis on how many people were being transferred to other hospitals. In some cases, as was the case yesterday, people were transferred from Polokwane to Pretoria to be attended to. Last week a stroke victim was taken to Polokwane Hospital and there were no hospitals to see him in Polokwane. Since he was not a Covid patient, he did not form part of the formal triage. He ended up being taken 120kms to a hospital in Tzaneen which was terribly traumatic. It meant that while this delay was taking place the patient’s health rapidly deteriorated. Queues were seen outside hospital mortuaries to collect the bodies of the deceased. Some cars were queuing for several hours. The Committee needed an update on the mortuaries. She heard that cold trucks were being hired to store the deceased. Were there any incidents of exhumation of bodies? Legislation stated that a person must be buried within 3 to 4 days. It was known that there was a shortage of coffins. People were not allowed night vigils and families were not allowed to collect bodies for public viewing. Families were not allowed to take the body home which was part of the traditional practices in this area. Was there a problem of exhumations?

The most alarming challenge was the severe constraints on oxygen equipment and infrastructure. It was no secret that Limpopo was really struggling. The Committee received information about deaths and active cases last week from Modimolle, Mookgophong and Mokgalakwena where the statistics were actually given back to front. It created a lot of panic when it was unnecessary. When LDoH gave out incorrect information it was considered serious because the people on the ground can very rapidly lose trust in the Health Department systems and whether the information given was correct. Despite the fact that the Limpopo Department of Health was in severe trouble, the Committee appreciated that it was honest that it could not rollout vaccines and that it did not have the infrastructure. That type of honesty in a presentation, which the Committee did not receive from other provinces, was commendable.

Dr Jacobs said that Limpopo was a very rural province and had a large geographical spread. There would be challenges in Limpopo especially in managing the pandemic. He did take a number of positives out of the presentation and acknowledged some of the concerns that other Members raised. The positives was that a lot of work has been done to get the necessary beds and wards established to assist the sick people. The Department had done quite a bit of work towards commissioning new facilities and revamping facilities. He hoped that a lot of the work towards commissioning wards would become permanent so that it would assist government with the universal healthcare that was required. He did not want them to be temporary structures. He expressed concern about the contracts of the community service professionals. He thought that these would mostly be nurses and nursing staff were very important. The Department needed to make certain that those contracts were sorted out within Limpopo because there could not be a gap between until June.

He raised the point that ambulances were not provided with the necessary equipment to manage patients who were transferred between facilities when they needed high flow oxygen or CPAP machines. The Department should have the necessary infrastructure within ambulances so the required care can continue for a patient who is already in distress. He understood that healthcare workers were exhausted and overwhelmed. There seems to be no end to the pandemic at the moment. At some stage it would become difficult for healthcare workers. Has LDoH considered looking at community caregivers to be employed as ward assistants? A lot of work can be done by people who are not necessarily nursing staff or medical doctors. The reason he was talking about the third or fourth wave was because any training done now would not be wasted as it would be required in the country going forward. He hoped that LDoH had enough CPAP machines and ventilators to provide the necessary assistance to patients who required it to save lives.

Dr Jacobs noted the psychological support of healthcare workers and was impressed that LDoH had thought that a programme would be in place to support the healthcare workers. It was very important that it looked at the mental health of the healthcare workers and the population at large. It was a serious challenge that would hit Limpopo very hard. The Department needed to be proactive on that matter. He thanked LDoH for the hard work done and said that the challenges can be solved moving forward.

Ms Hlengwa thanked Limpopo leadership for the comprehensive report. Last week Limpopo registered the highest daily number of Covid-19 infections. Then the MEC declared that funerals in Limpopo were super-spreader events. What additional steps was LDoH taking to ensure that people were aware that large gatherings of people do not occur?

Ms Gwarube said that she knew Limpopo dealt with the significant challenge of Beitbridge. It was not mentioned in the presentation and she wanted to understand how that was dealt with? What was its impact on Limpopo health services? Did Limpopo see a tremendous number of new cases arising due to the border crisis? What was the role of Health Department in Limpopo in dealing with that? She asked for an update from the MEC what was happening there. Part of those queues relate to the work done by Home Affairs but part of it is the work done by the Health Department. The report was a very honest reflection of the state of LDoH but it did not inspire much confidence. The province was quite lucky in the first wave of infections to not have been badly affected. By Limpopo’s own projections it was expecting five times the number of infections now. Some of the challenges highlighted were more systemic than relating to the actual cases. There were staff shortages, HR matters and infrastructure. This was quite concerning because in the event of a massive resurgence, it will mean Limpopo will buckle under the pressure. What was being done to augment the efforts of the facilities across Limpopo so that they may be ready for a resurgence that was far more devastating than the first wave?

With the vaccine rollout plan, the province and LDoH had noted massive inadequacies within its own system. She understood that it was waiting for more details to come from NDOH but the reality was that many other provinces had started putting in the logistics of what a rollout plan would look like. It would be remiss of Limpopo to simply wait for NDOH to give details on the number of vaccines it would be given. The Department knew that it had to vaccinate almost 70% of the Limpopo population which equates to 4 million people. The Department already had an understanding of what would constitute herd immunity. Therefore, it should have a good understanding of what would be needed to get there. The Department already knew the challenges of the rural terrain of Limpopo and the proximity of facilities to communities. The Eastern Cape, had stated yesterday that it knew there were many communities more than five kms away from a facility so it had started making arrangements to utilise schools, as an example. Limpopo does not meed to wait for NDOH to provide details around allocation of vaccines. The requirement for vaccine storage was between two to eight degrees. Where were the facilities in Limpopo where the vaccine could be stored? These were examples why there was no need for Limpopo to wait for further information. Other provinces had started putting their plan in place. If Limpopo did not put the plan in place now it would scramble at the end when it needed to roll out the vaccine. Healthcare workers were stretched and the quicker the vaccine was rolled out the better. She wanted the MEC to comment on some of the specifics being done on this rollout plan. She did not think that LDoH just saying it was waiting on details was good enough.

Dr Thembekwayo said that the daily report of new cases had a disclaimer in red that there exist differences in reporting as there were delays in reporting which results in duplication of data. Her problem was that there was supposed to be reliable and valid data reported on a daily basis. How did LDoH intend to get a clear system of reporting that did not have errors so the Committee could get valid and reliable data? The presenter said that there was no funding at the present moment which was honest. Health Minister Mkhize in his press statement made a declaration that the health workers would receive the vaccine by February 2021. That was only in a week’s time. How would Limpopo be able to secure enough funding so its health workers were able to receive the vaccine on time? The security and storage of the vaccines was important. How was LDoH going to ensure that there was not going to be fraudulent behaviour or possible stealing of the vaccine? What was the contingency plan for the storage and security of the vaccines provided? She also asked if other chronic patients were being under-served during the second wave? If they were, what were the plans to avoid this occurrence? They remain important patients within Limpopo.

Ms Gela asked about an alternative oxygen supply for Limpopo. Did Limpopo have plans in place, as Afrox was having some challenges? She referred to human resources, equipment, PPE and infrastructure. The Committee knew that Limpopo was a rural province and during its NHI study visit to Limpopo the members saw how vast Limpopo was. The Committee needed to focus more on Limpopo. If government implemented NHI in Limpopo then the situation could be better. While government was fighting Covid it needed to fast track implementing NHI so that the infrastructure challenges in that province could be addressed. There were general health issues in the country. The Committee needed to assist Limpopo in procuring extra resources. She hoped the MEC has already communicated with Treasury. Perhaps the Committee needed to make a recommendation to save the situation in that province so those South Africans can get the same quality of health service. The Department indicated that it needed more resources to ensure that they implement programmes. There was a challenge with communication in that province. She thanked the MEC for the communication strategy. It was clear that it was reaching deep rural areas in Limpopo using a language that the people of Limpopo could understand. The Department made sure that it educated people on Covid-19. People were told to wear masks and wash their hands which was good. The Committee understood the frustration Limpopo was facing. The Committee needed to focus on Limpopo to ensure the people of Limpopo were given good health services.

The Chairperson asked how far LDoH was in establishing the electronic patient register system in Limpopo as the Department did not want patients to harvest ARV medication from multiple clinics. This would accelerate the support needed for the NHI.

LDoH response
Dr Phophi Ramathuba, Limpopo Health MEC, appreciated the inputs by the Committee. The Department would work on the suggestions given by the Committee to improve. LDoH had planned for the worst like it did with the first wave. The Department knew that it was in a rural province with resource constraints. It believed that this battle could be won on the street through preventative measures rather than winning it in hospital and ICUs. It was seen that medical aid was not assisting people. She did not know what report Ms Wilson was referring to. She did not know what healthcare system Ms Wilson was talking about. Ms Wilson was speaking on behalf of 9% of the Limpopo population which was dependent on private healthcare which was currently struggling. Most of her comments were directed towards that particular system. Since the outbreak of Covid-19, Limpopo decided to work as one healthcare system and support private healthcare when they were struggling. This pandemic did not care about the size of your pocket. The media reports on bed shortages refer to private facilities. At Mediclinic in both Tzaneen and Polokwane there were challenges. The patient Ms Wilson referred to that wanted to be airlifted to Pretoria was not at a public hospital – that occurred at a private hospital.

The MEC and her team were the ones who made arrangements for that patient to be airlifted because Mediclinic did not have a pulmonologist and they were trying to get the patient to a pulmonologist in Pretoria. The queue of ambulances seen on social media were at a Netcare facility. The queue of undertakers seen on social media was from private hospitals. She was not celebrating that fact because the mortality rate in Limpopo was a problem. She made the comment because this was the reason why everyone needed to rally behind universal healthcare coverage. This was a time when everyone needed to work towards government’s goal of NHI. Public healthcare in Limpopo catered for more than 91% of the population. Private hospitals only cater for 9% but they were failing to cope with that 9%. Patients were now being referred from private to public hospitals which becomes a concern for LDoH. The Department was already overburdened with over 91% of the population and now had to absorb those who the other system was supposed to assist. The lawmakers of South Africa needed to put an end to the two-system healthcare coverage. Universal healthcare coverage aids all South Africans.

On the circular Ms Wilson referred to, this matter had been discussed with all political parties and it was agreed upon beforehand on how to pool the beds together. In the first wave, since Limpopo did not reach a two percent attack rate, the beds were not pooled together as they are now. The resurgence plan was the plan that LDoH had in the beginning taking into account the phases that they were in. That circular was planning for a situation where a Covid-19 patient did not have access to a bed at the nearest hospital. No patient in Limpopo must be told that there were not any beds. Bed availability reports were being sent out daily. The clinic manager will check where the next nearest hospital with an available bed was. If the patient needs an ICU bed then the clinic manager will look for an available bed. The ambulance would then transport the patient to that ICU and be put on a ventilator. Each and every district had ICU beds assigned to it but if those ICU beds were full in a district then the patient will be transferred to the nearest district. There was nothing wrong with that. That was called planning so that no patient sleeps on the floor waiting for a bed to be made available. That was why she did not know which province Ms Wilson was really talking about.

Yes, Limpopo did have resource challenges. In the first wave the public listened to the warnings of the Health Department about how the virus spread. The second wave was a brutal variant which did not care how young or old people were. Unfortunately, this second wave was mostly started by younger people and matriculants. She visited lodges where matriculants were having parties and the police commissioner was called in. Unfortunately, the parents did not assist at the time. When the students went home they infected their parents. Lots of people were coming to Limpopo to have weddings. The rate of infections spiked because of the Christmas parties and weddings held over the festive season. If you trace all the patients dying in hospitals, those patients contracted the virus from their children. Senior citizens were complying and staying at home but their children and grandchildren went all over, gallivanting. The MEC was receiving messages of young people feeling guilty saying that if they did not go out partying, their parents would still be alive. That was why the presentation talked about how the psychosocial hub was going to be expanded to deal with the broader community. Young people were now beginning to feel afraid and guilty because they infected their family.

People were burying family members in succession after attending a wedding. Now Limpopo was dealing with funerals being the super-spreader events. She briefed the Premier and other leadership in Limpopo. Instructions were given that all funerals must be registered and the police must know that there would be a funeral. Health inspectors and police would go to all those identified hotspots to ensure that protocols were adhered to in the districts. Funerals have become super-spreaders. On the psychological aspects of funerals, the Department was of the opinion that culture was not static and that it could change. Some people in Limpopo believed that the only way to mourn was to view the body. LDoH wanted to avoid people exhuming bodies which had not yet become a problem. The Department was anticipating that it could happen in the future. People might say that the wrong person was buried. Alternative ways of mourning were being developed to come to closure without the rituals that were always done. That was a lot of work to do but social workers, psychologists and psychiatrists were currently busy with that particular work.

Dr Ramathuba responded to the concerns about Limpopo’s preparedness to roll out the vaccine. The Department and province were ready with a strategy and it had been adopted. The mistake that LDoH might have done, which she did not believe was a mistake, was that they considered all the different scenarios that could occur and were waiting from more guidance from NDOH. The province would only make a conclusion after NDOH provides assistance.

The province was allocated money in the first wave and because it did not have a lot of admissions money was returned to Treasury. Yesterday, Limpopo presented to Treasury to say that the money that was returned needed to be sent back to Limpopo. Currently, Limpopo was experiencing a resurgence of the pandemic which was more brutal than the first and Limpopo needed resources. NDOH would be acquiring the vaccines centrally and provinces would roll them out. The province had already looked at whether it needed additional workers to support nurses in the roll out. That whole plan was there and should the Committee want it, LDoH would submit it.

On Beitbridge, the MEC said that South Africa was a very nice country and that was why sometimes it experienced certain challenges. Regulations were made that no one would cross a port of entry without Covid-19 test results. Mobile clinics were put up in case the test results might have expired so people could be tested again. Bus drivers and truck drivers were transporting people without having been tested. When they got to the border they did not have those test results. The queue was there because of the testing being done. The province had to communicate with the Minister saying that everyone should be released to leave. Those people left without results because government was portrayed as a monster for trying to provide alternative testing. The province decided that it wanted to provide that testing because it contained a border. It had briefed the Minister and he had been guiding Limpopo. When people come to the border from Zimbabwe they were standing in queues for many hours. By the time they reached South Africa their test results would have expired. The province added six more testing stations at the border.

The Department's resources which were supposed to be inland dealing with the challenges in the country but had to be deployed to assist at the border post. The province welcomed the decision by the President to close the border posts. Yes, Limpopo has faced many challenges. The province knew exactly what challenges it would face. She had said previously that the honeymoon of the Limpopo case numbers would soon be over. She had said that the excitement would soon be over. The Department had a Plan B which said that hospitals, healthcare facilities and oxygen must be ready. This was the challenge Limpopo was dealing with currently. The private sector was struggling and people were dying on medical aid. People were sitting for three or four days in a casualty ward of a private centre because there was no bed. This was a time to implement universal healthcare coverage in South Africa and to ensure that every South African had access to quality healthcare irrespective of the size of one’s pocket. Covid has shown that it deals with everyone. Covid-19 could be used as an opportunity to do the right thing.

The Chairperson thanked the MEC and her team for the presentation and responses.

The meeting was adjourned.