Latest epidemiological evidence: province’s peak is likely to be flatter, later, and longer

Western Cape premier ALAN WINDE shared this advice at the most recent Covid-19 digital press conference on July 2

AT the start of the Covid-19 pandemic in the Western Cape, I made clear that our province’s Covid-19 response would be evidence-based and data-led.
In an unprecedented crisis of this magnitude it was critical that we considered potential scenarios, and to provide for them so that every person could receive medical care, should they need it.
In doing so, we have always opted for the most “pessimistic” outlook.  You plan for the worst, but intervene to get the best possible outcome.

Original provisioning scenario
In April, I revealed our first scenario planning projections to the public. These projections could not be based on real data in the province, as there simply wasn’t enough cases in the Western Cape and South Africa at the time.
It therefore looked at international trends, our population size, and factored in reasonable epidemiological assumptions.
Once the number of cases climbed in the province, and we had more data available to us, we again looked at our provisioning scenarios and checked whether it was still reasonable to follow these original projections.

National C-19 calibration using Western Cape data from end-May
In pursuit of maximum credibility, we partnered with two expert associations - the Actuarial Society of SA (ASSA), and the National Covid-19 Modelling Consortium - and recalibrated the provisioning scenario using new data available.
The National C-19 Epi-Model (NCEM) calibrated to the Western Cape data, projected at the end of May:
• A peak towards the end of June, beginning of July, that was notably steeper than our original provisioning scenario. This peak however was not as steep as the ASSA model.
• As a result, there was a requirement of approximately 7,800 beds at the peak of the pandemic. We had previously worked on a 6,200-bed requirement.
• Cumulative deaths of approximately 9,300 people in the Western Cape (over the entire curve).
At the time, our original provisioning scenario was still tracking the number of deaths and hospitalisations reasonably accurately. But the new modelling projected that at a point in time the two scenarios would diverge, and the Western Cape could see a surge of hospitalisations and deaths in line with this steeper curve.
We have been tracking our daily deaths and hospitalisations - which remain the most robust measurements available to us - against this new provisioning scenario and can now confirm that the significant surge projected as a realistic possibility did not take place to the degree anticipated during June.
Our hospitalisations (both public and private) of patients with confirmed C-19 have been tracking around 1,700-2,000 patients consistently for the last two weeks, and the estimated number of deaths is tracking around 60-70 deaths per day, accounting for anticipated delays and under-reporting.
We cannot be certain, because this pandemic is unprecedented. Most significantly, “modelling” is not a perfect science during a novel Covid-19 pandemic.
Models are projections, using available data and based on assumptions. They help us explore what might transpire, but the outputs should be treated with caution and full understanding of the inherent assumptions, limitations and uncertainty.
It is very important to remember that Covid-19 is a new virus and that we don’t have natural history to underpin these assumptions. Also, our daily behaviour does make a real difference. Certainty is therefore not possible during this challenging time.
This makes it difficult for a government to plan. Do we build more field hospitals, or do we have enough beds with the existing interventions?

Latest Western Cape data from end-June
With more data available, we have again worked with the National Consortium and the ASSA to recalibrate our provisioning scenario. The NCEM calibration has been completed, and the latest provisioning scenario has the following conclusions:
• The peak in the Western Cape seems to be later than was originally projected and is likely to take place from end-July to the beginning of August.
• This peak is also flatter than was originally projected. This means that we will not have as many hospitalisations and deaths at the peak as originally thought.
• It is now projected that 5,450 beds will be needed at the “peak”, should this scenario hold. This is lower than both the original provisioning scenario from April (6,304), and the previous NCEM calibration from May (7,800).
• However, this flatter trajectory would last for longer. This means potentially more cumulative deaths of approximately 10,000 people during the pandemic.
• The virus could be with us for longer than we thought, with this first peak only ending late-November.

Implications for Western Cape provisioning
Given this latest projection, and that we have not seen the expected surge in hospitalisations, we will not proceed with a CTICC 2 Hospital of Hope expansion at this stage. Our existing platform, with the operational field hospitals and private sector capacity, means we can manage the expected burden at this stage.
However, we have done extensive planning for such an expansion and it remains on-the-table, should data suggest it will be needed.
Indeed, these latest projections can change given the unprecedented nature of this pandemic, so we will continually analyse the data to make the best possible decisions.
The Western Cape Government Cabinet has also approved a plan to purchase additional beds in private facilities for public-sector patients, its advantages being multi-fold:
• The infrastructure and capacity (they are fully equipped and staffed) exists in place and can be accessed at any time.
• We have done the preparatory work, have signed off with the major private hospital groups, and are in the process to sign independent practitioners.
• Several engagements, processes and mechanisms have been put in place to manage the interface between the public and private sector including referral, governance, billing and information management through an intermediary ethics committee and evidence-led clinical guidelines.
• This also adds capacity in rural areas that do not have access to existing field hospitals in the Cape Metro.

Change the curve again through your behaviour
The Western Cape Government is fortunate to have some of the best and brightest minds working in our Department of Health. These top scientists are not yet clear on what has caused our curve to be flatter and pushed out. We are dealing with an unprecedented scenario, and are learning more about this virus every day.
Some of the factors posited is that the virus is peaking in different places at different times. Another scenario is that the virus does not infect everyone in the same way. Behaviour interventions, such as wearing a mask and keeping a distance, can also make a real difference.
As more data becomes available and as we learn more about the pandemic in the Western Cape and South Africa, we will be able to be clearer on the reasons for these changes. I will share this information with you as soon as received.
For now, I want you to know one certainty during this time: you have the power to change this curve again.
Changing the way that we behave, by wearing a mask, keeping a distance, and following good hygiene, will interrupt the spread of the virus. This will flatten the curve further. This will keep your loves ones safe. This will save lives.
I know that this pandemic is overwhelming and we are “told” by government do so many things. I want you to know that you really can make a difference by making these simple behaviour changes in your life.
I am most grateful to everyone who has done this already, and I urge every person who hasn’t yet to join us in our effort to beat Covid-19 in the Western Cape.
Stay Safe. Keep your loved ones safe. Save Lives.