Why the Eastern Cape Covid-19 numbers don’t add up

Eastern Cape health boss Dr Thobile Mbengashe said things were not as simple as people imagined and verification processes had to be undertaken to ensure the cause of death was, in fact, the coronavirus. Image: 123RF/Jarun Ontakrai
As speculation over the veracity of Eastern Cape Covid-19 figures rises — with the province’s first two deaths still not registered on the National Institute for Communicable Diseases (NICD) website — provincial health boss Dr Thobile Mbengashe said things were not as simple as people imagined and verification processes had to be undertaken to ensure the cause of death was, in fact, the coronavirus.

Deaths, in any event, he said, were not the department’s main focus, with screening and testing the priority.

Mbengashe’s statement came shortly after health MEC Sindiswa Gomba confirmed two Covid-19 deaths at Livingstone Hospital last week.

The total number of Covid-19 cases in the Eastern Cape is 199.

Gomba confirmed that the deaths of a 77-year-old man and 66-year-old woman were Covid-19 related.

She said the man had been admitted to Livingstone with renal failure and it was only discovered during a post mortem that he was Covid-19 positive.

Asked why the two Eastern Cape deaths were still not registered on the NICD website, Mbengashe said a verification process was still underway to determine if the deaths were indeed a result of Covid-19.

“A death of a person must be diagnosed by a doctor and be given a certificate,” he said.

“Most people who die, [have] multiple [medical] conditions.

“There has to be a clinical diagnosis as to what killed someone.

“When we say the number of Covid-19 [deaths] is so much, this is a big assumption because we’re saying that if they did not have Covid-19 they would not have died.

“This process takes slightly longer than the number of positive cases and deaths.

“[For example,] if a person has TB or asthma, they can still die of a heart attack.

“The doctors are making a clinical judgment as to what is truly the cause of death because you can die of a stroke while you also have Covid-19, so that is really why it is taking so long.”

Mbengashe said there was much more scrutiny attached to Covid-19 numbers and deaths.

He said there were three to four deaths [in the province] that were being investigated.

“The delay is a reflection of the work and verification that need to be done.

“It’s not that national [government]  doesn’t know about it.

“We’re not at that stage where we say everyone who has died has died because of Covid-19,” Mbengashe said.

On Tuesday, Gomba said that according to verification processes, someone was first pronounced dead by the the national health department.

“National [follows] its own processes such as [attaining] documents, [doing] assessments and then [the process is] finalised,” she said.

“The national department of health also conducts a postmortem to verify what killed the person.

“These verification processes are what create the delay with the national figures reflecting.

“Because we’re on the ground, we know what the stats are.

“We’re not hiding anything, there is nothing sinister happening.

“National in its own time will record the deaths.

“I’m sure it’s either the national department of health is overwhelmed by the deaths of the other provinces where people are dying in large numbers compared to the Eastern Cape, which is causing the delay, otherwise there are no sinister motives,” Gomba said.

Mbengashe said the hope was that they would soon be testing 1,500 people a day.

Asked if the province was testing enough people, Mbengashe said they had tested more than 2,000 people through tracing and others had come forward on their own.

“We know it takes about five days for people to show symptoms and we also know about 80% of people who are positive don’t show any or [or show only] mild symptoms and might not come forward.

“Our strategy, therefore, has been to isolate those who’ve tested positive, trace all the contacts they’ve had, assess them for the possibility of infection and out of that process we’ve conducted over 2,000 tests.

“We’ve screened more than 60,000 people through mass screenings in our communities.

“We’re going to have little spikes because these thing happen in clusters, but comparing that to the totality of the entire 5.7-million population of the Eastern Cape, it gives a different picture,” he said.

Representatives from the national health department and the NICD were vague on how they collated the numbers.

National health department spokesperson Popo Maja said they received information that had been collected and verified by the NICD.

“On the basis of that, the ministry crafts and releases a national update, which includes provincial breakdowns.

“We don’t release information to the level of metros and districts,” Maja said.

NICD spokesperson Sinenhlanhla Jimoh said at the moment they were only providing data at a national level.

“Please note that the NICD has to act responsibly and ethically in releasing information, especially concerning the deceased, in that only deaths having gone through verification are publicly announced,” she said.

Jimoh said verification varied as each situation was unique.

On Friday, The Herald reported that two women, one an expectant mother, had tested positive and were admitted to Dora Nginza Hospital.

Asked why they had been admitted there, when Livingstone Hospital was initially touted as the one at which Covid-19 patients would be confined, Mbengashe said patients were treated differently according to the severity of their condition.

“There are different levels to how we manage patients.

“Livingstone is a tertiary services hospital while Dora Nginza is a provincial services hospital.

“Depending on the severity of the patient[’s condition], we actually manage patients within that referral system.

“If you’re not that sick you’ll be managed at lower level, if you’re very sick you’ll be managed at ICU.

“The management of patients is not the Covid-19 diagnosis but the severity and support it needs.

“There are patients that will be kept at home and others in hospitals,” he said.

Mbengashe then also explained the department of health’s status when it came to contingency and crisis planning.

He said the department still needed to secure 2,000 beds and 240 critical and ICU beds — that formed part of the contingency plan.

Crisis planning — in the event of mass illness —  was yet to take place.

Mbengashe said the department was also trying to prevent large numbers of people being sick at the same time as that would collapse the province’s healthcare system.

Meanwhile, the Nelson Mandela Bay Covid-19 disaster management forum has set-up a toll free number for all those who attended a funeral in  KwaDwesi on March 21 so they could call and be tested.

The funeral has been linked to at least three Covid-19 cases in the Bay.

Municipal spokesperson Mthubanzi Mniki said they had received 150 calls so far.

BY NOMAZIMA NKOSI AND ZIPO-ZENKOSI NCOKAZI – HeraldLIVE

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