Minister Zweli Mkhize: Opening the first phase of field hospital built by VWSA through funding from German Government

23 June 2020

Programme Director Mr. Andile Dlamini

The Premier of the Eastern Cape Hon. Oscar Mabuyane

The MEC of Health in Eastern Cape Hon. SindiswaGomba

Acting Executive Mayor of Nelson Mandela Bay Municipality Hon. ThsononoBuyeye

Deputy Head of the Mission: German Embassy Dr RudigerLotz

Chairman and Managing Director of Volkswagen South Africa Mr Thomas Schaefer

The Reverend Dr. Elizabeth MamisaChabula-Nxiweni

Representatives of GIZ

Representatives of the German Mission

All Government Officials

Members of the Media

Fellow South Africans 

It is a great honour to be here at the Rev. Dr Elizabeth MamisaChabula-Nxiweni Field Hospital.   

This is the epitome of multi-sectoral collaboration: a partnership between spheres of government  and the private sector is bringing us together with one common purpose- to defeat COVID-19 together. 

South Africa has a long and rich history with Germany, and today is another day that this bilateral kinship etches its mark in history. I agree that this is a mark of solidarity. This is a special occasion where we solidify our bilateral relations.  

And so it is my sincere honour and pleasure to be here in Uitenhage, on the premises of the Volkswagen South Africa manufacturing plant.  

VW is a well known brand in this country: established in 1946, it is the largest German investment in South Africa and is a major contributor to foreign direct investment, technology transfer and skills development. This project is indeed a reflection of solidarity by two nations to save humanity. 

I was extremely impressed when I heard about this project, particularly because of the the collaborative spirit involving VW; the German Federal Ministry for Economic Cooperation and Development; the German development agency GIZ; Eastern Cape Department of Health; Nelson Mandela Bay Municipality and the Nelson Mandela Bay Business Chamber.  

It is indeed a very important Programme with collaboration and cooperation of various players.  

A great deal of thought and enterprise has gone into this project: I really want to thank you all for delivering a wholistic plan that has  resulted in a successful project. It has got quite a lot of implication . With infrastructure infrastructure combines the provision of hospital beds as well as the strengthening of the testing capacity by supporting the national health laboratory services.  A total of 3 300 beds, along with the oxygen reticulation to go with it, have been established in record time in the first phase. We discussed how this has demonstrated efficiency and strong project management- skills that government would benefit a great deal from. I want to say congratulations tO VW the Premier and all the players who were involved in this project Whilst we are at it I must convey special greetings from the President who was so excited about this project but could unfortunately not make it and asked me come in his stead.  

Many people doubted that we could build field hospitals in a matter of weeks las we had seen China. But we have seen in the process of our collaboration has demonstrated that with energy, innovation and and focus in social justice, we can never be stopped from achieving what is necessary to save the lives of our people. 

The Coronavirus pandemic demands no less, and you have all stepped up and become equal to the task.  

It is my wish that this initiative is the beginning of a lasting legacy that will positively impact the lives of our people for generations to come: the collaboration between public and private heralds a new future of partnership in the interest of building a stronger economy and creating a healthier population. 

The name that has been chosen for this facility is particularly befitting. 

I would like to take a moment to pay homage to Rev Dr. Elizabeth MamisaChabula-Nxiweni for the legacy of excellence and compassion she has embodied in health care-  we hope this field hospital will come to represent all these virtues. 

Your groundbreaking work and activism for safe circumcision surely emanates from a spirit of constantly seeking justice in the way we relate to one another as humanity.  

Towards Christmas last year, South Africa witnessed the dark side of initiation- at least 25 young boys died during the initiation season.  

When we came to the Eastern Cape to gain a deeper understanding of the issues, I was heartbroken by the stories I heard: human stories of suffering where young people lost their lives and some were mutilated.  

Therefore, Reverend, I can only appreciate this war which you must have waged, against all manner of cultural difficulties.  

We face a similar challenge now as a nation, with the Coronavirus forcing us to accept new cultural norms and rituals. We have to have the courage to abandon some of the traditions we have come  to hold dear and find a new way of relating with one another for the sake of saving lives. 

On behalf of the nation, we thank you for your selfless contribution and I congratulate the Province for choosing such a befitting compatriot to name this facility after. 

On the 5th of March 2020, exactly 107 days ago, we announced our very first confirmed case of COVID-19 and this was followed by the second announcement on the 7th of March 2020.  

Both these cases had emanated from a group of South Africans who had travelled to Italy on holiday and had experienced symptoms a few days after returning.    Before this first case, On 29 January, I addressed the nation from the National Institute of Communicable Diseases to reassure South Africans that, as a country, we were prepared for active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of Coronavirus  infection, and to share full data with the World Health Organisation (WHO). 

This was the commitment we made and this is the commitment we have adhered to- what is happening here today remains a part of those fundamental principles of our outbreak response. We have said that we will be ready to deal with a large number of infections and today is confirmation of that commitment .

Yesterday evening, as we received the daily update for COVID-19 cases, we confirmed that South Africa has officially reached the 100 000 mark. When we reported the first case, none of us would have predicted that we would reach this landmark in a matter of months.  

As we reported the total numbers of confirmed Covid 19 cases in South Africa, which are now at 101 590, it is also significant is that we have now seen a rapid rise in daily numbers of cases, of late exceeding 4000 a day.  

A mere 4 months ago, this pandemic was a foreign concept to most South African citizens- but now it is here and has come with many surprises and many lessons that we might never have imagined we would have to learn so quickly and so decidedly.  

Some have publicly debated whether this increase in numbers means failure by government to effectively respond to the spread the COVID-19 pandemic.  

Today I want to publicly and boldly dispel such notions. 

It is my humble view that the South African government, under the leadership of His Excellency President Cyril Ramaphosa, has thus far done our very best to mount an effective response to COVID-19 and even achieving what even the most developed countries in the world have found challenging to achieve.  

It is important that we remind our citizens that while we do not claim to have a perfect strategy, it is important for the nation to be united  behind the Programme spearheaded by government involving the whole of society and sparing neither strength nor commitment as we fight this pandemic and protect our people.  

Several weeks ago I warned about an impending difficult and devastating storm ahead. All indications are, as a country, we may be riding right into that storm whose devastating impact is expected to peak during the cold winter months.  

The rising numbers may be an indication that such a reality is now with us.  

This vicious virus has cost us the lives of our loved ones. We have painfully witnessed our people, mostly the elderly and those living with underlying medical conditions, succumb to this virus.  

This cruelty that we have witnessed has cut across racial, sexual and ethnic lines. It has targeted both the rich and the poor and undermined the phenomenon of life as we knew it.  

In a period of more than 100 days we as a country have reported a total of almost 2000 deaths. Although on paper this number may look small we acknowledge as government that these are mothers, fathers, brothers and sisters that families had plans for the future with. 

I want to express my heartfelt condolences to all the families that have had their loved ones stolen by the pandemic.  

Despite all of this, we still celebrate the satisfactory rate of recoveries that we are seeing.  

Our total recoveries, at 53 444, assures us that more than 50% people who have been infected and detected have recovered and we remain optimistic that the number of recovered patients will continue to rise.  

A few days after our first confirmed case, I made what appeared to be an unpopular statement- but it had to be said that our scientific estimation is that 60-70% of our population may be infected by the coronavirus- particularly in an era where there is no vaccine and no herd immunity.  

I also warned South Africans that 20% of those infected would be cases that would need to be hospitalized. 

Most of these figures are based on various models which have many variables and some margin of uncertainty. We take note of these as they guide us as to what we may expect.  

Whilst the models are very helpful for scenario planning, we should expect that the numbers will continuously get modified as the real data becomes available. 

As it stands, South Africa has 2 888 patients who are in isolation in general ward, 262 patients who are in high care, 539 patients who are in ICU, 218 patients who are on ventilators and 566 patients who are on oxygen.  

These figures are much lower than the 20% we had initially projected and represent a public health response that has placed emphasis on proactive, preventative medicine. 

This has resulted in some of the best COVID-19 health indicators in the world We can keep this up but it requires a concerted effort by all South Africans to adopt the necessary behaviour change that will keep us all safe and ensure our morbidity and mortality rates remain low. 

When the pandemic arrived on our shores, local spread took off exponentially and initially it seemed that we would follow the trajectory we had witnessed in Western Europe.  

After witnessing a doubling time of two days, we were compelled to institute a hard lockdown on 26 March 2020.

This not only assisted to dramatically reduce the spread of COVID19, but it also gave us an opportunity to expand our health infrastructure. We delayed the doubling time to 15 days during level five lockdown and it is now at around 12 days during level three lockdown. 

By repurposing existing facilities and building field hospitals from the ground up, we have successfully increased our COVID-19 bed capacity to above 27 000.  

In addition, for those patients who need to quarantine, in partnership with the Department of Public Works and Infrastructure, we have identified over 400 quarantine sites with a capacity of just under 38 000 beds across the country.  

The President also announced that as a country we had embarked on an intensive community screening campaign and to this end we  have deployed just over 50 000 community health care workers who have successfully screened almost 20 000 000 South Africans.  

I am aware that some sectors of the society had felt that this was not necessary, that we should have done targeted screening and testing.  

Once again, I want to boldly and publicly state that this was one of the most effective campaigns by government. 

Through this we identified ordinary members of the community who had symptoms and were referred for testing and some did indeed test positive. This curbed the risk of the spread of the virus by unsuspecting citizens who were continuing with their daily activities.  

It was through this intense screening and testing campaign that we were able to identify the variations in the transmission of infection- that is low transmission areas and high transmission areas which we now call hotspots. 

What the basis is for the variations in transmission pattern will be the subject of future research. 

We have now shifted to a differentiated approach, involving a targeted response, with the ability to direct resources to areas of greatest need and retain resources in low transmission areas such that we can continue to surveil and detect surges in the beginning stages. 

We now prioritize persons under investigation who are in hospital, those with co-morbidities, the elderly and health care workers. 

Indeed, our accomplishments were not missed by the World Health Organisation which made special mention of our proactive community based strategy in a statement delivered by Executive Director of the WHO Health Emergencies Programme, Dr Michael J Ryan on 27 April.  

He said that South Africa had “used its initial lockdown very well,”  and they lauded our four point plan for preparedness against the pandemic.  

The co-operation of all sectors of society was absolutely critical. It is important to acknowledge the leaders of this country for answering the call to stay at home during lockdown. If it were not for churches, schools, civil society holding hands with government there is no telling where we would be now.  

must pause at this stage and commend the efforts of each and every provincial health MEC and their officials in our country to immediately deploy tracing teams and implement effective tracking and tracing strategies in order to identify contacts of all the infected patients.  

The evolution of the outbreak in the country has illuminated variable success rates between the provinces.  As such we have studied the unique dynamics in each province and continue to offer the necessary support to achieve the desired outcomes.  

Some provinces, like North West and Northern Cape are at this stage low transmission areas which have hitherto managed to contain the situation.  However, as economic activity that typify those areas resumes, such as mining in the North West, the provinces must expect that cluster outbreaks will drive their numbers towards an upward trajectory.  

Other provinces, such as KwaZulu Natal,  have slowed down after an initial explosion. These provinces initiated robust containment andcontact tracing strategies and we would encourage that they maintain the gains they have made and constantly look to strengthen and up-capacitate where they have succeeded so that they do not find themselves with a resurgence.  

The Free State is one of the success stories of the early days of the pandemic. A cluster outbreak from a church gathering threatened to become a runaway bushfire but we quickly doused the flame by deploying mobile testing units and instituted an aggressive contact tracing strategy with immediate quarantine or isolation of persons under investigation. As a result, we all but halted the spread- for many weeks the number of infections in the Free State remained around one hundred. This province must guard against complacency as we are seeing the numbers steadily climbing again.  

Provinces, such as the Western Cape and Eastern Cape, now have well established cluster outbreaks that are driving a surge and will likely peak first before other provinces. In these instances, contact tracing, quarantine and isolation were the biggest weaknesses and the Western Cape in particular is having serious challenges in the reluctance of community members to go into quarantine and isolation.  

In addition, the close economic and social interconnectedness of the Eastern and Western Capes adds complexity to an already volatile epidemiological picture. Ok the other hand it is an opportunity for the provinces to learn from each other and in fact I will be facilitating a collaborative response of both provinces working together.  

With such variables still paying a role in the dynamics of the pandemic in this region, caution needs to be exercised as we re-engage the predictive models and revise the numbers. It needs to be well understood that that any interpretation from revised models at this stage must take into account that there are factors that are yet to play themselves out and influence the picture we will see as things develop. 

Urgent social behavioural change will be a key intervention in these provinces- it is for this reason that the Multi-sectoral Ministerial Advisory Committee on Behavioural Change was established. The members  are already immersed in the business of finding solutions that will facilitate a social compact to empower and enable citizens to effect change in partnership with government.  

Since we made a call for health care professionals to come forward for employment, 6508 professionals have been employed of which 6108 are nurses, 194 are doctors and 206 are EMS personnel. Our call for all qualifying health professionals to take up a post in public health care continues- we need all hands of deck for the coming months. Even those who are retired must present and we will ensure they play a role in a safe and appropriate environment.  

We pay special tribute to the 187 strong Cuban brigade that has been deployed across the country to bolster our public health response. We thank the Cuban government for coming to our rescue. We appreciate our health care workers, who have worked tirelessly in the frontline at their own personal risk. 

As at 16 June 3 583 health care workers acquired COVID-19 and of those we have lost 34 soldiers to this war. May the souls of these self-less warriors rest in eternal peace and we thank them for their unwavering service right until the end. 

For those health care workers who are still battling the virus, we wish them a speedy recovery and we are indeed very pleased that 1 993 health are workers have recovered. 

We, as government, cherish our health professionals and have done everything in our power to ensure that they get protection and training.

We have always maintained that we have enough stock for about 8 weeks at any one time and this has remained true for the duration of the pandemic- it is just a matter of ensuring that management distributes PPE equitably. 

We engaged the unions and encouraged them to be involved in the oversight of PPE stock management and this has proven to be a very useful collaboration which has ensured that where we find problems we solve them together and avert labour disputes that would divert us from our most urgent work. 

Human Resources for Health is key but so too is testing capacity. 

We targeted a testing capacity of 30 000 tests a day. Despite the enormous challenges we faced of global shortage of testing kits and re-agents, we fight every day to achieve that target. The joint procurement strategy that the President is spearheading through the African Union is expected to relieve many of these pressures and we look forward to the rollout of this programme.  

Our testing capacity, at 22 400 per million population, exceeds some of the nations who have much higher numbers than us such as Brazil.

Our testing strategy has enabled us to complete over 1,2 million tests in just under 4 months and detect community spread and cluster outbreaks early. 

The backlog, which has been a cause for much anxiety, has been reduced and we are particularly pleased that we have completely cleared the backlog in the Western Cape and the Free State.  We stand by our decision to clear the backlog as an epidemiological and case management exercise and so we will continue to work hard to achieve that in the remaining provinces- Eastern Cape, Gauteng and KwaZulu Natal. 

Despite certain contention from some experts that the NHLS must discard aged specimens, we have not agreed with this approach. 

Our view was that if such a decision has to be made, it must be based on sound scientific evidence that degradation of a specimen over time renders it no longer suitable for testing after a specific period.  

While we are now prioritising certain tests, we still have an ethical obligation to process the specimen as submitted by clinicians to the laboratory.  

This matter attracted much public interest and at some point the department was accused of not listening to scientists.  

To ensure that act in the best public interest and adhere to the highest ethical standards, a legal opinion was obtained by the NHLS which clearly states that, in fact, there is a legal obligation on the NHLS to test all specimens that have been delivered to it. This duty stems from the guidelines for testing. This is further embedded in all citizen’s constitutional right of access to quality health care.  

Another area we have had to focus on is our capacity to ventilate critically ill patients.  

We currently have a capacity of 7134 ventilators of which 5401 are currently available in both public and private sectors combined; 1000 have been pledged to be donated and 733 have been procured.  

We are also very pleased to have had a conversation with VW on manufacturing non invasive devices to deliver oxygen to patients who need assistance. We look forward to these developments because the guidelines for critical care are indicating that less invasive ventilation confers better outcomes.  

ow added to to this is the advent of the RECOVERY trial findings, which have demonstrated the efficacy of dexamethasone in oxygen requiring COVID-19 patients. 

The trial demonstrated that dexamethasone reduces deaths by a third in patients on ventilators and by a fifth in patients requiring non-invasive supplementary oxygen. 

We are especially at an advantage as we are a country that is very familiar with dexamethasone. We have three South African companies supplying intravenous dexamethasone, one of them also manufacturing the oral form. We have looked into our stock and have 300 000 vials, and so we are in a position to immediately secure and administer this life saving medicine to all patients.

I must stress that dexamethasone does not mean you can abandon the basic behavioural rules for COVID-19. The medicine will only help those who are seriously ill. You still have to wear masks, wash your hands and keep a social distance . 

We have taken it upon ourselves to re-open the economy despite the rise in infections. We have had to take this approach, backed by scientific evidence that a prolonged lockdown will not make a meaningful difference, because we have now come to a point where we have to balance saving lives and saving livelihoods.

The Government has done everything in its powers to enable each and every South African to seek assistance, prevent onward spread by wearing masks, washing hands, keeping social distance and isolating or quarantining when necessary. 

We have set up the infrastructure, ramped up our capacity and embarked on one of the worlds most reliable information sharing campaigns to empower each and every South African to make the right choice and save lives. 

Now it is up to every South African to use the facilities we have availed to seek medical assistance early and agree to isolate or quarantine in a facility if one is unable to do so safely in their homes. 

It is up to each South African to adopt new habits and protect one another. 

We are now faced with a future that calls for permanent change in the way we conduct our lives. 

Influencing behavioural change is the toughest exercise a leader can undertake- we now find ourselves at this juncture where we need to move away from enforcement and rather use the powers of persuasion to enable and empower community members. 

Every South African must now use the armament at his or her disposal- simple, what we have termed the Toolbox- to beat the Coronavirus together. 

We have to see that we have an opportunity to prioritize as a society and use this time to make quantum leaps in our pursuit of the United Nations Sustainable Development Goals  

There has been a clear causal relationship demonstrated between adverse outcomes and the presence of co-morbidities. 

Hypertension, diabetes, chronic lung disease and chronic kidney disease have emerged as the most common co-morbidities seen in hospitalized and deceased patients with hypertension being the most commonly associated co-morbidity.  

We still need richer data to determine the risks for people living with HIV and AIDS although preliminary evidence does suggest increased odds of adverse outcomes, especially for patients who are not taking ARV’s, have high viral loads and low CD4 counts. 

As we become increasingly embattled with Coronavirus, I wish to assure the nation that we have not taken our eyes off the nonCOVID issues that are also rampant in our country. If anything, COVID-19 compels us to pay urgent attention to the public health management of these co-existing epidemics. 

And so I wish to conclude that the COVID-19 fight must be taken outside of hospital wards and clinics into every sector of society if we are to defeat this virus. 

We all need to look after each other and work in partnership to protect each other. The partnership we are witnessing today is exemplary and this is the way South Africa should move forward as we battle this pandemic.  

I would therefore like to declare the Rev. Dr. Elizabeth MamisaChabula-Nxiweni Field Hospital open! 

I thank you. 

Issued by Department of Health, 23 June 2020