Cape Town - There is no correlation between the Western Cape Department of Health’s decision to restrict testing for people under 45 and the increase in Covid-19 deaths and under-reporting in the province.
This was Western Cape head of health Dr Keith Cloete’s response to the Cape Argus’ questions surrounding the impact of the third wave in the province.
The Western Cape Department of Health has limited testing at public healthcare facilities in order to prevent major backlogs developing.
The department said that this was a key lesson learnt during the first and second wave and enabled quick turn-around times in getting test results back to high-risk patients.
“This helps saves lives, as a quick diagnosis helps ensure careful monitoring and care to those who might need hospitalisation,” the department had said.
Testing for the following groups is available:
- People who are symptomatic and 45 years and older;
- All persons who are symptomatic with co-morbidities,
- All persons who are symptomatic and in need of hospitalisation, healthcare workers, and people living in congregate settings.
"So, while the testing criteria are tightened, the actual numbers of tests done are increasing dramatically and would increase to an unsustainable point if we did not implement tightened testing criteria,“ the department said.
Dr Cloete further explained that: “There is no correlation between the fact that we have restricted testing and increase in deaths and under-reporting.
“We have said in the first wave, we’ve said it in the second wave, and we continue to say it in the third wave. The reason is we see an increase in cases, then we see a flattening, we see an increase in hospitalisations, (then) we see an increase in deaths.
“From the first wave, when we started to talk about modelling, we said that the most reliable factor for Covid-19 is deaths. It is the most reliable factor,” Cloete said.
"It is why the MRC (Medical Research Council) has created the excess deaths notification so that we can compare how many deaths are we reporting compared to how many deaths the MRC is reporting.
“If you do that and check across the provinces, we have a less under-reporting of deaths than other provinces – so we’ve always modelled no deaths.”
Excess deaths are seen as a more accurate way of measuring total fatalities from the Covid-19 pandemic. It refers to the number of deaths that are occurring beyond what would have normally been expected – it is used to measure the mortality impact of a crisis when not all causes of death are known.
Dr Cloete added: “When the cases and the case positivity rate starts exceeding 20% - which means for all the tests you send to the lab, you only have 1 in 5 positive (result), it means you are testing too little anyway. So the number of cases becomes unreliable. Whether you test everyone or not, you don’t have enough capacity to test enough people.
“Case numbers are only reliable if your test positivity is less than 10% - that means that of all the 100 cases you send to (the lab) 10% is positive. Doesn’t matter who does what testing, nobody is going to maintain a test positivity of less than 10%, the moment it goes above 20% it becomes unreliable anyway.”
Dr Cloete said that what they’ve learned from the first wave has informed why they have limited testing and why their priorities are focused on the vulnerable and elderly.
“We’ve learned it from the first wave and second wave by redirecting our testing to the most vulnerable people because we want to pick them up early, we want to hospitalise them, we want to intervene and prevent deaths amongst them. That is the logic and rationale behind our testing.
“It has nothing to do with under-reporting of cases and the picture (of the third wave).”