Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report.

Neal David,Robert Mash

doi:10.4102/phcfm.v12i1.2499

Abstract

Corona Virus Infectious Disease 2019 (COVID-19) was first reported in Cape Town in March 2020 and the transmission was soon observed in local communities. Cape Town has many vulnerable communities because of poverty, overcrowding and comorbidities, although it has a relatively small elderly population. Amongst the unique and early responses to the pandemic in South Africa has been the strategy of community screening and testing (CST). This process has been drawn from health department’s prior adoption of a community-orientated primary care (COPC) approach, which relies on teams of community health workers working in delineated communities to prevent disease and provide early interventions for those at higher risk. The COPC principles were applied in the CST programme, which involved collaboration between facility and community-based teams, linking public health and primary care approaches, careful mapping of cases in highly vulnerable communities, targeted screening around cases, testing of those that screened positive, health education and linkage to primary care. The overall aim was to slow down transmission through early identification and isolation of diagnosed cases. Key challenges involved the designing of a screening tool with appropriate sensitivity and specificity as well as the logistics of staffing, transport, consumables, data collection and capture, security, ablutions and personal protective equipment. Key opportunities included synergies between CST and evolving commitment to COPC in the health system. Key threats were the deteriorating security situation in the most vulnerable communities because of loss of income, food insecurity and CST distrust as well as increasing turn-around-times for test results.

Highlights

The first case of Coronavirus infectious disease 2019 (COVID-19) in the Western Cape, South Africa, was reported on 11 March 2020
There was an acceptance that the virus would penetrate South African society, but efforts taken to slow down transmission would provide health services enough time to prepare for its check
The proportion of elderly is small, there is a high proportion of population with comorbidities such as human immunodeficiency virus (HIV), tuberculosis (TB), hypertension, diabetes and chronic lung disease that put them more at risk of severe infection

Summary

Introduction

The first case of Coronavirus infectious disease 2019 (COVID-19) in the Western Cape, South Africa, was reported on 11 March 2020. Community health workers worked under the supervision of professional nurses and were responsible for delineated geographic areas linked to a local primary care facility. Geographic information systems mapped known cases with the social vulnerability index (SVI) of their communities (Figure 1) These maps were used to target CST and define an area around approximately 200 households. Community health workers worked door to door in pairs and used a set of questions to determine whether any person had COVID-19 symptoms (Box 1). If someone was screened positive, they were sent to a local mobile testing centre or primary care facility. By the end of the third week of CST, the programme had screened 70 251 people and performed 6127 tests, of which 208 were found positive (3.4%), backlog of tests could increase the number of positive cases. If cases and contacts cannot be identified quickly screening and testing becomes ineffective

Conclusion

Findings

Data availability statement