South Africa: COVID-19 - Inside a Western Cape Quarantine and Isolation Hotel

In the Western Cape, 4 842 quarantine and isolation beds are available at 44 hospitals, hotels, converted office blocks and other facilities around the province. Of these, 1 037 beds are occupied, leaving 3 805 available to the public.

"We have had under-utilisation of these facilities, so we want to encourage people to use them," says Health MEC Nomafrench Mbombo during a visit to the Protea Hotel in Durbanville. On a hill in Cape Town's northern fringes, the hotel is serving as a quarantine and isolation site.

"Isolation is when a person with confirmed COVID-19 is separated from other people to avoid infecting them," explains Natalie Watlington, provincial health department spokesperson. "Quarantine is when a person who does not have COVID-19, but had close contact with someone who has it, is separated from others. Someone who is waiting for their test results is also required to be in quarantine."

At the time of the visit, the hotel had 27 isolation patients and 37 quarantine patients - with signs on room doors indicating whether they are in "quarantine" or in "isolation", plus the patient's dietary requirements.

The hotel opened as a COVID-19 quarantine and isolation facility on April 27.

New normal

"At the beginning it was weird," says the hotel's general manager, Patrick Fortuin, speaking from behind a mask. "But with all the safety protocol it has become the norm."

Within this "new normal" four kitchen staff are on duty per shift, preparing meals for the patients. Discussing the menu in the hotel's foyer, executive chef Reuben Barnes-Rossouw says: "We do nutritional dinners for example stews or grilled fish and veggies. For lunch, hot dogs, hamburgers, and so on. We cater for vegetarians, gluten intolerant and halaal patients."

How are the menus at the various facilities compiled? "This will vary at each facility," says Watlington. "But it is planned according to strict guidelines and dietary requirements."

Fortuin showed Spotlight into one of the rooms. Spacious and modern with crisp white linen covered twin beds and print wallpaper, it had an en-suite bathroom and a large balcony overlooking the leafy premises. The hotel's corridors smell of sanitiser. Rooms of patients in isolation are cleaned and sanitised only once they check out. If linen or towels need to be laundered during their stay, these items are put in a black bag and deposited outside the room's door for staff to collect.

The rooms are for single occupation - with only pairings of married couples and mothers or caregivers with children allowed. For entertainment, patients have televisions in their rooms and free Wi-Fi. No alcohol is allowed. Patients may not leave their rooms and visitors are not permitted.

Two nurses on duty

At the hotel, under supervision of site manager Rory Simpson, a professional physiotherapist appointed by the provincial health department, there are two nurses on duty per shift,

"We check in on the patients daily," said Simpson. "We do morning checks, telephonically. Each patient receives a thermometer, so they give us their temperature. If there is a problem, a nurse will dress in PPE (Personal Protective Equipment) and go inside. If it's serious, the patient will be referred to the Karl Bremer Hospital."

Low uptake

Spokesperson for the Western Cape MEC for Transport and Public Works, Ntomboxolo Makoba-Somdaka, says that on June 29, the City of Cape Town had a total of 2 276 quarantine and isolation beds available in 17 facilities, of which 631 were occupied.

In the Winelands, a total of 898 beds are available in 10 facilities, of which 187 are occupied. Along the Garden Route, there are 700 beds available in 3 facilities, of which 60 are occupied. In the Overberg, 307 beds are available in 7 facilities, of which 139 are occupied. And on the West Coast, there are 624 beds available in 7 facilities, of which 15 are occupied.

Makoba-Somdaka adds that private facilities are costing the public purse on average R770 per bed per night, while government-owned facilities cost R350 a night.

Spotlight earlier spoke to Nosisi Jacobs who was in isolation in a quarantine facility in Lagoon beach. Another Cape Town resident Spotlight spoke to who tested positive for COVID-19 and had since recovered, Claudia Manuel, declined the quarantine and isolation facility option. "I wasn't comfortable to stay in a government facility. What government usually says on television and what actually happens is often different. One hears all these bad stories about government hospitals and clinics, so it puts one off," Manuel said.

During a recent press briefing by the Western Cape Government, senior manager of asset management in the Department of Transport and Public works, Shane Hindley noted various barriers to the uptake of the quarantine and isolation facilities. Hindley said 78% of beds in these facilities are still available. Among reasons cited during interviews with residents, they noted issues and concerns ranging from questions of can I smoke, have sex, bring my own food, leave and come back again to issues relating to stigma such is "everyone will know I have COVID-19" and "who will look after my house?" Hindley said this high rejection rates will require a "whole of society approach".

Hindley said transport from people's homes to the facilities are provided through the Red Dot taxi service that include a fleet of 150 vehicles from the local minibus taxi industry, each fitted with a protective screen and tracker. Only 7 passengers and one driver is allowed per vehicle. The RED Dot service also transport healthcare workers to and from work.

Reflecting on the slow uptake, Mbombo said one must understand that it's "quite daunting for a person to leave their family behind and can understand these issues of separation also from accessing niceties and goodies they have at home". "So we shouldn't dismiss their truth," she said.

Mbombo noted that the department is engaging with communities and showcasing what they have been doing behind the scenes. This also include a concerted effort to include recovered patients' experiences of quarantine and isolation facilities.

Watlington also explained the impact of the perceptions around state facilities that may prevent people to avail themselves for quarantine and isolation.

"The uncertainty regarding what to expect may prevent people from being keen to make use of the quarantine and isolation facilities," says Watlington. "To this end, we are sharing stories from patients who have successfully completed their journey in isolation and their positive experiences."

She adds that the uptake is increasing daily.

"If you live in the Cape Metro and you have tested positive for coronavirus, you need to isolate," she says. "And if you have symptoms or have come into close contact with someone who has coronavirus, you need to quarantine, even if you have not been tested. So the Western Cape Government can help you with free, comfortable and safe alternative accommodation. We will provide transport, meals, and a laundry service."

For information visit the website https://www.westerncape.gov.za/general-publication/covid-19-quarantine-and-isolation-facilities-faqs

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