Day Zero could have devastating health effects for Cape Town citizens

DAY Zero would have significant implications for the health of people living in Cape Town. The city therefore needs to put plans in place to reduce the risks.

The immediate health effects can be categorised into three main areas. Pressure on the sanitation system which raises the prospect of the spread of life threatening diseases such as dysentery; loss of hygiene because people can’t wash their hands; dehydration and heat strokes. In addition, there could be other consequences such as stress levels spiking and people becoming violent as they try and access water or over stretched health

facilities.

First, the city depends on a waterborne sewage system and the inability to flush toilets may lead to a breakdown in sanitation. People may be unable to dispose of faecal waste easily and may resort to disposing of their faeces outside.

Many viral, bacterial and protozoal diseases are spread in the faeces and the risk of environmental contamination will significantly increase. Infectious diseases that cause diarrhoea, vomiting or dysentery, such as enteroviruses, salmonella, shigella, or E.coli, will be more likely.

Second, the absence of water in taps, wash basins and showers may lead to a loss of hygiene. Skin infections such as impetigo and infestations such as scabies may increase, as well as conjunctivitis. A reduction in effective hand washing may also increase the spread of acute respiratory viruses that cause coughs, colds, ’flu like illnesses, bronchitis and pneumonia.

A loss of sanitation and hygiene may also lead to an increase in hand-to-mouth transmission of infectious diseases that cause diarrhoea, vomiting and dysentery as outlined above. A lack of hand hygiene and water to clean food may also lead to an increase in foodborne diarrheal diseases.

Third, the absence of a readily available water supply may predispose people to dehydration and heat stroke. Children are particularly vulnerable, especially if they contract diarrhoea. This would also be a particular risk on hot days and to those performing manual labour without an adequate supply of fluids. In addition, people may be tempted to drink contaminated or non-potable water if they cannot afford to buy water or cannot easily access points of distribution.

Conflict could also break out at health facilities as waiting times and staff workload increase because of a spike in illnesses.

To deal with these challenges, various bodies in the City of Cape Town are working together to respond appropriately.

For example, the City is working with the police and the National Defence Force to ensure that order is maintained when Day Zero arrives.

From an environmental health perspective, there are routine systems in place to monitor and respond to outbreaks in the city. Surveillance for outbreaks will be enhanced over this period.

But the water supply to most health facilities will be maintained to enable them to manage ill patients, outbreaks and cases of dehydration.

Water will also be supplied through designated distribution points to limit the risk of dehydration, maintain hygiene standards and enable the flushing of toilets through the use of grey water. Areas that are at a high risk of outbreaks such as informal settlements will have their water supply maintained. This will assist with these areas to dispose faeces.

Residents are still being encouraged to wash or sanitise their hands to reduce the risk of infectious diseases spreading. – The Conversation

Mash works at the Division of Family Medicine and Primary Care at Stellenbosch University.

Mahomed is a public health specialist in the Division of

Health Systems and Public Health at Stellenbosch University and Peters is public health registrar in the Division of Public Health Medicine at the University of Cape Town.