Thread by @watershare

There seems to be a lot of misinformation and miscommunication regarding the #CholeraOutbreak in #Hammanskraal, so here is a short 🧵 to help clarify some things.

Buckle up & lets talk about 💧 and 👥 and 💩
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The World Health Organisation (WHO) identifies diarrhoeal disease as the leading cause of death in developing countries. In 🇿🇦, more than 50,000 people die annually as a result of diarrhoeal diseases, and it is one of the major causes of infant deaths in our country.
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Many communities in 🇿🇦 are still relying on untreated water from surface resources for their daily supply, and/or have no or limited access to adequate sanitation facilities. These communities are particularly at risk of getting waterborne diseases such as cholera.
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Cholera is an acute intestinal infection caused by the ingestion of contaminated water and/or food containing the bacterium Vibrio cholerae. It is communiable (easily transmitted from person to person), and can quickly reach epidemic proportions.
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Vibrio cholerae strains can be agglutinating or non-agglutinating (NAG). Most of the >100 NAG strains occur naturally in the aquatic environment, & do not cause epidemic cholera. An epidemic can be caused by 2 serotypes of the agglutinating O1 strain, and the NAG strain O139.
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In its virulent form cholera can cause a healthy person to die within hours. It has a short incubation (1 - 5 days) & produces an enterotoxin that causes abrupt onset of massive watery diarrhoea, rapidly depleting all body fluids, leading quickly to severe dehydration & death.
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Vomiting occurs in most patients. Both children & adults can be infected. In highly endemic areas, it is mainly a disease of children, but breastfeeding infants are less affected. Most diarrhoeal diseases cause dehydration, and may be mistaken for cholera in the early stages.
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When cholera occurs in an unprepared community, fatality rates may be as high as 50%, usually because there are no facilities for treatment, or because treatment is given too late. Most cases of cholera can be treated adequately by giving a solution of oral rehydration salts.
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Re-hydration treatment of cholera, oral and/or intravenous, is dramatically life saving if administered in time, before dehydration has progressed too far, & reduces the mortality to < 1%. Treating symptomatic patients alone will however NOT address the spread of the disease.
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Less than 10% of ill persons develop typical cholera with signs of dehydration. Most infected persons do not become ill, but are “healthy carriers” of the bacterium, which is present in their faeces for 7 to 14 days
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Vibrio cholerae is an interesting pathogen, in that it has the ability to switch certain genes off or on (genetic switching), depending on the environmental conditions. This may be why it causes serious illness in one individual, and asymptomatic infection in another.
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The presence of Vibrio cholerae in the stool of (healthy or sick) people, and in water, is determined by a Culture Growth procedure (Moore Pads) or a Polymerase Chain Reaction (PCR) procedure. Tests for E coli or Total coliforms CANNOT indicate the presence of cholera.
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The claim by the @CityTshwane that they tested the water for E coli and Total coliforms & that there is "no cholera present", is therefore false. Where are the test results for CHOLERA in the effluent of the Daspoort STW, Rooiwal STW, and Temba water plant?? And for chlorine?
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It is also false to say that Hammanskraal is "because foreigners". This is just xenophobia - cholera is endemic in at least 80 countries, incl. 🇿🇦. As most viral&bacterial diarrhoeal diseases, it is spread by a faecal-oral route. Poor water supply&sanitation cause outbreaks.
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According to the WHO, “Cholera will ultimately be brought under control only when water supplies, sanitation, personal hygiene and food handling practices are safe enough to prevent the spread of Vibrio cholerae O1”.
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In 2019, the SAHRC warned residents of Hammanskraal to not drink their water, as it contained contaminants that can cause acute diarrhoeal diseases such as cholera & high nitrates that can cause chronic health conditions (incl cancer & blue babies).
tinyurl.com/3ndf8pfu
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In 2009, Tshwane was warned that the quality at the intake of the Temba purification works is poor because of the lack of proper treatment of sewage by the @CityofTshwane at its Rooiwal Sewage Treatment Works, 10 km upstream from Temba, and Daspoort STW, about 30 km upstream
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And here we are, all the way into 2023, still killing babies with poor service delivery to ESPECIALLY black communities. Because of corruption, which started LONG before 1994, and because of the historic injustices, and because of the lack of understanding amongst corrupt...
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...politicians of the direct link between these things, so much so that they hand out "dignitiy packs" to schoolgirls parading for them for a photo-op, without even THINKING of the dignity of schoolkids having to use a bucket or a longdrop when they need to go to a bathroom.
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And then those same politicians cry "political stunt" when they get chased away from a hospital where they show up for a photo-oop while ppl are dying. If Cilliers Brink REALLY cared, he should have shown up at Rooiwal or Daspoort, and asked why wastewater is not chlorinated
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Now they try to cry "poverty" cause it will cost billions to fix Rooiwal, but they havent done anything to get the money back that the DA-appointed Edwin Sodi stole from us, and they havent even properly tested the water. N'mind implemented a proper response to the epidemic.
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They should instead be immediately establishing rehydration centers, and ensuring adequate and safe water supply&sanitation to these centres, hospitals, clinics, & schools as minimum. This does not mean "water trucks" and "testing for E coli".
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It means finding workable and affordable SOLUTIONS so that we stop killing babies with poor water management because of politiking. It means IMMEDIATELY installing modular water purification plants, which can be up-and-running in a week. In the medium term, it means..
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It means rerouting the abstraction infrastructure for Temba to upstream of the Rooiwal STW discharge point, to prevent the ppl of Hammanskraal from being exposed to poorly treated water. And in the long term, it means looking at alternative sanitation solutions for EVERYONE.
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PS: I wrote a cholera outbreak management guideline for @DWS_RSA in 2002 which explains all this in great detail, but with the collapse of the DWS since its Zumafication, I dont know if they even know they have it... yet they try to score cheap political points from ppl dying.

And here are the "officials" who appointed Sodi. Yeah. They need to be prosecuted. And go clean hospital linen. In #Hammanskraal.

https://twitter.com/SowetanLIVE/status/1661436808880701441?t=y7K0oLb3tEzD81itct1pHA&s=19