In the introduction, we mentioned the existing COVID-19 dashboards both in the Netherlands and South Africa. We approached all the owners and partners to participate in the stakeholder engagement.

As mentioned previously, the official, national South African dashboard is managed by the NICD. When we interviewed the NICD they had just awarded the tender to develop the dashboard. In the meantime, several other dashboards were being built across the country, mostly on a provincial level. This was done out of necessity, and due to a delay in ownership and operation of a national wastewater-based dashboard. The national wastewater-based dashboard is currently a work in progress. Most of the stakeholders indicated a preference for the provincial dashboards.

We approached this task with the mind-set of promoting the Eureka dashboard as an early-warning tool, as opposed to only monitoring. i.e. historic wastewater-based epidemiology (WBE) data, with the potential of implementing predictive modelling, data science, AI and other digital tools. In general, stakeholders found this approach very attractive. These additional tools are certainly all possible for future versions, however it is important to note that emphasis must be placed on “sufficient” and “standardised” data, as a dashboard is only as good as the data it receives.

At the time of writing, WBE is no longer an early warning of clinical cases and hospitalisations as originally seen. During late 2020 / early 2021, wastewater provided an early warning of approximately 7 days before clinical cases were observed (TKI Rijnmond report). The data currently appears to move in parallel with the clinical data. The decision to replace clinical testing (almost completely) with wastewater surveillance is being considered in many countries and was voiced by South African stakeholders on several occasions. The need for a single methodology remains stronger for South Africa, due to the added financial strain. Testing in South Africa, unlike in the Netherlands, is not routinely done unless testing is indicated by a health professional. Therefore, one would need to be assessed by their medical practitioner in order to qualify for testing.[1] At the start of the pandemic 98% of tests were being done in the private sector[2], but public sector testing has increased significantly since then. Although public sector testing is free of charge, and private labs charge a fee, the testing facilities are not always easily accessible to the majority of the population. In general, healthcare in South Africa remains divided between a world class private system for those who can afford it, and an overburdened public system for most of the population who cannot. “Politics and racial undercurrents run rife within the COVID space.”, stated a South African stakeholder.

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