Health minister Dr Zweli Mkhize has announced that the number of confirmed Covid-19 coronavirus cases in South Africa has climbed to 2,272, with total deaths rising to 27.
In a presentation following the minister’s announcement on Monday evening (13 April), epidemiologist and infectious diseases specialist, professor Salim Abdool-Karim outlined the current status of the virus, and efforts to combat its spread in the country.
Abdool-Karim, who is heading up the country’s response to the Covid-19 outbreak, noted that South Africa’s infection rate is unique, bucking all of the trends seen elsewhere.
Initially, South Africa’s infection rate was expected to grow exponentially, as has been the case in many European countries, and the US. However, it has instead begun to flatten out much sooner than anticipated.
Plotting a graph of the infection rates, South Africa’s pattern follows more closely to Asian countries including South Korea, where new infections have also begun to plateau.
The reason for this is likely South Africa’s very swift response to the outbreak, the professor said, where a state of disaster, and subsequent lockdown was implemented early.
However, the professor stressed that this does not mean that South Africa is winning the war against the virus, nor does it mean the country will be spared totally.
“This is an entirely new virus – none of us have immunity against it. It doesn’t matter if you are black or white or young or old – we are all vulnerable and at risk, because no one is immune,” he said.
People will continue to get infected, and the world is still, optimistically, 18 months away from a vaccine, he said – but the epidemic could have run its course in South Africa by that point.
The key, he said, is keeping the number of new infections under control and as low as possible. This rate of infection is referred to as R-0. If the infection rate is one (one infected person infects one other person), the daily infection graph is flat.
If it is higher (one infected person infects more than one other person), the graph trends upwards – and if it is lower, it trends downwards.
According to Abdool-Karim, South Africa is currently seeing around 67 new infections each day, on average – which is down from 76 in the first week of the lockdown, and 110 before the lockdown.
The coming week is vitally important for this number, he said, as it will be the first indication of whether the lockdown is working to reduce infections.
The figures this week will show the infection rate of those who became infected between 10 and 16 April.
It’s only by tracking these numbers (minus the active screening that is being done) that government can determine what action to take regarding the lockdown, he said.
- If the infection rate is higher than 90+ per day, the lockdown will likely continue;
- If the number is between 45 and 89 – and the active screening rate is higher than 0.1% (1 in 1,000), the lockdown will need to continue;
- If the number is between 45 and 89 – and the active screening rate is lower than 0.1% (1 in 1,000), an ease in the lockdown can be considered;
- If the number is lower than 44, then an ease in the lockdown can be considered.
The professor said that there are likely to be large variations and some increases in positive tests as active case finding ramps up. We will know these numbers by April 18th, he said.
The warning is that an abrupt “return to normal” will again lead to a rapid spread of the virus, which will undo all the work done during the lockdown period.
Where to next?
The professor noted that South Africa has taken an 8-stage response to the epidemic – which is approaching the halfway point.
These stages are:
- Stage 1: Preparation, including community education, establishing lab capacity and surveillance of the virus.
- Stage2: Primary prevention, including social distancing and hand-washing, closing schools, reducing gatherings, and closing borders and international travel.
- Stage 3: Lockdown
- Stage 4: Active case-finding, a unique measure in South Africa, where healthcare workers are being sent out to test vulnerable communities.
What happens next, is that the country has to find the hotspots of the viral outbreaks in communities, and handle the peak of infections – something which healthcare workers and facilities are currently preparing for.
These are the next stages of the response to the virus:
- Stage 5: Finding hotspots, including surveillance and interventions, monitoring of new cases and other outbreak investigations.
- Stage 6: Medical care for the peak, including managing case load capacity, healthcare staff exposure and infection, building field hospitals and expanding ICU and ventilator numbers.
- Stage 7: Dealing with the Aftermath, including expanding burial capacity, regulating funerals, and managing the psychological and social impact of the epidemic.
- Stage 8: Ongoing vigilance – keeping one step ahead of the virus and infections.
The professor said that South Africa’s response to the outbreak is “putting out the small flames to avoid a raging fire”.
Stage 8 is about getting ahead of the viral spread by not waiting around for patients to arrive at hospitals to act.
To be proactive, the government wants to conduct ongoing house-to-house screening and testing, and introduce a one-a-month ‘surveillance day’, where communities (schools, mines, prisons and companies) conduct self-testing.
This will hopefully be aided by advances in testing methods, he said.
There are still concerns, however – mainly to do with stage 6, or medical care.
Here, there are trends which show that where there is poor access to healthcare, the number of deaths increase.
In South Africa, the number of South Africans cases of HIV (and not on anti-retrovirals), and tuberculosis is high.
Another big worry is that the Covid-19 outbreak will be intermingled with the flu epidemic that happens every year.
The elderly, and those with underlying health issues (diabetes, heart diseases, lung disease), are at particular risk and may need a voluntary partial lockdown until the end of September, just to reduce exposure, the professor said.
“I don’t know if the epidemic will be over by September, I’m not a crystal ball, but that’s a target we have provided, for now,” he said.
A partial lockdown scenario would be something like children going to school – but when they get home, they cannot interact with their grandparents.
According to Abdool-Karim, the lockdown has bought the country some time – four to six weeks. Community transmission has been curtailed and the peak case load will likely be reduced (flattening of the curve).
However, the exponential curve is almost inevitable, he said, and South Africa’s lockdown cannot end abruptly.