Most cases ‘mild’ and lockdown will flatten the curve — Mkhize

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Despite exponential daily increases in coronavirus infections over the past few day, Health Minister Zweli Mkhize is confident that the national lockdown will see a decrease by the third week, writes MedicalBrief. Mkhize also says most patients are displaying “mild” symptoms.

The number of COVID-19 cases in South Africa has risen to 709, an increase of 155 on the day before. Business Day reports that this was according to Health Minister Zweli Mkhize who said on Wednesday morning that the biggest increases in reported cases since Tuesday are in Gauteng (64), Western Cape (61), KwaZulu Natal (11) and Free State (15).

The minister said the concentration of cases around Mangaung in Free State was a worry, and the Red Cross was helping the Health Department trace people who had been at a church gathering attended by five travellers from overseas who tested positive for the disease. “This is an area of great concern,” he said, describing Mangaung as an emerging epicentre.

There are also clusters of COVID-19 in Sandton, Ekurhuleni, Tshwane and Cape Town, he said. The main source of the disease remained travellers from European countries, but there was as growing number of cases of internal transmission, he is quoted in the report as saying.

Mkhize said earlier that while there might be an increase in the number of novel coronavirus cases in the next week, he is confident the lockdown measures announced by President Cyril Ramaphosa will have an impact. “We expect that probably if there should be a change, we should probably start seeing it in the third week. The theory and the thinking (is that) if we contain everyone with potential infections it should be possible to allow as many people to shed the virus without any spreading,” he is quoted in a News24 report as saying

To identify infected persons, the department said it was now compulsory for every clinician and pathology laboratory, both private and public, to ensure that every patient provides full personal details when testing. That includes the patient’s full names, identity number, physical address and an alternative contact number.

With the flu season on its way, Mkhize also encouraged people, especially the elderly, to get vaccinated to ensure a limited impact of influenza.

The report says encouraged by the low number of internal transmission, he said once movement is frozen, government will be able to go to densely populated areas such as townships and informal settlements to check for infections.

Ramaphosa took aggressive action on Monday night to contain the COVID-19 outbreak, announcing a 21-day national lockdown that will virtually bring the struggling economy to a halt, reports Business Day. Acknowledging the effect this will have on people’s livelihoods, the president also announced measures to support small businesses and protect employees.

“It is clear from the development of the disease in other countries and from our own modelling that immediate, swift and extraordinary action is required if we are to prevent a human catastrophe of enormous proportions in our country,” said Ramaphosa. “Without decisive action, the number of people infected will rapidly increase from a few hundred to tens of thousands, and within a few weeks to hundreds of thousands,” he said.

The report says the new steps follow a meeting Ramaphosa convened with business leaders on Sunday, which was immediately followed by a meeting of the National Command Council, which he established to co-ordinate South Africa’s response to COVID-19.

The lockdown will be accompanied by a big push to step up screening, testing, contact tracing and medical management, focusing first on high-density and high-risk areas.

Ramaphosa has announced a public health management programme to increase screening, testing, contact tracing and medical management to curb the spread of the coronavirus. Ramaphosa is quoted in News24 as saying that a system would be put in place for centralised patient management for severe cases and decentralised primary care for mild cases.
In his much-anticipated national address, the president told the nation community health teams would focus on expanding screening and testing where people live, focusing first on high-density and high-risk areas. “Emergency water supplies, using water storage tanks, water tankers, boreholes and communal standpipes are being provided to informal settlements and rural areas,” he said.

Ramaphosa added the country’s fundamental task was containing the spread of the virus. He said he was concerned a rapid rise in infections would stretch the country’s already ailing health services beyond what it could manage and many people “will not be able to access the care they need”.

The government’s decision took cogniscance of the modelling work of a team of researchers at the University of the Witwatersrand that found that close to 1m South Africans could contract COVID-19 within just 40 days, unless the government takes drastic action to avoid the country reaching a tipping point of 100 locally acquired cases. Business Day reports that the model shows aggressive containment is essential for slowing the spread of the virus and keeping the numbers to a more manageable level.

The Wits group has also modelled the impact of containment measures, drawing on the experience of several European countries, and found that the growth in the epidemic could be slowed significantly. “The spread of the virus is exponential without containment. With containment it becomes close to linear,” said Wits professor Bruce Mellado, who is also a senior researcher at iThemba LABS.

A key concern among health professionals is that exponential growth would overwhelm the health system. The Actuarial Society has warned that if only 40% of the population is infected and 5% require hospitalisation, 1-million hospital admissions would be necessary.

There are two pieces of good news, says a Daily Maverick report. It quotes Mkhize as saying first: “For some reason we are not seeing very severe cases,” with the majority of people who have contracted the virus in South Africa experiencing relatively mild symptoms to date.

Second, although Mkhize did not specify numbers, he said that not many of the current cases are the result of local transmission. The majority of cases were contracted while travelling abroad.

The report says answering the question – how long is South Africa’s COVID-19 outbreak expected to last? – Mkhize said: “The pattern for every country is not the same.” He pointed out that few people would have predicted that China would be dismantling some of its COVID-19 hospitals at the end of three months. Mkhize said it was not possible to predict with any certainty how long the virus would continue to be a threat in South Africa.

The health minister said, however, that “for the next week or two” experts expect South Africa’s case numbers to continue to rise. This will hopefully be the result of viral transmission which occurred before the lockdown – as the whole point of the lockdown is to prevent the virus from being passed further from person to person.

Gauteng Health says that it is still in consultation with private hospital groups for resources, while the number of confirmed cases continues to rise in the highly populated province. “We have been in engagements with the private sector to see how resources can be pooled beyond just bed capacity,” spokesperson Kwara Kekana is quoted in Polity as saying. Gauteng Health MEC Bandile Masuku said that spaces would be announced for patients who could not quarantine in private.

He added that the department was in consultation with a private hospital group for 250 beds on the West Rand. “We are meeting today with labs for example, so the engagements are ongoing.”

As the custodian of research for health, the SA Medical Research Council (SAMRC) has joined global efforts against COVID-19 by setting aside R8m towards COVID-19 research, says a Cape Times report. The SAMRC said this would be made available towards disease surveillance at five hospitals, with a further R5m going towards genomic sequencing at the National Institutes for Communicable Diseases. They added that they anticipated making additional funding available towards drug treatment trials.

The Department of Science and Innovation set aside R4m towards COVID-19-related interventions as a way of mobilising funding, reconfiguring research priorities and creating a conducive ethical and regulatory environment to facilitate COVID-19 research.

KwaZulu-Natal Health is limiting patient visitation and not allowing international visitors at any of its hospitals during the global coronavirus pandemic, reports The Times. KZN Health MEC Nomagugu Simelane-Zulu announced that visiting hours would now be limited to one hour – 1pm to 2pm – and visitors would be limited to two per patient.

International visitors will not be allowed at the facilities.

“With the immune system of some in-hospital patients already compromised because of their ailments, the department has a responsibility to prevent infection and minimise their exposure to people who could be carrying the virus unknowingly,” said Simelane-Zulu.

COVID-19 news from elsewhere:
The global COVID-19 total passed 400,000 cases today (24 March), fuelled by more steep rises reported from Italy, Spain, other parts of Europe, and the US. In other developments, more nations, including the UK and India, ordered countrywide lockdowns, and officials confirmed that the Tokyo Summer Olympics will be postponed until 2021.

Yesterday, 23 March, the World Health Organisation (WHO) warned that pandemic activity was accelerating, noting that it took only 4 days for cases to jump from 200,000 to 300,000. It took only 3 days for cases to make the jump to 400,000. The total is currently at 417,698, according to the Johns Hopkins online dashboard.

As expected, the International Olympic Committee (IOC) president and Japan’s prime minister issued a joint statement that said after reviewing COVID-19 developments, they concluded that the Tokyo games should be rescheduled to no later than summer 2021 to safeguard the health of athletes, everyone involved in the games, and the international community. The event was expected to draw about 11,000 athletes from about 200 countries.

The IOC said the Olympic and Paralympic games next year will keep 2020 as part of the event name and that the Olympic flame will stay in Japan.

Italy cases rise again; UK begins lockdown
After slight decreases in reported daily cases over the past 2 days, Italy’s number today was higher, with 5,249 cases, compared with 4,789 yesterday, for a total of 69,176, according to the health ministry. Similarly, the number of deaths today, at 743, were up from the 601 reported yesterday.

In Spain, health officials reported 4,540 new cases, up from 4,321 reported yesterday, to bring the overall number to 39,636. The country also reported 489 more deaths, up from 435 reported yesterday, for a total of 2,800.

In the UK, Prime Minister Boris Johnson yesterday announced a national stay-at-home order that will last for 3 weeks and be enforced by the police, affecting a population of about 66.5m. The order shutters nonessential businesses, closes public gathering places, and bars gatherings of more than two people, except for those who live in households and those attending funerals.

UK health officials today said they are working with military planners and engineers to open a new 500-bed hospital in London next week to treat COVID-19 patients. So far, the UK has reported 8,077 cases, 422 of them fatal.

China reopens much of Hubei province
China’s government today eased restrictions in most of Hubei province, which has been on lockdown for the past 2 months. The exception is the city of Wuhan, China’s former epicentre, where restrictions remain until 8 April.

In other developments, China today reported 78 new cases, including the first from Hubei province (Wuhan) in 5 days, according to the National Health Commission. Of the new cases, 74 were linked to international travel.

Elsewhere in Asia, some countries continue to battle resurgences, including Hong Kong, which reported 30 more cases today, 19 linked to travel; Singapore, which reported 49 new cases, 17 of them linked to travel; and Malaysia, which reported 106 more.

Activity rises in Africa
In a weekly update the WHO’s African regional office said COVID-19 activity is intensifying in Africa, with 12 more countries reporting their first cases over the past week, bringing the affected number of countries on the continent to 43. Also, the region reported 868 cases last week, the highest so far in a single week.

Five countries are experiencing local transmission: South Africa, Algeria, Burkina Faso, Senegal, and Cameroon. All but six countries in the region have reported local infections in contacts of imported cases. The WHO said many of the cases are still linked to travel and that the region still has a window of opportunity to contain the disease.

More cases in Iran, India
Elsewhere, Iran reported 1,762 cases, up from 1,411 reported the previous day, lifting the overall total to 24,811. The country also reported 122 more deaths, putting the death count at 1,934. The WHO said that it has delivered another shipment of medical supplies to Iran, the seventh so far. Among the contents were lopinavir and ritonavir medications to allow health workers to treat patients enrolled in research studies that are part of a large international collaboration.

Last week in an update, the WHO’s Eastern Mediterranean regional office said Iran’s health ministry has launched a self-assessment tool that directs sick patients, if needed, to 16-hour treatment clinics that can diagnose and treat the disease, then refers patients to hospital or home care, as needed.

And finally, India’s President Narendra Modi ordered a 21-day lockdown for the whole country, affecting 1.3bn people. In an address to the people, the president warned that if the measure fails to curb the virus, it would set India back 21 years. He also pledged $2bn to bolster the country’s health system. India has reported 536 cases, 37 of them fatal. And the WHO has warned of accelerating outbreaks in South Asian countries.

And in the US:
New York governor Andrew Cuomo said the COVID-19 pandemic case count is doubling every 3 days in his state, as the WHO warned that the US could become the next epicenter of the novel coronavirus, given that the country accounted for 40% of new cases recorded globally over the past 24 hours.

As of this afternoon (24 March), according to the New York Times case tracker, the US reported at least 52,215 cases, including 675 deaths. New York reported about half of those cases – 25,665, including almost 15,000 in New York City.

Trump weighs lifting restrictions by Easter
Meanwhile, President Donald Trump told viewers during a Fox News virtual town hall that he wants the country “opened up and raring to go by Easter Sunday,” which this year falls on 12 April.

The announcement comes one day after Trump changed his tone on coronavirus response and cautioned the “cure would be worse than the disease” in reference to the social distancing and shelter-in-place mandates in several states that have shuttered non-essential businesses and removed millions of US children from school.

Thirteen states have shelter-in-place orders.
“Our time is up on Monday or Tuesday of next week,” the president said, referring to the “15 days to slow the spread” campaign rolled out by the White House last week. “We will assess at that time and give it more time if we need a little more time. We have to open this country up.”

Vice President Mike Pence, surgeon general Dr Jerome Adams, and White House coronavirus response coordinator Dr Deborah Birx, joined the president during the town hall. Both Adams and Birx said the president was listening to his scientific advisors, including Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and using their expertise when making policy decisions.

When asked if he and Fauci were at odds with one another, Trump said he had a good relationship with Fauci, who has worked under six presidential administrations. Fauci was not at yesterday’s or today’s briefing. “Tony is extraordinary,” Trump said. “Today he is working on other things.”

Cuomo asks for ventilators
Cuomo has tweeted that the federal government needs to provide 40,000 ventilators to New York immediately. “The new projections suggest that the number of hospital beds needed could be as high as 140,000,” Cuomo said during his daily briefing. “We haven’t flattened the curve, and the curve is actually increasing.”

Pence during the town hall said the Federal Emergency Management Agency (FEMA) shipped 2,000 ventilators from the national stockpile to New York state earlier today, with another shipment of 2,000 ventilators expected tomorrow. Cuomo said he needs 30,000 ventilators to be prepared for the influx in cases over the next 14 to 21 days.

Though New York has by far the most US cases, other hot spots have been worrying experts in recent days: Louisiana, which reported no cases 10 days ago, now has at least 1,388 cases and 46 deaths. Michigan‘s cases also rose, from 65 cases about a week ago to 1,328 confirmed this afternoon, including 15 deaths. New Jersey now has reported 3,675 positive cases, and 44 deaths, as well.

In Louisiana, Governor John Bel Edwards said he was seeking a major disaster declaration for his state by FEMA. Washington state, which was the first US hotspot, now has 2,221 cases, including 110 deaths.

Auto maker starting to make ventilators
After days of speculation, it was reported that Ford will partner with General Electric (GE) Healthcare and 3M to make ventilators, respirators, and face shields. Ford said it would be able to make up to 1,000 respirators per month, and plans to make up to 100,000 face shields per week.

Ford said it would partner with GE Healthcare to a produce hundreds of thousands of ventilators between now and June.

FDA approves plasma treatment, new vaccine candidates
Today the US Food and Drug Administration (FDA) said individual patients may be eligible to receive convalescent plasma as part of exploratory treatment for COVID-19 infections, under single-patient emergency Investigational New Drug Applications.

“This process allows the use of an investigational drug for the treatment of an individual patient by a licensed physician upon FDA authorisation. This does not include the use of COVID-19 convalescent plasma for the prevention of infection,” the FDA said.

Finally, biopharmaceutical companies announced new partnerships to develop potential COVID-19 vaccines: Dynavax and Clover Pharmaceuticals and Ology Bioservices and Innovio.

Full Business Day report

Full News24 report

Full Business Day report

Full News24 report

Full Business Day report

Full Daily Maverick report

Full Polity report

Full Cape Times report (subscription needed)

Full report in The Times

CIDAP material

CIDRAP material

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