SA’s worst-case COVID model: no ICU beds by June, 48,000 deaths by November

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After reluctance to release its modelling data in case it sparks panic, South Africa‘s Health Department has bowed to pressure and opened up on its modelling of the COVID-19 pandemic.

On top of predictions that the tanking economy will suffer millions of job losses – as many as 2m of those may come in Gauteng alone – South Africa’s COVID-19 deaths, currently among the lowest in the world, could reach 48,000 by November and the country could run out of ICU beds as early as June. That is the most pessimistic projection from the modelling consortium advising the government, but its optimistic scenario is not much better, with a projection of 40,000 deaths by November, with the ICU bed capacity, which stands at a mere 3 300, exhausted in July.

A Business Day report notes that until now the government has refused to disclose any details of the epidemic models that have guided its decisions and went as far as requiring experts to sign non-disclosure agreements.

The data was provided by the consortium at a briefing hosted by Health Minister Zweli Mkhize last night, and follows growing pressure on the government to release details of the models it has used to guide its response to the COVID-19 pandemic, which included imposing one of world’s most stringent lockdowns on 27 March, less than two weeks after confirming the country’s first case.

The SA Reserve Bank projects that the economy will shrink 6.1% over 2020 while some have said it could be double digits, notes Business Day. Unlike many countries in Europe and Asia that began easing their lockdowns when infections slowed, the government is planning to ease restrictions as transmission accelerates. As of yesterday there had been 17,200 confirmed cases of the disease, an increase of 767 on the day before, and 312 deaths.

In the face of mounting legal action by those advocating a return to work, Mkhize said the lockdown had served its purpose, in slowing transmission and buying critical time to prepare the health system, but South Africa could not avoid a large number of cases.

The modelling consortium, which is being co-ordinated by scientists at the National Institutes for Communicable Diseases, includes experts from the SA Centre for Epidemiological Modelling and Analysis at Stellenbosch University, the Modelling and Simulation Hub – Africa (Masha) at the University of Cape Town, and the Health Economics and Epidemiology Research Office at Wits University.

According to the Business Day report, Masha’s Sheetal Silal emphasised that there was considerable uncertainty about how the epidemic would play out in South Africa over the next six to eight months, and said the model was adjusted weekly as more information and data became available. The model projects there will be 30,433 confirmed cases by the end of May, but the figure could be as low as 18,710 or as high as 54,540, she said, to illustrate the range of uncertainty.

South Africa is now in the amplification phase of COVID-19 as hospitalisations and the death curve grow, said Mkhize, according to a Daily Maverick report. He said that South Africa is focused on stages five and eight of COVID-19 – managing hotspots and heightened surveillance as well as field hospital construction (now under way). There are eight stages recognised by the World Health Organisation as the clinical management of COVID-19.

Stage seven is death, bereavement and its aftermath – a phase South Africa is now going through. On the upside, the modelling consortium says that the five-week lockdown has worked to flatten the COVID-19 curve. Mkhize showed charts which revealed that the Southern African Development Community has the lowest case fatality rate of all regions in the world – 1.9%, compared with 2.9% for the rest of Africa and 8.8% for Europe.

In addition, Mkhize said in his presentation that the rate of increased cases per week was at manageable levels. While hospitals report an increased caseload, the actual ICU ward utilisation is still low but projected to grow very fast. The reproductive rate of the virus is hovering between one and two in the Western Cape but is closer to one in the rest of South Africa.

Mkhize revealed the 10 COVID-19 hotspot districts and metros which will determine the epidemic trajectory as: Cape Town metro; Lembe district (KZN); Cape Winelands district; Nelson Mandela Bay; Buffalo City; eThekwini Metro; Ekurhuleni metro (all red zones); and Johannesburg, Chris Hani district and the Garden Route district (all orange zones). These are the most densely populated parts of the country.

South Africa is lifting lockdown just as it enters what most people agree is going to be the toughest three months of our COVID-19 journey, says the DM report. Silal said their projections reveal that South Africa is likely to breach the number of ICU beds available in the short-term while 70% of normal ward beds are also likely to be needed for the raging infections that COVID-19 causes and which often require hospitalisations.

While the lockdown had flattened the curve and pushed the peak later, that peak was now in view. ‘(The) peak in active cases is likely between early July (pessimistic) and early August (optimistic). This will be affected by post-lockdown measures,’ said the COVID-19 modelling consortium in its presentation. It predicted considerable variation in timing and scale between provinces.

UN secretary general António Guterres has described actions taken by President Cyril Ramaphosa and his government in fighting the spread of the deadly coronavirus as “strong” and “necessary” measures. Polity reports that Guterres has been quoted as saying while he understood the frustrations expressed by those demanding an immediate reopening of the economy, he believed steps taken by Ramaphosa were correct.

“One thing is clear – there is no real contradiction between measures taken to prevent the disease and economic recovery. If we let the disease spread, no economic recovery will be possible,” Guterres said.

“I hope the population will have patience and I hope the government will progressively find the ways to, in a very smart and targeted way, progressively re-open society and the economy to minimise the social and economic impact of COVID,” the UN secretary general said.

The report says in his address to the 73rd World Health Assembly, Ramaphosa called for global solidarity in a bid to fight the pandemic. He warned that COVID-19 amplified already dangerous and growing inequalities within and between different countries. Guterres, who said he was also separated from his family due to a semi-lockdown, called on South Africans to be patient.

He added that the South Africa government showed lots of determination in addressing the pandemic. The UN chief said it had always been obvious that South Africa would be vulnerable to COVID-19, as it had great movement of people in and out of the country and had been seen as a “magnet” for other African states.

Gauteng’s move to level three at the end of the month will provide much-needed relief from an unprecedented economic and human catastrophe, according to Premier David Makhura. Addressing a virtual sitting of the provincial legislature, Makhura said the province, which ordinarily contributes more than a third of the country’s GDP, could lose as many as 2m jobs, notes a Business Day report.

Business for SA has called for a swift move to a lower level, which would remove restrictions on virtually all sectors, including retail, construction and mining as well as domestic air travel and car rental services. Business leaders have also warned against a tiered relaxation, which would not make sense with complex supply chains that depend on interconnected operations between provinces.

The economic effects of COVID-19 will be like that of the Great Depression almost a century ago, Makhura said. The modelling done for the province looked at the worst and best-case scenarios in terms of job losses, he said. In the best-case scenario the province would lose 900,000 jobs, which could reach up to 2m in the worst outcome. The “road ahead will be tough and painful”, he said.

Full Business Day report

Full Daily Maverick report

Full Polity report

Full Business Day report

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