Wildly divergent projections muddy Western Cape waters

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Business Day asks whether the Western Cape‘s dire COVID-19 statistics are skewed by its testing protocols or whether the province is experiencing a qualitatively different epidemic from the rest of SA.

Western Cape hospitals, at the epicentre of the pandemic, are filling up rapidly with COVID-19 patients. But, Business Day reports, despite how bad it looks now, South Africa’s tourist capital may not have it any worse than the other large provinces in the long run. The report says the impression that the province is experiencing a more severe epidemic than the rest of the country is skewed by the fact that it does proportionately more testing and tests more aggressively in known hotspots, according to the provincial government. (As of last week, it had conducted 1,200 tests per 100,000 people, against Gauteng’s 837 per 100,000.)

“The Western Cape is doing more testing per 100,000 of the population and has been testing differently, using an active case-finding approach, specifically testing around clusters and ‘bushfires’, which has resulted in a higher positive rate,” explains Western Cape premier Alan Winde. But Business Day reports, he also concedes that community transmission, which started earlier in the Western Cape than in other provinces, has now become entrenched. “This means that our curve has accelerated faster, resulting in a higher number of infections,” he says.

Right now, the numbers look scary. But, the report says, Winde is not panicking. “Our peak will be earlier, but we expect that similar trends will be seen elsewhere in the country in the coming weeks,” he says.

However, according to Business Day, Neva Makgetla, a senior economist at the Trade & Industrial Policy Strategies (Tips) think-tank, believes the Western Cape is facing a “qualitatively different” pandemic to that of the rest of South Africa. Makgetla likens this pattern to the situation in South Korea, where Daegu, a city of 2.4m people, was put into lockdown in March when the rest of the country had almost no restrictions in place. Similarly, in New York City the incidence of known cases reached 2,400 per 100,000 on 24 May, while it was just 400 per 100,000 in the rest of the US.

In addition to the usual reasons advanced – the Western Cape’s role as a global tourism hub and its relatively dense informal settlements with largely shared facilities – Tips contends that the province has been less successful in managing mass screening and contact tracing than other provinces. “That made it more difficult to prevent new infections by identifying infected people and quarantining them,” says Makgetla.

According to Business Day, she cites national Health Department figures which show that as of 14 May, the Western Cape had failed to reach 17% of the identified contacts of known cases, compared with 14% in the Eastern Cape, 0% in KwaZulu-Natal and 2% in Gauteng and the remaining provinces. Makgetla also notes that while the Western Cape has a higher level of testing per resident than the rest of the country, it also has a much larger incidence of COVID-19, which means that it requires higher testing rates relative to the number of known cases to track infection. Instead, its figures are much lower than other provinces. Business Day reports that with the jury still out as to whether South Africa will continue to experience two divergent epidemics over the long run, a severe one in the Western Cape and a milder one everywhere else, wildly divergent model projections are muddying the waters even further.


The Medical Research Council (MRC) has reported a sharp spike in natural deaths in Cape Town in the week to 19 May signalling the city’s deepening COVID-19 epidemic. Natural deaths are those triggered by a disease such as cancer or an infection, and do not involve external causes such as accidents or murder, reports Business Day.

The researchers compared the weekly numbers of natural and unnatural deaths with the trends observed in previous years. During the COVID-19 lockdown, non-natural deaths have been significantly lower than expected, due to fewer traffic accidents and homicides.

This trend continued during the week to 19 May. But for the first time since the first case of COVID-19 was confirmed in South Africa on 5 March, the weekly analysis has identified significant increases in natural deaths in Cape Town, Nelson Mandela Bay and the Western Cape.

“We are taking it as an early signal of the impact of COVID-19,” the director of the MRC’s burden of disease unit, Debbie Bradshaw is quoted in Business Day as saying.

Researchers have been closely monitoring trends in South Africa’s natural deaths because they are expected to provide the clearest picture of the impact of the pandemic on mortality.


Full Business Day report
Full Business Day report

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