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HomeWeekly RoundupSA'S COVID-19 situation — 16 April, 2020: Expert panel outlines SA strategy

SA'S COVID-19 situation — 16 April, 2020: Expert panel outlines SA strategy

On Monday, Health Minister Zweli Mkhize, accompanied by various experts and the chair of the ministerial advisory group, Professor Salim Abdool Karim, took the public into their confidence and provided a breakdown of South Africa’s efforts to tackle the spread of COVID-19 as well as plans for the road ahead.

Polity reports some important points that Karim made:
The trend in COVID-19 infections in South Africa has taken a unique path, unlike that of other countries, Abdool Karim said. As the rate of infection plateaued, the number of tests conducted increased, Abdool Karim said.

While a lack of testing makes a small contribution to South Africa's unique trajectory, a major factor is due to a "genuine effect", Karim said. This reduces the possibility that a lack of testing caused a "false" flattened curve. More likely, Abdool Karim explained, the rate of infection declined because the lockdown reduced the opportunities for the virus to spread in communities.

A first wave of infections brought about by international travellers led to a second wave of community transmissions. However, Abdool Karim explained that this, surprisingly, did not lead to an exponential growth of infections. Instead, South Africa's community transmissions are not "spreading like wildfire", creating a unique curve. The government is concerned, however, about aggravating factors for community transmissions, which are high-density hubs where there is a high potential for the spread of the virus. These hubs include Johannesburg, Cape Town and eThekwini.

Looking ahead, Abdool Karrim said although it's a best-case scenario, it is highly unlikely that the virus will simply disappear, Abdool Karim said. What's more likely, is that once the lockdown ends, there will be an exponential growth in infections. Despite the success in stemming the spread of COVID-19 in communities, Abdool Karim said the "difficult truth" remained that an exponential spread of the virus was unavoidable.

Government interventions have delayed a potential disaster. We now have time to truly flatten the curve and South Africa is in a unique position to deal with COVID-19. "We chose to be proactive; we have chosen to go out there and do active case-finding. Everyone needs to follow the lockdown rules while the government monitors community transmission, Abdool Karim said.

If the average number of day-to-day cases increase between 10-16 April, the lockdown will continue. Should this average stay the same, the government will use active case-finding to determine whether to continue with the lockdown.

Abdool Karim announced that once a month South Africa will have a national surveillance day during which a 5% sample will be collected from a small number of schools, mines and companies. The number of samples and tests could be increased if the government sees fit, Abdool Karim said.

South Africa's COVID-19 epidemic will occur at the same time as the flu epidemic, making it more confusing for people to distinguish between flu and COVID-19.

The elderly, particularly those older than 70, are also a concern. "We need to think about whether it is possible to have some kind of partial lockdown – and it can be a voluntary partial lockdown – until the end of September, when we think the wave of this epidemic will be over," Abdool Karim said.

Finally, Abdool Karim added that medical staff will be prepared for the exponential curve. This means getting ready makeshift ICUs, ventilators and personal protective equipment – a challenge dealt with worldwide.

Abdool Karim cautioned that lifting or easing the lockdown, which has been extended until the end of April, could see the trajectory turn and the exponential increase the state had feared, materialise. "Once we end the lockdown, and we are going to have to end it at some point, we have 57m people (and) we have no immunity, we have no vaccine, we have no treatment," he is quoted in an IoL report as saying.

In terms of epidemiological modelling, the point at which restrictions could be eased, would be an average daily increase in infections of 44 new cases.

Karim said the special attention had to be paid to the greater Cape Town, Johannesburg and eThekwini areas, where there was a risk of a rapid upswing in community transmission, and to protect the country's elderly citizens, who were at the greatest risk, along with those whose immune systems have been compromised by HIV and tuberculosis.

The report says he mooted the possibility of a selective form of lockdown that would see the elderly remained confined, possibly in voluntary fashion, until September.

Marcus Hollington, research director at Focal Africa Research and Monique Bennett, a data scientist at Good Governance Africa write in Daily Maverick that in contrast to the rest of the world, South Africa’s efforts to flatten the curve have been nothing short of world-class coming in second to Algeria, attesting to the advantage of implementing physical distancing and lockdown measures in a timely manner to curb the spread of COVID-19.

They write in the context of case fatality rates, countries with the highest number of COVID-19 cases are high for some countries and low for others. Algeria is currently the most affected country on the continent with a case fatality of 15.31% followed by Egypt, Morocco and Cameroon with case fatality rates of 7.49%, 7.15% and 1.46% respectively. South Africa ranks fifth in the sample of countries with a case fatality rate of 1.19%, which translates to how many of those infected with COVID-19 will die as a result thereof.

They say that given that no vaccine has been developed yet for the virus, South Africa’s case fatality alludes to a responsive health sector with the capacity to attempt treatment thereof and save as many lives possible as illustrated by the country’s COVID-19 recoveries, which currently stand at 410. In statistical terms, this translates to a case recovery rate of 18.05% as per current data.

Hollington and Bennett write that arguably, the most important indicator in assessing South Africa’s approach to the pandemic is “active cases” which many governmental bodies, both domestic and pan-African, have failed to publicly release alongside their confirmed case statistics which are abundantly available. This is problematic as it undermines the tremendous efforts that healthcare workers are tirelessly putting in to curb the spread of the virus as well as to treat those who have been infected.

It also undermines the measures that the South African government has put in place to achieve the aforementioned and facilitates panic as the populace continues to see a rise in cases, though gradual.

They write that although we are still below the target of 10,000 tests per day, overall testing in communities has gradually increased and we are currently on an average of 5,678 tests per day.

They say that Abdool Karim advised South Africans on why the lockdown will assist the healthcare system to prepare for what will be an inevitable rise in cases. Since the lockdown, 28,000 community healthcare workers have been deployed in vulnerable communities to screen and test individuals.

Hollington and Bennett write that “active” case findings are vital if we are to identify where the community transmission is taking place. This allows the government to intervene before community transmission takes place. A similar strategy was conducted in South Korea (Trace, Test and Treat), which helped flatten their curve.

They say the difference is South Africa’s lockdown came much earlier and has bought the healthcare system some valuable time to prepare hospitals, staff and community clinics for a worst-case scenario.

Abdool Karim was joined at the first briefing by the country's top scientists, among others Professor Glenda Gray, the chair of the Medical Research Council, Professor Koleka Mlisana, a microbiologist from the University of KwaZulu-Natal, and Professor Brian Williams, an epidemiologist formerly with the World Health Organisation.

News24 reports that Abdool Karim, a world-renowned figure in the field of HIV research and epidemiology, is the chair of a Ministerial Advisory Committee (MAC) made up of more than 20 professors, doctors and scientists who advise Mkhize and the National Command Council chaired by President Cyril Ramaphosa.

The report says experts from the MAC and Mkhize steered clear of any projections on the numbers of people they expected to be infected at the peak of the virus, and how many people were expected to need hospitalisation or die from COVID-19.

Abdool Karim explained that while concern existed over whether testing was adequate in poorer communities and that many cases lay undetected in those areas, it was far more likely that early and decisive interventions had curbed the spread of COVID-19.

Professor Cheryl Cohen, the co-head of the National Institute for Communicable Diseases (NICD) Centre for Respiratory Diseases and Meningitis, explained that the country's early cases were largely imported. As the local epidemic curve flattened and plateaued to a lower average number of daily new cases, testing capacity for the 80% of the population who do not have medical aid had been ramped up.

However, the report says, Abdool Karim highlighted that testing numbers were still too low.

The wide ranging briefing hosted by Health Minister Zweli Mkhize has cracked open the sphere of technical and political deliberation about “The COVID Response” in many ways, writes Alex Welte, research professor at, and the former director of Department of Science and Innovation – National Research Foundation (DSI-NRF) Centre of Excellence for Epidemiological Modelling and Analysis (SACEMA) at Stellenbosch University in Groundup. He says the minister spoke with humanity about the latest deaths, on which he is clearly fully briefed.

Welte writes that it was also good to see him decline to hog the floor, allowing key subject experts to bring their experience and knowledge to the table. The main presentation, given by Abdool-Karim gave clear evidence of the pragmatic, deep and multi-layered planning discussions that have been going on for weeks.

He says stages of the epidemic were presented in intuitive graphics, showing imported cases, early transmissions, and the dreaded community spread, with reflection on (problematic) data from nominal case counts and (so far, absent) signs of health system strain. Questions were answered on delays between infection and case reporting, the shifting of the meaning of case data as testing criteria evolve, the nuances of mask use, and the strong age-dependence of severity of COVID-19 disease.

There was a sensible balance between fear of the inevitable worsening of the situation and hopeful indications that an early conflagration has been avoided. There was even space for fine detail such as the point made by modelling expert Brian Williams, that contact tracing, our main real tool besides social distancing, is more efficient than intuitively expected because it naturally follows the infection routes to the main hubs – the so-called super-spreaders.

Welte writes that there was a lot of detail to digest, and a welcome opportunity to engage but, he says, there is a key gap in the presentation. It contains, on page 24, criteria for whether the lockdown is eased or not. If the average daily cases from 10 to 16 April is 90 or more the lockdown will continue. If it’s below 44 the lockdown will be eased. If there are 44 to 90 daily cases, the slide on page 24 is unclear but it appears to depend on the proportion of positive results among tests performed by the community health workers.

Welte writes that besides the calculations behind this decision being unclear, no substance is provided about the range of options between full lockdown and no lockdown. He says this is a discussion that very much needs to take place.

Daily Maverick reports that Mkhize and Abdool Karim, have reprised an old relationship to establish a medical bromance that was on display to the public. The report says at the end of the Zoom meeting, a questioner asked whether Mkhize was indeed a doctor and Abdool Karim stepped in to say that he and Mkhize had both been students at what is now the University of KwaZulu-Natal. The two doctors and their doctor partners (Qurraisha Abdool Karim and May Mashego) had all studied together.

The report says what was clear from the briefing is that the two doctors work closely together. And the decision to hold the briefing also suggests that the scientists and the health activists in the COVID-19 National Command Council have, for now, the upper-hand over the securocrats who favour a more punitive approach in how this public health emergency is managed. It also suggests that a strong lobby to reopen the South African economy from its hard lockdown (among the most draconian in the world) to a lighter version has taken second place to science and safety.

The report says for the foreseeable future, the double act of Mkhize and Abdool Karim – the politician and the scientist – will be the public face of the fight against COVID-19 in South Africa.

[link url="https://www.polity.org.za/article/coronavirus-9-things-we-now-know-after-the-health-departments-covid-19-briefing-2020-04-14"]Full Polity report[/link]

[link url="https://www.iol.co.za/news/politics/sas-covid-19-infection-plateau-is-unprecedented-ministerial-adviser-46661184"]Full IoL report[/link]

[link url="https://www.dailymaverick.co.za/article/2020-04-15-south-africas-world-class-fight-against-covid19-the-data-tells-the-story/?utm_medium=email&utm_campaign=First%20Thing%20Wednesday%2015%20April%202020%20Port2Port&utm_content=First%20Thing%20Wednesday%2015%20April%202020%20Port2Port+CID_e7041f75631edc34cfe6bebd67a7ca4a&utm_source=TouchBasePro&utm_term=South%20Africas%20world-class%20fight%20against%20Covid19%20The%20data%20tells%20the%20story"]Full Daily Maverick report[/link]

[link url="https://m.news24.com/SouthAfrica/News/sa-unlikely-to-avoid-wildfire-spread-of-covid-19-but-lockdown-bought-time-top-scientist-20200414"]Full News24 report[/link]

[link url="https://www.groundup.org.za/article/covid-19-unanswered-questions-after-minister-mkhizes-teams-excellent-presentations/"]Full Groundup report[/link]

[link url="https://www.dailymaverick.co.za/article/2020-04-14-the-new-doctors-pact-that-could-help-flatten-the-covid-19-curve/?utm_medium=email&utm_campaign=Afternoon%20Thing%20Tuesday%2014%20April%202020%20Henley&utm_content=Afternoon%20Thing%20Tuesday%2014%20April%202020%20Henley+CID_efc135ad96fa8cbf6cd11915bc89d3f4&utm_source=TouchBasePro&utm_term=Mkhize%20and%20Abdool%20Karim%20form%20a%20united%20front"]Full Daily Maverick report[/link]

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