As South Africa’s confirmed cases of Covid-19 rose to 17,200 on May 19, modellers said the number was likely to grow to 30,000 cases by the end of May at a best-case scenario and 54,000 cases in a worst-case scenario.
The SA Covid-19 modelling consortium led by National Institute of Communicable Diseases doctor Harry Moultrie made its first public presentation to senior editors and journalists, at which consortium member UCT statistician Sheetal Silal said their projections suggested the mortality rate could be 40,000 deaths by November in a best-case scenario and between 45,000 and 48,000 deaths in a worst-case scenario.
Overnight to 19 May, 26 more South Africans died due to Covid-19, bringing the total number of deaths to 312, with 187 (the vast majority) being in the Western Cape. Northern Cape recorded its first death, leaving only Mpumalanga free of Covid-19 deaths.
South Africa is now in the amplification phase of Covid-19 as hospitalisations and the death curve grow, said Health Minister Zweli Mkhize. He said that South Africa is focused on stages 5 and 8 of Covid-19 – managing hotspots and heightened surveillance as well as field hospital construction (now underway).
There are eight stages recognised by the World Health Organisation (WHO) as the clinical management of Covid-19. Stage 7 is death, bereavement and its aftermath – a phase South Africa is now going through.
What’s the upside? The modelling consortium says that the five-week lockdown has worked to flatten the Covid-19 curve in South Africa, while Mkhize showed charts which revealed that the Southern African Development Community (SADC) 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 (Rt) of the virus is hovering between one and two in the Western Cape but is closer to one in the rest of South Africa.
The 10 hotspots
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),
- Chris Hani district and
- the Garden Route district (all orange zones).
These are the most densely populated parts of the country.
Once the lockdown is relaxed to Level 3 where a greater part of the economy is reopened and many regulations lifted, the hotspots will have to be firmly managed to ensure that infections do not run wild.
“[There is] no room for complacency. The case numbers will rise. Expect outbreaks,” according to Mkhize’s presentation.
The focus now will shift to hotspot identification and intervention to fight the flames to prevent raging fires, it added. Yet, these 10 areas are also the economic drivers of the provinces in which they sit and a restart of the economy will require a city kickstart, presenting a political and health tightrope to be walked.
Charts presented by the health minister showed (again) that South Africa’s epidemic trajectory until now has placed it in the ranks of countries like Japan, South Korea and Singapore which are recognised as leaders at flattening the curve of infection. But, in each of those countries, there have been secondary waves of infection. Scientists use the United Kingdom as a comparator country as first cases occurred at about the same time as in South Africa – the UK now has 248,818 cases and 35,341 deaths.
“There is no reason to doubt we should have deviated from that trajectory without interventions,” said Mkhize, adding “The South African response is flattening the curve. Early [intervention] is better.”
Gauteng announced that it is likely to enter Level 3 lockdown in June, suggesting that this is the national direction as announced by President Cyril Ramaphosa last week.
Mkhize, however, warned that South Africa does not meet all of the six WHO criteria for easing a lockdown or coming out of it gradually.
These six criteria are:
- a low percentage of case increases per district and per 100,000 population (South Africa’s infection rate may be manageable but it is climbing not decelerating);
- the percentage of cases being tracked and traced (not yet high enough);
- a strategy for managing caseloads in cluster infection hotspots like prisons, mental health homes and old age homes;
- being able to measure a weekly rate of change at workplaces and schools (neither has reopened to provide a base-case);
- screening at ports (not an issue as South African ports are largely closed) and
- engaged communities who understand messages and adopt sustainably safe procedures.
June, July, August 2020 – the winter of our discontent
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. Silal said their projections reveal that SA is likely to breach the number of ICU beds (3,300) 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. The variation will be greater between districts and sub-districts – the way to track at this granular level is still being modelled.
“Under almost all scenarios, hospital and ICU capacity will be exceeded, though timing and extent are uncertain.” DM