By 8 April, the number of coronavirus cases in the country stood at 1749 with 13 deaths. Although the number of cases increases every day, the rate of escalation appears to be relatively stable. However, there are concerns that South Africa’s testing numbers remain low.

To date, approximately 84% of the total tests conducted have been performed by the private sector. This is deeply worrying. The government simply isn’t doing enough testing and in areas like informal settlements and rural locations, this could spell disaster.

From a policy perspective, it is this number that the government must give its single-minded attention to. There can be no delays; there can be no compromise. If South Africa fails to roll out mass testing throughout the duration of the lockdown, much of this effort risks being wasted.

There are two countries in particular that are worth paying close attention to – South Korea and Germany. In South Korea the numbers of infections exploded in late February and early March. The government responded rapidly, immediately moving to produce test kits on a mass scale.

They then focused on testing thousands of people as early and as often as possible. The strategy behind early testing and identification is a simple one: if an individual tests positive for the virus, even if no symptoms are manifesting, they can be isolated in order to stop the spread of the virus to other people.  If testing is done later, for example only by the time the individual develops symptoms, there is a high likelihood the patient has already spread the virus to other people.

Early detection is everything

The South Koreans opened 600 testing stations and over 50 drive-through stations where testing could be performed within a space of 10 minutes and the results delivered within hours. Currently, the country has the capacity to run 15,000 tests per day. Once a case is identified, tracing and subsequent isolation can begin.

In Germany, the government recognised early on that the virus was likely to become a global problem. Before the viral genome was even sequenced, Germany had already produced millions of test kits based on SARS and other coronaviruses. They soon had the capability to test 12,000 people a day.

South Africa has paid heed to a few of these lessons. The country responded quickly in instituting a lockdown after just a few hundred cases were detected. The lockdown would at least assist in slowing down the rate of transmission at those early stages. However, the reality is that the country cannot stay in lockdown for months on end.

An exit plan is needed

The government must consider how it can ease lockdown regulations while ensuring that our public health infrastructure is capable of fighting the virus. This can only be done through mass testing. Again, the South Koreans have mastered this in that they have been able to keep their economy moving while staying on top of their testing.

However, this should also be approached cautiously. The South Koreans are expecting a second wave of COVID-19 cases. There are concerns that once flattened, the curve won’t necessarily stay flat unless you keep up a disciplined and strict regime of testing and isolation behaviour.

This is where South Africa could possibly face its toughest test. This was hinted at recently by Health Minister Zweli Mkhize. In just a few months the country will enter into winter. At the moment, virologists are still speculating on the types of conditions that this novel coronavirus thrives in. Ed Yong from The Atlantic has tried to unpack this through a series of engagements with top scientists, where there has been speculation that the virus does better in areas with cold, dry air.

Mkhize has already appealed to the public to start taking the necessary precautions to stay healthy during winter. He urged people to stay warm and take immune boosters if necessary.

South Africa is fortunate in that the country has not hit crisis levels right out of the gate, and this is to the government’s advantage. It can watch and learn from the decisions, and the mistakes, being made by other countries in their fight against the pandemic.

Testing, testing, testing

Right now, the key lesson from these observations is the need for mass testing. The only way in which the country’s healthcare infrastructure will not collapse is if there’s sufficient capacity to test extensively.

The approach of winter also presents another challenge in that cases of influenza will increase significantly across the country. This could see a flood of people battling to seek medical opinions and treatment in the fear that they have contracted Covid-19.

With the current sluggish rate of testing, there is a strong possibility that at the end of 21 days lockdown, the total number of positive results will appear relatively low. There is also the possibility that the virus has simply struggled to transmit aggressively in South Africa due to our current climatic conditions.

Although one could speculate endlessly on the reasons for this, it is worth noting that one month after reporting its first case, South Africa hit 1,655 cases. Contrast this with Italy which reported just under 25,000 cases after its first month.

Nonetheless, we need to end the speculation as fast as possible so we can begin building robust modelling and forecasting models on the effect this virus is having on the country. The only way to do this is through the expansion of testing so we can gather as much data as possible.

It is critical that by the time the lockdown is over, we have been able to test thousands of citizens proactively and that we can carry on with testing into the future.

South Africa does not have the economic luxury of being able to extend the lockdown further than is absolutely necessary. Wealthy countries are able to fund small businesses and even give their citizens a basic income grant, as is being done in Spain. In the US the government is working towards giving $1,000 to each of its citizens. South Africa simply does not have this kind of money to distribute on a universal scale.

In the coming week, the president and his team will be hard at work assessing whether the lockdown should be extended, and if so, for how long.

At current infection rates, the government will be hard-pressed to justify an extension to a restless and anxious population. People need to get back to work. If, however, the lockdown is lifted on 16 April, the country will have to seriously ramp up the testing process. This is non-negotiable.

Winter is coming and we must be ready – there is already a real risk of a second wave. DM