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10 May 2020




SA URGED TO INCREASE COVID-19 TESTING TO AVOID 48 000 DEATHS IN NEXT 4 MONTHS

Vuyo Mkize and Poloko Tau
Share
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A man is swabbed during the Covid-19 scanning and testing process that took
place in Diepsloot this week. Gauteng Premier David Makhura and health MEC
Bandile Masuku visited the site during the proceedings. Picture: Tebogo
Letsie/City Press



South Africa is only expected to reach the peak of the Covid-19 coronavirus in
August or September, but the Actuarial Society of SA (Assa) has warned that as
many as 48 000 people could die if the country fails to flatten the curve.

Public health specialists have also suggested that now may be the time to move
from surveillance of the disease and active case-finding to focusing on hotspot
areas, which would mean intervening in the clusters where the disease has been
shown to be problematic.



They argue that this change in strategy is necessary as the community screening
intervention process – which saw 28 000 community healthcare workers go
door-to-door in vulnerable communities to screen and test symptomatic people –
has not quite yielded the detection of cases that was anticipated.

48 000
The number of people who could die if the country fails to flatten the curve

On Sunday, Health Minister Zweli Mkhize said the number of confirmed Covid-19
cases had risen to 10 015.



Eight more people were also confirmed to have died of the virus, bringing the
number of deaths to 194.

A total of 341 336 people have been tested for the virus across the country.

The Western Cape has recorded the highest number of cases, with 5 168 people
testing positive for Covid-19.

Gauteng lags behind the province with 1 952 cases of Covid-19.

The government has identified other hotspots, including metros in Johannesburg,
Tshwane, Ekurhuleni, eThekwini, Gingindlovu and Buffalo City.

After a meeting with Western Cape Premier Alan Winde, as well as seven
professors, epidemiologists and doctors working on the province’s response to
the outbreak, Mkhize said it was clear that the province was a hotspot – and, as
such, it required a containment strategy.



He expressed concern at the countrywide shortage of diagnostic test kits.

Earlier in the week in Rustenburg, North West, Mkhize had said he was “pleased”
with the countrywide screening of citizens, adding: “As of May 5, 8 216 605
citizens have been screened across the country.” Mkhize has attributed the
success in pushing back the Covid-19 peak infection rate to the lockdown.

However, he has cautioned that the storm could still arrive earlier.

“In the worst-case scenario, we can expect that to be earlier in July. But if we
were to prolong the lockdown longer than that, it would not proportionally
increase the extension of the peak by many more months. So, the difference is
not going to be too much … Our timing was perfect. We had a bit of an advantage
and time to plan,” Mkhize said.

“The focus did indicate that there was a need for us to do the lockdown to slow
the rate at which the infection is spreading, therefore pushing the peak to a
few months later, and this has been achieved. Of course, it means the infection
is still going to rise, but it won’t increase to the same level that it would
have if we did not do anything.”

we need to start easing the lockdown bit by bit, depending on where the
high-risk areas are
Health Minister Zweli Mkhize

However, added the minister, “we cannot continue with the country locked down
forever … we need to now get people to begin to understand the change in
behaviour that allows us to get back to normal economic activities”.

“For that to happen, we need to start easing the lockdown bit by bit, depending
on where the high-risk areas are,” he said.

“In this case, we are actually looking at how to reclassify each and every
district so that we know what more we can do in which area.”

Mkhize appeared to agree with the strategy of a focused approach, as suggested
by the experts, saying things would be done differently, depending on each case
and situation in various parts of the country.

“In some areas where we think the risk is too high, we need to contain it a bit
before we can actually open up normal activities. So, a different approach will
be seen because we are dealing with a practical and dynamic situation … The
districts are not the same,” Mkhize said.

Citing the Free State as an example, he explained how the situation in that
province was being dealt with: “If you asked me a few weeks ago, I was very
worried about the Free State … I thought it was going to be an epicentre, like
Wuhan in China. We went there and dealt with it, and we actually got it
contained in a way that stalled the infection, in a manner that is now different
from what we have seen in the Western and Eastern Cape. We don’t have a
one-size-fits-all situation.”

Mkhize expressed the same sentiments yesterday at the meeting with Winde and the
medical professionals.

He said it had been agreed that the approach going forward would require a
differentiation and delineation of various areas into blocks, and that stricter
restrictions might need to be applied to areas in the Western Cape with higher
numbers of cases.

“Cluster outbreaks in the Western Cape are happening in commercial settings such
as factories, supermarkets and such, which have had to close down. This means
that there are higher rates of infection … this means that we need stricter
restrictions in these areas,” he said.

Commenting on the need to quarantine people who had tested positive for the
virus to prevent them from infecting others, Mkhize said this was an area of
concern.

He said that a resolution taken at the meeting was that every patient testing
positive in the province would be hospitalised, even if they were not sick [in
other words, were asymptomatic].

He added that the province would increase its field hospital capacity to keep
Covid-19-positive people from contacting others while they were still
infectious.

According to Dr Kerrin Begg, a specialist in public health medicine, community
screening has not been as effective in detecting cases as was hoped.

She attributed this to provinces – save for the Western Cape – having focused on
testing symptomatic people as opposed to asymptomatic people.

READ: WC remains Covid-19 epicentre as confirmed infection cases in SA edge
closer to 10 000

She pointed to new global evidence showing that, in 50% to 80% of cases, people
will not show any symptoms at all, meaning they will not be ill.“What we were
hoping, in the active detection of cases from community screening, was that our
case detection would go up. But it has been quite low – only 1%. We are not
being very effective in detecting cases that way,” Begg told City Press this
week.

“When we look at the Western Cape, case detection is much higher than in the
rest of the country, particularly in the past two weeks. Overall, over the past
two weeks, it has been over 10%, which is five times what the other provinces
are picking up.”

Mkhize has expressed concern about interprovincial movement between the Western
and Eastern Cape after lockdown restrictions were lowered to level 4 to allow
people to travel back to their provinces of work or residence.

Just this week, 56 people travelling from the Western Cape to the Eastern Cape
tested positive for Covid-19 after being tested at the borders. The figure has
since increased to 80.

On Friday night, Mkhize said: “With interprovincial movement between these
provinces being an issue, it will be crucial for us to understand the dynamics
driving the epidemic in this region and assist where necessary.”

However, Begg said that the surge in cases was always going to come; it was just
a matter of when – and it appeared that the Western Cape’s surge had come before
the rest of the country.

“What’s happening is that the Western Cape is detecting at a higher rate, either
because the province does indeed have more cases in reality, or because the
other provinces are not being effective in detecting cases,” Begg explained.

“Furthermore, global evidence is showing that 50% to 80% of people who contract
Covid-19 will not have any symptoms and, in light of that, the Western Cape has
been more intentional with screening in workplace-based clusters, and has tested
even asymptomatic people – which is why we have seen more people test positive.

“We did a review this week and saw that at least a quarter of cases in the
workplace clusters [from essential service areas such as hospitals, supermarkets
and police stations] are asymptomatic cases.”

Using a baseline scenario that assumes that one infected person is likely to
infect three others, and that 75% of infected people present as asymptomatic, a
team consisting of some of the country’s leading healthcare actuaries developed
a model to assist their profession’s stakeholders in understanding the impact of
Covid-19.

Deaths may exceed 48 000 within the next four months if government does not
remain strict about to flattening the curve
Lusani Mulaudzi, a healthcare actuary and the president of Assa

Lusani Mulaudzi, a healthcare actuary and the president of Assa, said that the
model was based on the key mechanisms of a pandemic, namely susceptibility,
exposure, infection and recovery.

“Conservative modelling indicates that the peak is only likely to be reached
between August and September, depending on the effectiveness of lockdown and
other non-pharmaceutical interventions (NPIs). Deaths may exceed 48 000 within
the next four months if government does not remain strict about to flattening
the curve.”

According to Mulaudzi, the most optimistic scenario assumes that the lockdown
initiative reduces the reproduction number (a method of rating the ability of
the virus to spread) to 1.5 and that NPIs after the strict lockdown period
result in a reproduction number of 2.1.

In this scenario, hospital bed usage would peak at 70 000 between August and
September, and requirements for intensive care unit beds would be just over 10
000. Expected cumulative deaths stop short at just over 48 300.

“We have to caution that the projected mortality figures are sensitive to the
mortality assumptions made. Views on the Covid-19 impact on mortality rates
still vary widely and, as more data becomes available, we may find that the
actual mortality figures are significantly different to what has been
projected,” he said.

An projection prior to the lockdown was reported on by News24 in March. Prepared
by the SA Centre for the Epidemiological Modelling and Analysis in conjunction
with the National Institute for Communicable Diseases, the model showed that
between 87 900 and 351 000 people would die from Covid-19 if no interventions
were made.

These projections were reportedly behind what catapulted the state into action
to impose stringent regulations.

Shabir Madhi, a professor of vaccinology at Wits University, said the country
was still at an early stage of the pandemic, even though the case numbers seemed
“frightening”.

READ: Covid-19: Doctors concerned about test results delays

“It is only in the next few months that we are going to see many, many new cases
peaking, probably at up to 6 000 new cases per day come July and August.”

Madhi said that between 15 000 and 20 000 people should be tested daily.

“We are not testing at scale in South Africa. Another big problem is that it’s
taking five to 10 days for the results to get back from the National Health
Laboratory Service. It is a waste of resources to be testing when it takes five
to 10 days, because, even if the person was positive five to seven days ago,
they probably are no longer infectious. And it is too late to try to find all
those who that person had contact with in those 10 days.”

Begg said it was time the country moved to stage five of the national response,
in accordance with the presentation given last month by epidemiologist Professor
Salim Abdool Karim, chairperson of the ministerial advisory committee on
Covid-19. This would mean homing in on the hotspots.

She said: “We have learnt lessons from the Ebola outbreak – for instance, that
you can isolate mini areas like in an informal settlement, where you can isolate
an area and let people move around, but only in that block. This, rather than
have the whole country in lockdown when a farmer in De Aar has so little risk of
being infected. That’s what hotspot management is, which is what the professor
explained.



“Then we make sure we are ready for the [infected] people, which is what we’ve
been doing by creating field hospitals and managing healthcare worker exposure.
Those are things we should be putting our limited time and money into.

--------------------------------------------------------------------------------




VUYO MKIZE

Health journalist | City Press





+27 11 713 9001



vuyo.mkize@citypress.co.za



Media Park, 69 Kingsway Road, Auckland Park





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Poloko TauJournalistCity Pressp:+27 11 713
9001w:www.citypress.co.za  e: poloko.tau@citypress.co.za      

 

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