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8 DIFFERENT MODELS PREDICT HOW CORONAVIRUS CASES COULD INCREASE IN SOUTH AFRICA

GroundUp22 May 2020
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A week ago many were complaining about the lack of published models by
government to explain Covid-19 decision-making. On Thursday the Department of
Health hosted a Zoom call in which more models were presented than could fit on
a Milan catwalk.

Some models are useful. If modellers carefully explain their assumptions and
present multiple scenarios, we can get a better understanding of the epidemic’s
possible trajectories, or the potential of different interventions to reduce the
number of infections.

But models, especially because they are surrounded by fancy equations, can give
a false sense of certainty.

No one truly knows how the epidemic will play out. We humans, in contrast to any
other species, have an insatiable desire to know the future.

But we can’t. We can only make educated guesses based on the limited information
at our disposal, and when it comes to Covid-19 that information is still very
limited indeed.

Some common uncertainties that stand out in the models are the rate of
asymptomatic infections, how infectious SARS-CoV-2 is, how effective various
interventions are, and the death rate.

A number of the models suggest that South Africa will not have enough ICU beds
for everyone who will need one. Estimates of Covid-19 deaths range from a few
thousands to several hundreds of thousands.

Here then is a very brief summary of each model and a link to more information
about it.

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

Government’s primary model

The South African Covid-19 Modelling Consortium mainly consists of researchers
from the universities of Cape Town, Stellenbosch, Wits and the National
Institute of Communicable Diseases (NICD). It is the main model that the health
department is using.

The model makes projections under optimistic and pessimistic scenarios with
epidemic peaks in August and July, respectively. It projects six months into the
future.

Under the two scenarios this model estimates between 34,000 and 50,000 deaths by
November, although the modellers stress the significant uncertainty about these
numbers.

“These projections are subject to considerable uncertainty and variability.
Estimates will change and improve as the epidemic progresses and new data become
available.”

The model assumes that after the lifting of hard lockdown measures, level four
remains in place for one month, and after that social distancing measures reduce
transmission by 10 to 20%.

Even in the optimistic scenario ICU capacity is exceeded by many thousands of
beds in August to September.

While they do not factor in the additional deaths that this will cause, it might
be considerable given that ICU bed capacity is about 3,300 and that the need for
ICU beds may exceed 20,000 to 30,000 at the peak of the epidemic.

The modellers estimate that dealing with Covid-19 will require R26 to R32
billion over the next six months, of which R10 to R15 billion will accrue to the
national health department.

South Africa’s health budget for this year is about R230 billion, and the
national department has allocated R20 billion to Covid-19.

(Note that government originally was using a very simple, but possibly no less
prescient, model developed by some of the members of this consortium, that we
described here.)

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

Actuarial Society of South Africa

On 29 April the Actuarial Society of South Africa warned that as many as 48,000
people may die of Covid-19 in the following four months if “government does not
maintain a strict approach to flattening the curve”.

The society also projected that the need for ICU beds may peak at 10,000,
significantly above the estimated 3,300 capacity.

The society is open about the very significant uncertainty in its model and has
indicated that it is being updated, with new projections to be shared soon.

This Powerpoint presentation of the ASSA model, dated 21 May, may indeed be an
update, but we’re struggling to read the graphs.

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

Van den Heever

A model by Alex van Den Heever of the Wits School of Governance looks at
strategies for keeping the epidemic suppressed, or, to put it technically, to
get R below 1 (see this explanation of R).

His model is not concerned with trying to predict the future. Some of the
interventions he considers are testing and contact tracing, lockdown, closing
borders, social distancing and workplace protocols.

He also considers the effect of cold and warm weather (other coronaviruses
transmit a bit less efficiently in warm weather so this is a reasonable
assumption for SARS-CoV-2).

Van den Heever has argued that if government is using a model that assumes R
goes above 1 (like the one we described above), then it has effectively given
up, because the epidemic will run out of control.

His model, on the other hand, envisages the switching off and on of a selection
of interventions as the epidemic is suppressed here and resurges there.

Vital to this strategy is good contact tracing, but Van den Heever has expressed
frustration at the poor quality of government’s test and trace strategy so far.

Van den Heever has described his model in detail here.

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

SABCoM

Most of the models of the epidemic are what’s called compartmental ones; they
divide the population into compartments (susceptible, exposed, infectious,
recovered, and so on) and then describe how people move between these
compartments with a set of equations.

A different kind of model is the SABCoM one developed by researchers at UCT.
This simulates how people move around and transmit or contract Covid-19.

The creators of this model deserve credit for making the computer code of their
model available online.

They have applied their model to each ward in Cape Town, but, as with the Van
den Heever model, rather than predicting the future, their main aim appears to
be to see what the effect of different interventions are on the epidemic.

Alternatives to lockdown exist, they write, but must be done properly. In
particular they emphasise the importance of effective contact tracing.

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

Other models

Auditing and consulting firm Deloitte has developed a model for Business for
South Africa (B4SA) to assist B4SA in its engagement with government. The model
projects the need for hospital beds, oxygen, ventilators, N95 masks etcetera.

The London School of Hygiene and Tropical Medicine has produced a model of the
South African epidemic that estimates 310,000 deaths if there are no
interventions (more than died of AIDS in South Africa in 2005, the worst year of
the HIV epidemic).

Introducing social distancing as well as “shielding” high-risk people from
infection, can reduce the number of deaths considerably, to below 100,000 if
implemented very effectively. Charles Simkins explains the model well on
Politicsweb.

A group called Pandemic Data Analysis estimates only 20,000 deaths with, as they
write, “a sense that we might bring it down or decide that it is the top of our
range.”

Researchers at the University of East Anglia have used Chinese and Italian data
to estimate the number of deaths in many countries for different infection
rates, corrected for age distribution, including South Africa. We’ve
previously explained their work.

By Marcus Low and Nathan Geffen. This article was originally published by
GroundUp. Read the original here.

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

Read: New police guidelines for South Africa’s lockdown – including what to do
when a person is not wearing a mask


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