The details you need to know from Professor Karim’s health briefing last night, Monday, 13 April 2020.
Adhering to lockdown rules will be vital this week if the nation hopes to return to normal life soon.
Health experts, using a scientific approach to determine if South Africa’s lockdown will continue, and to what extent, say the rate of community transmission during this week is critical.
Professor Salim Abdool Karim, a clinical infectious diseases epidemiologist, and chairperson of the Ministerial Advisory Committee on Covid-19, shared this insight into the science behind government’s intervention measures, and what South Africans can expect going forward, during a briefing on Monday.
SA’s unique epidemic trajectory
South Africa has achieved a unique Covid-19 trajectory, seeing a plateau in the rate of infections much earlier than other countries. This is in comparison with countries that have had significant success in containing the spread of the coronavirus.
“Once a country reaches about 100 cases, the epidemic grows at a rapid rate, which is called the exponential curve. Usually, when countries get into an upward trajectory, it just keeps going. As the number of new cases starts increasing rapidly, medical care systems get swamped and are overwhelmed,” explained Prof Karim. “South Africa was in an upward trajectory, entering the exponential curve but on March 26 the epidemic took a turn. We began to see a decline in the number of news cases reported and then we saw a plateau in the curve.”
Scientists studying the ‘flattening of the curve’ have disregarded the possibility this is a result of not enough testing being done.
“Lockdown has essentially reduced community transmission in South Africa. When Covid-19 spreads into the community, it spreads like wildfire. We are seeing cases but it’s not spreading like wildfire, which makes our curve quite unique.”
Community infection is a real threat: ‘There is no mojo to protect us’ – warned Karim
The fact that South Africa has managed to stay ahead of the curve until now, does not mean the country is out of the woods.
“As much as we have managed to keep community transmission at a low level, I have to tell you a difficult truth, South African cannot escape the worst of this pandemic, unless we have some mojo to protect us,” Karim said.
“Once we end this lockdown, 55 million people will be vulnerable to this new virus because none of us have any immunity. We have no vaccine. There is no treatment. That is when we are likely to see the exponential curve again.”
R0 will determine if lockdown will continue beyond April 30
The rate of infection or the R0, pronounced ‘R naught’, will be used to determine if the lockdown should continue. An R0 of one means, on average, each infected person transmits the virus to one other person. If the R0 is above 1, it is likely the lockdown will continue. If the number of new cases per day increases by an average of 90 cases or more, the lockdown will continue. The lockdown will also continue if even one in 1 000 people screened during the home visits are found to be positive for Covid-19.
Dr Karim cautioned against an abrupt end to the lockdown, advocating for the lockdown to be phased out in a systematic way to give the health-care system time to prepare.
Why is there a delay in the stats
Health Minister, Zweli Mkhize, has explained the stats shared with the public are not ‘live’ numbers. While each day’s confirmed Covid-19 numbers are tallied at midnight, there is a lag in the numbers being confirmed, as the Health Department awaits post-mortem results and verification of clinical reports before making the information public.
Prof Karim said a person who is symptomatic today, was likely infected two weeks ago. Two weeks into lockdown will, therefore, be a critical time to determine the actual rate of infection in South Africa. “This week, we need to follow the lockdown rules and monitor community transmissions daily,” he said.
The 8 stages of managing an epidemic
Government is already halfway through the 8 stages it has identified to manage the Covid-19 epidemic.
- Stage 1 – setting up laboratories.
- Stage 2 – declaring a state of national disaster, while encouraging social distancing, closing schools and closing borders to international travel.
- Stage 3 – curtail human interaction through the lockdown.
- Stage – on-going surveillance and actively identifying covid-19 positive patients through door-to-door screenings.
- Stage 5 – identifying hotspots where infections are likely to flare-up.
- Stage 6 – ensuring medical facilities are ready for a possible surge in the number of covid-19 cases.
- Stage 7 – dealing with loss of life and bereavement.
- Stage 8 – is to remain vigilant and to stay one step ahead of the virus.
Dr Karim compared stage 8 to putting out small fires to reduce the risk of a raging blaze. “If you don’t have people on the ground looking for fires, you won’t even know they are there. As soon as we see a little fire, we can douse those little flames. If we don’t, it will be much more difficult to put out a raging fire.”
Physician, Professor Glenda Gray, emphasised that containing the epidemic requires buy-in from the public at large. “The next couple of days will be critical as we try to contain the contagion,” she agreed.
What to expect post lockdown
Prof Karim recommends that a ‘voluntary lockdown’ that requires people over the age of 70 and those with underlying conditions be imposed after the lockdown is lifted. Learners attending school should not visit their grandparents as this could expose them to infection.
One day each month, 5% of health care workers will be required to participate in a door-to-door surveillance programme to monitor for new infections. Prof Karim further proposes a monthly ‘national surveillance day’ when random samples may be collected from schools, mines, prisons, and large companies for covid-19 testing. Eventually, there may be a rapid test available, which will be used as a surveillance tool.
Concluding his presentation, Dr Karim warned “an exponential curve is inevitable,” especially when taking into consideration the country’s large HIV positive population and the fact that these patients are immune-compromised. “Plus with the large number of TB patients, and dealing with Covid-19 infection as a time when we are entering flu season, means we will need an effective ambulance system, and field hospitals will be built in large cities including Johannesburg, Cape Town and eThekwini, so only people who need critical care or to be on a ventilator will be referred to a hospital,” he concluded.Department of Health✔@HealthZA
The community transmission will guide and determine the next steps in SA response #COVID19 and the #LockdownSA. The easing of lockdown depends on the number of confirmed cases per week. If cases are less than 44 per week easing of lockdown to be considered #CoronaVirusUpdate
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