The new mantra that almost every country affected by COVID-19 is holding on to and promoting is: Flatten the Curve. In essence, flattening the curve is mostly about slowing the virus’s rate of infection, and this is something that South Africa has managed to do in quite a short space of time (for now).
This is according to epidemiologist and infectious disease expert Professor Salim Abdool Karim who, alongside the Minister of Health Zweli Mkhize, gave a presentation on the status of COVID-19 in South Africa earlier this week.
Where is SA now?
The country is currently sitting on 2 415 positive COVID-19 cases, 27 deaths, 410 recoveries with 87 022 tests conducted (as of 15 April 2020). Prof. Karim, who’s also heading up South Africa’s response to the viral outbreak, started his presentation by looking back at what was expected at the beginning of the viruses spread.
“When you look at the South African epidemic, we were on an upward trajectory [and] we were entering that exponential curve where the number of cases was increasing rapidly,” he says.
“On 26 March, the curve took a turn and instead of continuing a straight and upward curve, we began to see a decline in the number [new] cases. We reached a stage of what we call a plateau.”
The big question: why?
Prof. Karim noted that no other country has seen this kind of turn in the time that South Africa has. He offered three possible reasons as to why this has been the case for us, with one of them being the most viable.
The first possible reason outlined for the decline is that maybe South Africa isn’t testing enough people, but he thinks that this is unlikely to be the overarching reason for it.
“Over the two weeks in which we saw the epidemic go into a plateau phase, we see a continual increase in the number of tests being undertaken. This reduces the likelihood that it’s simply a problem of lack of testing,” he said. “While it may be a contributor, it’s certainly not a dominant one.”
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The second possible reason the professor outlined was that not enough people in underprivileged circumstances are being tested, but he also doubts that this has been a significant factor in the decline.
“Just at the time that we saw the plateau in the South African trajectory is the point at which the National Health Laboratory Services (the NHLS offers public testing) sharply increased the number of tests it is doing,” he said. “So, it’s not because we’re not testing in the townships and communities.”
The third, and the most likely reason that we’ve seen the South African curve flatten, is the result of the measures that have been implemented, including the restrictions placed during the national shutdown and the national lockdown. The next question is how?
The three waves
Prof. Karim explained that the infections in South Africa happened in three waves. The first wave of infection came from individuals who had travelled overseas, acquired the virus and returned to South Africa infected.
“This wave has [essentially] come to an end because we stopped international travel.”
The second wave of infection included the people these travellers interacted with, and the third wave of infection includes general community transmission – this is when those who interacted with the travellers come into contact with the general community.
“We expected to see a rapid take-off in the number of infections that occur [from the third wave], but that didn’t happen,” he said. “We are just not seeing the wildfire spread that we expected.”
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Now, each infected person on average is only infecting one other person, which the professor says is the key reason that we’ve seen our curve straightening. This is the exact reason why all the guidelines and interventions were put into place.
“When there’s a lockdown, each infected person becomes a dead end (so to speak); they don’t transmit [the virus] to others because they’re not interacting with them,” he said.
“Right now we’re not even seeing much evidence of clinical disease; we’re not seeing large national increases in the amount of respiratory distress.”
In short: If community transmission is low, [new] cases decline and vice versa.
But our flattening curve is unlikely to be on the downturn for too long.
What’s coming?
Going forward, Prof. Karim highlighted Johannesburg, Cape Town and eThekwini as the three hubs where the virus could spread rapidly as most infected people are in these regions. With all the above said, and the unique success South Africa has achieved in controlling the spread of the virus so far, the road is far from over and things are probably still about to get worse.
“We probably can’t escape the exponential part of this epidemic, but the lockdown has bought us time to become more proactive. It’s also dampened the curve so that when we see the peak, we won’t see it in the same [way we would have] if we didn’t have the lockdown and the other interventions we implemented,” Prof. Karim said.
The 8 stages of response
But the country does have a plan in place broken down into eight stages. We’re currently on the third and fourth stages, which focus on the lockdown and active case-finding. Here are the eight stages:
Stage: 1: Preparation
This includes community education, establishing lab capacity and surveillance.
Stage 2: Primary prevention
This includes social distancing, hand-washing, closing schools, reducing gatherings and closing the borders to international travel.
Stage 3: Lockdown
This is to intensify the curtailment of human interaction.
Stage 4: Surveillance and active case-finding
This has been a measure unique to South Africa and involves health workers being sent out to screen and test vulnerable communities.
Stage 5: Hotspots
This includes surveillance to identify and intervene in hotspots and spatial monitoring of new cases.
Stage 6: Medical care
This includes surveillance on caseload and capacity, managing staff exposures and infections, building field hospitals for triage, and expanding ICU bed and ventilator numbers.
Stage 7: Bereavement and the aftermath
This includes expanding burial capacity, placing regulations on funerals and managing psychological and social impact.
Stage 8: Ongoing vigilance
This involves staying on top of the virus and infections.
Let’s all continue to play our part by respecting the lockdown rules, social distancing, washing our hands, not touching our faces and wearing face masks when possible. None of it is done in vain.
You can read through the presentation for yourself .
