SA’s battle plan for COVID-19

Government has developed an eight-stage plan to tackle COVID-19

South African epidemiologist and infectious diseases specialist Professor Salim Abdool Karim believes that government's novel coronavirus (COVID-19) interventions – most notably the national lockdown – were successful in slowing down the viral spread.

However, he cautioned that as soon as the opportunity arises for the virus to spread, South Africa could see an abrupt increase in the infection rate. On a positive note, he said the lockdown has bought us time.“We cannot end lockdown abruptly. It will undo all we have achieved.”

At a briefing held with Health Minister Zweli Mkhize in the first week of April, Professor Karim, the chairman of the Ministerial Advisory Group on COVID-19, gave an overview of how COVID-19 originated, what the early trajectory was in South Africa and the country's eight-stage plan for tackling the virus, among others.

Professor Karim said that the world's first cases of COVID-19 probably occurred in November 2019, but the first reported case was on 19 December in Wuhan, China.These initial cases emanated from a seafood market in

the area where pangolins, which are among the things being considered as the source of the virus, were sold.

“In the short four months that we've known about the virus, we have seen it go from a small outbreak in relation to the seafood market to a situation where we have just over 1.8 million people infected.”

This gives some indication of how rapidly the epidemic can grow.

“When we look at each country and the way in which the epidemic grows, we can see that once a country reaches 100 cases, the epidemic grows at a rapid rate – what we call an exponential curve – that reflects the high number of new infections that occur almost daily.

“When you have this exponential curve and new cases increase rapidly, people need medical care and the medical system gets overwhelmed.”

People infected with the virus generally show symptoms seven days later, he said.

According to Professor Karim, South Africa was on an upward trajectory and entering the exponential curve before lockdown. On 26 March, the day lockdown commenced, South Africa began to see a decline in the number of cases. Following this, the country reached a plateau, where it was seeing a similar number of cases every day – between 60 and 70.

He explained that when South Africa reached 100 positive cases of COVID-19, it seemed to be following the same trend as the United Kingdom.The initial trajectory of the epidemic in these two countries showed similar numbers. However, after lockdown, South Africa's numbers declined and the curve started to flatten.This is a very different situation to other countries, such as the United Kingdom and China.

“I've also compared our epidemic curve to some of the most successful countries that have been able to make a marked impact on the growth of the epidemic, particularly South Korea, Japan and Singapore. No other country has been able to reach a stage where you get that kind of plateau.”

Why is SA different?

Professor Karim said there are three possible reasons why South Africa's trajectory is different.

The first, he said, is that we could not be doing enough testing, especially in the public sector. If this is the case, we could not be getting a true sense of what the epidemic is doing in our poor communities that don't have medical aid.

The second is that the reduction of cases could be genuine.“The overall number of tests increased in the past two weeks.That reduces the likelihood that it's just simply a problem of a lack of testing.There has to be a third explanation… It's most likely due to some genuine effect… It's not something we can say definitively, but we can say that it's the likely situation. We still need to do more in terms of testing.”

The first wave of cases in South Africa came from people who