Lifting the lockdown: this is the target

The lockdown won’t be lifted completely unless the number of daily new cases of Covid-19 drops below 44 – if health experts get their way. The alarming implication of this is that should SA not be able to get on top of the virus during the two-week extension announced by President Cyril Ramaphosa last week, the lockdown may be extended further. But socio-economic conditions will also influence the decision

The technical models used to tackle the spread of the virus was laid out on Monday night by epidemiologist Professor Salim Abdool Karim, chair of health minister Zweli Mkhize’s 45-member advisory committee on Covid-19.

Abdool Karim said it was clear that the lockdown and the social distancing measures imposed in the days before it was put into effect had slowed the spread of the virus and delayed a spike in infections. But putting an abrupt end to the lockdown would allow cases to increase rapidly. “We need a systematic approach to keeping infection rates low while easing the lockdown in stages,” he said.

The lockdown, which took effect from March 26, is at present scheduled to end on April 30.

Abdool Karim’s proposal is that a full lockdown can end once the daily number of new cases drops below 44, on average, for the week of April 10-16. Should the average number of new cases remain between 45 and 89 a day, with low community transmission in townships, a slow easing of conditions can take place. But at more than a daily number of 90 new cases a day the lockdown should continue.

In other words, what happens in the coming week is critical.

At present the average two-weekly rate of new infections stands at 72 a day. On Monday Mkhize announced 99 new infections, taking the total number of cases in SA to 2,272, with 27 deaths.

However, Mkhize said any decision about when to ease the lockdown would not be made without input from President Cyril Ramaphosa’s cabinet. “Socio-economic issues are also being looked at,” he said.

Abdool Karim has finally provided South Africans with some insight into the epidemiological models being used by the government, and the details were hardly encouraging.

For example, he pointed out that when the lockdown ends cases will increase. “The exponential curve is almost inevitable. ... Lockdown bought SA some time – four to six weeks – to delay the curve,” he said. This extra time has given the government a period in which to plan the building of field hospitals where people can be isolated who are sick but don’t need to be admitted to intensive care units (ICU), buy more ventilators and get hold of more protective gear for doctors and nurses.

Worse news is that whatever happens with the lockdown, those older than 65 (who are most at risk) ought to prepare for “voluntary lockdown” until after September. And they shouldn’t care for children, to reduce their risk. Younger people with pre-existing conditions are also, however, at a relatively high risk of dying from Covid-19.

But while people are holding thumbs for the number of new daily cases to drop below 44 so that the economy can restart, the reality is that new infections are more likely to rise.

A key part of Mkhize’s plan is increasing testing to give a better handle on where the virus is situated.

Importantly, the number of tests being conducted is increasing markedly in the public sector, which caters for the 85% of the population who don’t have medical aid. To date 21,290 tests have been handled by the state – about a quarter the total. The goal is to hike the number of tests the state deals with from 3,000 to 30,000.

Abdool Karim admits that until about 10 or 12 days ago testing was done only if people had symptoms of Covid-19 and had a history of travel. “The criteria were rigid and tight, to identify those likely to be positive. The situation today is very different – we can up do up to 50,000 tests a day. We are doing only 5,000-6,000 [in total],” he says.

In particular, there is now far more testing in densely populated townships. Mkhize’s team of scientists is using 28,000 community health workers to scour for cases in “hot spots”, to prevent the virus from spreading more widely.

Abdool Karim called this a uniquely SA approach. How it works is that community health workers go from door to door, asking people whether they have fever, cough, a sore throat or shortness of breath. People with one or more of those symptoms are tested.

Screening will also be done in areas where doctors are detecting pockets of increased occurrences of respiratory disease.

It’s a vital step, since the concern is that if the virus spreads too fast, SA’s fragile public health system won’t cope.

Abdool Karim said the concerns include an inadequate state ambulance service, a shortage of hospital and ICU beds, a shortage of ventilators and the presence of 3-million people who are HIV positive and not on antiretrovirals. In addition SA has between 350,000 and 450,000 cases of tuberculosis every year. Such people are susceptible to Covid-19, which also attacks the lungs.

And he warned that SA ought to prepare for grim consequences that include increasing burial capacity and dealing with the psychological aspects of grief.

Even though the presentation took place only late on Easter Monday, it will hopefully address a central criticism of Mkhize’s handling of this crisis, which is that his communication with the public about the models that are being used to predict the virus’s trajectory has been less than fully transparent.

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