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What needs to happen before the coronavirus lockdown is relaxed in South Africa

Jan Vermeulen13 April 2020

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The next four days will be critical in determining whether South Africa will remain under lockdown, or whether the lockdown regulations will be eased.

This is according to Professor Salim Abdool Karim, who was speaking at a public information session held by the Minister of Health Zweli Mkhize on Monday evening.

Karim is director of the Centre for the AIDS Programme of Research in South Africa and chair of the advisory committee on COVID-19 to Mkhize.

The reason this week is so important is because it is the third week since President Cyril Ramaphosa instituted the national lockdown on 27 March.

Karim explained that when someone tests positive for the coronavirus today, that reflects an infection from two weeks ago.

“From the time you get infected, you have a period in which you are in incubation that takes about 7 to 10 days,” said Karim.

Patients only go in to a doctor, clinic, or hospital when they start experiencing symptoms after the incubation period.

From there the patient needs to receive a laboratory test, and only when the results come back positive is the patient considered an active coronavirus case.

In other words, the new case numbers that come in this week will be a reflection of how effective South Africa’s lockdown has been.

Lockdown decision tree

Karim explained that South Africa’s coronavirus infection numbers currently show that the rate of local community transmission is much lower than expected.

However, they will only know by 18 April whether it is indeed true that the levels of local transmission are as low as they appear.

Currently, there are an average of 67 cases per day in South Africa. The 95% confidence interval of this average is 45 to 89.

“In other words, the true number of cases is between 45 and 89,” Karim said.

To decide whether the coronavirus lockdown in South Africa should be continued as-is, or whether the lockdown regulations should be eased, government will be looking at the basic reproductive number of the infection. This is also known as R0.

R0 is a measure of how many people an infected person is spreading the virus to, Karim explained. The aim is to keep R0 less than or equal to 1.

To gauge whether the R0 is acceptable, Karim said they will look at the average number of new positive coronavirus cases in South Africa for the period 10-16 April 2020.

He explained that the number of positive cases identified as a result of active screening will be subtracted from this average. Only passive cases will be considered for making the decision.

  1. If the average daily cases for 10-16 April is 90 or more, then the lockdown must continue. This is because the average number of cases is increasing, which means R0 is above 1.
  2. If the average daily cases is between 45 and 89, and the number of people testing positive after being screened for coronavirus is more than one in every thousand (0.1%), then the lockdown will continue.
  3. If fewer than 1 in every 1000 people being screened for COVID-19 test positive for the coronavirus, then the lockdown may be eased.
  4. If the average new daily cases is 44 or less, then the lockdown may be eased.

Don’t worry about large daily variations

Karim said to expect large daily variations in the number of new coronavirus cases in South Africa. This is due to active case-finding, and the timing of lab results coming in.

“You will see some large numbers and some small numbers… don’t let that bother you,” he said.

You have to look at the data over a period, which is why they are looking at a whole week at a time, stated Karim.

“We compare weeks with weeks, so that we’re comparing apples with apples.”

Lockdown can’t end suddenly

Karim also warned that the lockdown can’t end suddenly.

“We know that if we end the lockdown abruptly, we may run the risk of undoing all of the effort and the benefit we’ve achieved,” he said.

This is because you will be creating a situation where high-risk and low-risk people will be interacting, including traveling together on buses, taxis, and trains.

“We have to do something about that. We have to avoid that situation,” stated Karim.

“We have to think about and plan for a systematic easing of the lockdown, starting with transport hubs and then working our way down from the lowest risk to the highest risk.”

Latest coronavirus case numbers

Earlier this evening, Mkhize announced there were 99 new cases of the coronavirus in South Africa, bringing the total number of cases to 2,272.

The total number of tests conducted in South Africa currently stands at 83,663, which means 3,578 test results have been logged in the past day.

Mkhize also announced they recorded two more deaths caused by COVID-19 in South Africa.

While one of the deceased had an underlying health condition, the other case has raised concern as he was not in a risk group.