SA’s lockdown has bought the country time to prepare the health system for Covid-19, but there is no escape from the highly contagious virus – which could take months if not years to overcome, members of health minister Dr Zweli Mkhize’s advisory committee warned on Monday night.
“No one has encountered this virus. We have no immunity, no vaccine, no treatment. That means we are all at risk,” said Prof Salim Abdool Karim, the co-director of the Centre for Aids Research in Africa at the University of KwaZulu-Natal and chair of the minister’s 45-member advisory committee on Covid-19.
“We cannot escape, not unless SA has a special protective factor not present anywhere else in the world. Our population will be at high risk again after the lockdown because all of us are vulnerable,” he said.
Medical Research Council president Glenda Gray, a member of the advisory committee, said the Covid-19 epidemic would be with SA for months and possibly years to come.
“This is a long-term march, not a sprint,” she said.
Covid-19 has spread rapidly around the world since it emerged in China late in 2019, prompting a growing number of countries to order lockdowns to try to slow transmission of the highly contagious respiratory virus.
By Monday evening, more than 1.8-million cases and 116,000 deaths had been reported in 185 countries and regions, according to the Johns Hopkins University tracker.
The SA government has moved swiftly to try to slow the spread of Covid-19 after the first case was confirmed on March 5.
Ten days later, President Cyril Ramaphosa announced what were at the time Africa’s most stringent restrictions on travel and mass gatherings, which were quickly followed by a national lockdown that began on March 27. Initially slated for three weeks, the lockdown has now been extended until the end of April.
As of Monday, SA’s tally stood at 2,273 confirmed cases, with 27 deaths.
SA’s Covid-19 trajectory is unique, because unlike most other countries, it did not see an exponential increase in cases after its first 100 cases.
The most likely explanation was that the country had seen three epidemics: one among travellers, a second among their contacts and a third epidemic of community transmission. By the time the lockdown began on March 26, the first two epidemics had largely burnt out, and community transmission was not occurring at a significant level, said Karim.
An abrupt end to the lockdown would lead to rapid increase in new cases, he said.
Karim sketched what a “systematic easing of the lockdown” and the next stages of the response would look like. First would be to find where clusters of cases are occurring.
“We need to go in there; we need to slow it down. We have got to be very careful so that every hotspot that emerges we can deal with. Next is medical care … we need to be ready for when those cases come in.”
This, he said involved having the field hospitals for the “triage”, where a decision can be made on whether a person is sick enough to go to hospital, so that hospitals are not overwhelmed. The next stage is getting ready for the challenge of bereavement, which people must be ready for both socially and psychologically.
The final stage of the response is “ongoing vigilance”, to stay one step ahead of the response.
“This is a tall order. We are not going to wait for people to pitch up at hospitals.”
Ongoing vigilance will have several aspects: once a month 5% of emergency health workers will be tested. These are “the canaries in the coal mine who will show us where we are. Once a month we will have a national surveillance day in which a sample of schools, prisons, mines and big companies will be tested.
“We will aim for 5% sample. As rates go up we will want to do that more quickly,” he said.
“The identification of hotspots is paramount. We need to be vigilant and make sure we investigate each outbreak,” Gray said.
She emphasised the need to protect health-care workers, both physically and psychologically.
“They need adequate PPE [personal protective equipment], training and we must make sure they are supported both mentally and with the equipment they need,” she said.