Worst yet to come in South Africa - Coronavirus
The early measures taken by South Africa to contain the coronavirus outbreak have bought us time, but the worst is yet to come.
This is the warning from Professor Salim Abdool Karim, chairperson of Health Minister Zweli Mkhize’s COVID-19 advisory group.
To date, South Africa had a unique epidemic trajectory, with an initial exponential rise in cases and then a sudden decline and plateau.
This was not seen anywhere else in the world and is partly a result of measures implemented by the government and a relatively low number of coronavirus tests.
While this is good news for the country as it gives us more time to prepare, it does not mean that we will avoid the worst of the epidemic.
Karim said the scenario where the number of cases in South Africa continue to decline is highly unlikely.
Instead, he said the likely scenario is a delayed exponential growth of coronavirus infections in South Africa.
Karim said the government interventions have slowed the spread of the coronavirus, which means the curve has been impacted and we have gained some time to prepare.
The two graphs below show the unlikely scenario of declining cases and likely scenario of rapid growth after the lockdown is ended.
Preparing for the worst
Karim said because of the coronavirus is completely new, no-one has immunity against it.
“This puts all South Africans at risk as we have no treatment, vaccine, or immunity against it,” said Karim.
This means as soon as the opportunity arises for the virus to spread, we are likely to see the exponential growth curve again.
He explained one of the reasons why the coronavirus is so difficult to contain is because of the nature of the virus.
For a week before you start showing symptoms of the virus, you are infectious. This means long before you know you have the virus you can transmit it to other people.
“How do you fight something which you do not even know you have,” Karim said. “That is our one challenge”.
“One you show symptoms you remain infectious for another two weeks. You have this long period of infectiousness when you are spreading it around.”
He said evidence shows that the coronavirus can rapidly spread. On average, an infected person will infect between two and three other people.
This results in an exponential infection rate unless strict measures are implemented to curb the rate of infection.
Why the delay is important
Karim said the delay in the spread of the virus in South Africa is important to avoid a situation like the one in New York, where the health care system is overloaded.
South Africa now has time to flatten the curve. It also has time to prepare for the inevitable growth in cases and the increased load on hospitals and medical staff.
The country also has the opportunity to go house-to-house in vulnerable communities for screening and testing.
Other benefits of the delay are that new diagnostics which are quicker and simpler are becoming available and new treatments which emerge can be used.
Karim said only South Africa has been able to delay the impact of the virus. Other countries like the US, Italy, Spain, and the UK only responded when the virus was “on top of them”.