Clinician Recommends Tailored Response to SA’s Unique COVID-19 Circumstances

We have to understand “our epidemic” as a unique thing and build our own tailored response, says clinician and UKZN COVID-19 war room Epidemiologist Dr Richard Lessells.

Speaking at the latest data@breakfast Friday morning webinar, Lessells provided a general update on how the epidemic was unfolding in South Africa and challenges that could be expected during the gradual easing of the lockdown.

Lessells noted that the number of confirmed COVID-19 cases continued to increase steadily, but not exponentially as was the case before lockdown. ‘If we consider South Korea, they flattened their curve due to large scale testing,’ he said. ‘We are scaling up testing and also expanding the reach with active case findings in communities. But it is still early days to judge success.

‘Personally, I think it is unlikely that we will replicate the success of South Korea and get to zero deaths because we have other challenges, such as a stretched public health system and a population with a high prevalence of HIV and TB. But because of our very early response we have bought time. This has enabled us to prepare and get ready for an increase in cases. Many facilities are now prepared and operating.’

With regard to progress with testing, Lessells said South Africa had significantly scaled up the number of tests it was conducting, which in the past week had been on average of 7 000 tests a day. This trend was driven by both increased capacity and demand, with the majority of tests conducted switching from private labs to the National Health Laboratory Service (NHLS). South Africa’s current rate of testing stood at around 40 tests per confirmed COVID-19 case, ‘which places us somewhere in the middle compared with other countries and their rate of testing.’

‘With tests being conducted on people displaying symptoms of acute respiratory illnesses, and with 2%-3% of those tests coming back positive for COVID-19, what it is also telling us is that there are a lot of other respiratory illnesses out there,’ he said.

Lessells touched on the particular challenge highlighted by outbreaks in hospitals, prisons and other institutions in South Africa. ‘The worry is that these institutional outbreaks become amplifiers of transmission in the community,’ he said. ‘We have had some outbreaks in our hospitals and we expect to see more of this. What this is telling us is that the virus can spread easily in any environment where there is close contact between people. It highlights the importance of the government’s hygiene messages.’

‘We have to think what we can do to protect our healthcare workers and other essential workers.’

Lessells elaborated on what was known so far about COVID-19 deaths in South Africa and compared the country’s rising number to those of other countries. ‘With only 75 deaths as of today (24 April) it is still early days here,’ he said, ‘but the graphs show two different international trajectories: a high European/USA one and a lower Asian/Australasian one. South Africa seems to be following the low growth rate at the moment, again because of the very early response.’

Lessells advised that while deaths were concentrated among the elderly and those with comorbidities such as high blood pressure, diabetes and lung disease, ‘in other countries we are seeing young healthy people dying, and also seeing deaths of health care workers. It is important for the public to understand this’.

Lessells said that it was too early to show to what extent COVID-19 was affecting trends in death from all causes in the country, but this was something the South African Medical Research Council was now monitoring. He cautioned that with the advent of winter months and the influenza season there would be a natural increase in deaths, ‘which will bring its challenges.’

‘What the mortality stats do show us is a decline in trauma deaths, namely deaths from traffic accidents and homicide. This is one positive side-effect of the lockdown,’ added Lessells.

Words: Sally Frost

Image: Supplied