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A leading epidemiologist warned that the Covid-19 epidemic is evolving in the country.
This means that there has been a shift from importing cases to low-level local transmission whereby people, who have not yet been tested for the virus, are passing it on to their families and other contacts.
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This is according to Professor Cheryl Cohen, co-director of the National Center for Respiratory Diseases and Meningitis at the National Institute of Communicable Diseases and associate professor of epidemiology at the University of the Witwatersrand, who spoke to News24 in an extensive interview on Thursday. .
And as winter approaches, millions of South Africans will catch the flu, and in the process, identifying Covid-19 cases would become “very, very difficult,” Cohen said.
There are almost certainly cases in our communities that have yet to be identified, a fact that President Cyril Ramaphosa alluded to in a televised speech to the country Thursday night in which he announced a two-week extension to the restrictions.
Ramaphosa said the current drop in new daily infections, up to 4% from 42% a day before closing, was evidence that it was working.
So far, 2,028 people have tested positive for the virus and 25 have died.
Cohen said the drop in the new cases was attributable to the travel ban and that the true effects of the blockade would be measurable two weeks from now.
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According to her, the blockade had given the country time to prepare and launch massive test campaigns aimed at identifying cases in the communities, finding hot spots of infections and taking measures to prevent further spread in those areas.
Test levels have yet to reach ambitious levels of more than 30,000 per day, as envisioned by the National Service of Health Laboratories.
“We look forward to the [number of] Cases may arise. It is also accepted that the number of cases that we see reported is not all cases. No one says they are all cases in SA, “said Cohen.
“The epidemic is, in a sense, evolving. What we saw at the beginning, with the exponential increases in numbers, the vast majority of that was the importation of cases and reflected, in fact, the exponential growth in other parts of the world that are ahead of us on the curve. ”
Sting in the tail
The mildness of symptoms that would arise in most people who contract the virus, Cohen described as Covid-19’s “tail bite”.
Evidence and studies from other countries showed that approximately 80% of people who contracted Covid-19 would only have mild symptoms, but would still transmit the virus to others.
Other coronaviruses, such as SARS or MERS, have a higher mortality rate, but were easier to identify due to the severity of symptoms, making it much easier to contain. Those coronaviruses were also only contagious later in the onset of symptoms.
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Covid-19 can be transmitted early, sometimes days before any signs become clear.
“We are in that phase now. We know that there is likely to be local transmission at a low level and we know that although we are greatly expanding the evidence, it is very difficult to identify each case, there really are tens of thousands of people every week in South Africa having a fever or cough, “said Cohen.
Professor Cheryl Cohen (left) with Health Minister Zweli Mkhize during a press conference on March 5. Photo: Jan Gerber / News24
With the rapid winter approach and the increase in influenza infection rates, case detection would be made even more difficult because the symptoms of Covid-19 are nonspecific and reflect the symptoms of other normal respiratory diseases such as influenza.
Many people would not seek to be tested for Covid-19 or receive medical treatment.
“In that ocean of people with respiratory illnesses, it’s not easy to find Covid cases,” said Cohen.
In September 2019, a study that co-authored the burden of the flu in South Africa found that, on average, 10 million people in the country contract the flu each year.
“The world was waiting and preparing for another influenza pandemic,” said Cohen.
Instead, the coronavirus outbreak has brought with it a virus that would equally affect rich and less wealthy communities.
Equal Opportunity Killer
The first confirmed case of Covid-19 in South Africa on March 5 was a Hilton, KwaZulu-Natal, a man who had returned from a ski trip in Italy on March 3. He was part of a group of 10 travelers who had returned to the country.
His wife became the second confirmed case and both recovered, but in late March, South Africa was seeing an increase in daily confirmed cases of between 100 and 200 cases per day.
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Since closing, the number of confirmed daily cases has dropped to between 20 and 90 per day.
Most of those early cases were due to travelers returning from the US. The United States, the United Kingdom and Europe, which at that time were already experiencing exponential infection rates that had not been detected.
“There were some local broadcasts expected of those cases to your contacts, but they didn’t really reflect exponential expansion in South Africa. It was reflecting a lot of import,” said Cohen.
Residents of Alexander’s informal settlement are being tested by Covid-19 by a health worker. Photo: Nomvelo Chalumbira
He added that much was done to identify those cases and trace their contacts to contain and reduce virus transmission, and these efforts likely had a substantial impact.
“But what we also know from what we have seen in other parts of the world and what we know about the disease, because this disease can present symptomatically and because it cannot be collected at the border, so it is necessary to depend on people who show up and isolate themselves afterwards, we know that there are likely to be additional cases that we haven’t picked up.
“Those additional cases may have spread the disease to his contacts, which would lead to local transmission that we know is happening.”
A study by the University of Texas at Austin published this week found that for every identified case, there could be up to 50 unidentified cases in some parts of the United States. A hesitant early response from the Trump administration has resulted in an explosion of cases in the United States. New York has been particularly affected.
Cohen mentioned similar studies that indicated fewer hidden cases, about 10 for each identified case.
Poor and wealthy alike at risk
If the country saw a significant increase in cases, both the wealthy and less wealthy would be equally affected, he said.
There was concern that the impact of the spread would be more difficult to contain in areas where people live in overcrowded conditions, such as informal settlements.
But this was clearly on government radar, and work began weeks ago to identify facilities where less affluent people could be taken to self-isolate if they were found to be infected with Covid-19.
“I think this is a respiratory disease and therefore there is a possibility that it will become more widespread within SA as it has in Europe and America, and in other countries. We know from other respiratory diseases … that they have the Same effect between richer and less affluent sectors of the population.
“What is very surprising about coronavirus disease, because of its mode of transmission, all communities have the same risk of contracting it.”
Cohen warned against complacency and emphasized that this virus would be with us for some time until a vaccine is found that could take up to two years.
“If the disease becomes widespread, it is very likely to affect all sectors of society. But obviously there is concern that the impact, the rate of spread, may be more in a crowded environment.”
The national blockade to contain the spread of Covid-19 is working. President @CyrilRamaphosa It is imposing additional measures to mitigate the impact of this pandemic. #LockdownSA # Covid_19SA pic.twitter.com/iX7kNVPsxE
– Presidency | South Africa ???? (@PresidencyZA) April 9, 2020
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