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South African scientist, epidemiologist and director of the Center for the AIDS Research Program (CAPRISA), Professor Salim Abdool Karim. Photo: Dean Demos
A proactive approach to combating community transmissions of coronavirus infections has given South Africa the edge for now in the war on the global epidemic, and while the blockade appears to be working, the country has a long way to go in fighting the illness.
South Africa is showing a unique trajectory of coronavirus infection, with provisional data showing that government measures to reduce the infection rate are working.
This was the message from the chairman of the South African Covid-19 Ministerial Advisory Committee, Professor Salim Abdool Karim, during a Zoom meeting organized to explain some of the data used by the government to make decisions related to the epidemic.
Abdool Karim reiterated that his main concern was for the two to 2.5 million South Africans who are HIV positive but not on antiretrovirals and especially some 500,000 of them with low CD4 counts. These counts are a measure of a specific type of white blood cell that is indicative of a person’s immune function.
He said that due to early and proactive government interventions, South Africa now has a unique trajectory, as community transmission has so far been reduced and continuing at a much lower rate than initially expected.
“We probably can’t escape the exponential curve [leading to a rapid increase in cases] but the blockade has bought us time. We cannot abruptly end the blockade. It will undo everything we have accomplished, ”he added.
The Minister of Health, Dr. Zweli Mkhize, who chaired the meeting, said that the pandemic behaves the same way around the world: it is up to communities to change their behavior and thereby influence the way in which it is triggered. outbreak.
He also announced the latest SA figures in the pandemic: More than 83,000 tests have been completed, and 2,272 people tested positive. That’s a 99-case increase from Sunday.
Mkhize also announced two other deaths: a 68-year-old man in the Western Cape with underlying diabetes, hypertension and chronic kidney disease, and a 57-year-old man in Gauteng.
Abdool Karrim said the data shows that in each country, once there were more than 100 cases, the virus spread at a rapid rate with a high number of new cases registered. He said that in these cases hospitals were overwhelmed by the number of sick people seeking help.
He added that South Africa was initially on a similar upward trajectory, but this changed on March 26 when the shutdown began.
“We started to see a decrease in the number of cases. They have reached a plateau. It is very significant, because March 26 was the day the blockade began, “he said.
He said that if the path of the outbreak is compared to that of the UK, it is clear what difference the blockade made. He said that during the first few weeks the number of new cases in South Africa was practically the same as in the United Kingdom, but as of March 26 the number of cases in South Africa did not continue an upward trend, despite the fact that in the United Kingdom yes.
“In each of the countries, we believe that the number of cases continued to increase. There is not a single country where we have seen this type of turn, “he added.
“Our epidemic trajectory is unique.”
Abdool Karim said they had three theories about this. The first was that very few tests were done. The second was that there was insufficient evidence in the public sector for patients without medical care.
He said that although testing was restricted at first, there had been a continuous increase and the number of tests in the public sector had taken off since the closure.
“There has to be a third explanation,” he said. “The blockade is about reducing community transmission.”
He explained that the first wave of infections that hit the country was from travelers who brought the virus from outside. The second wave was those who had contact with the travelers, including the medical personnel who attended them. He said what they did not expect was that there would be no widespread community broadcast.
“When the virus enters a community, it spreads like a forest fire,” he said. “You would expect an exponential increase in cases.”
He said that, generally speaking, they are not seeing that an infected person is infecting many. Until now, they were seeing an infected person infecting another person.
“Those are exactly the reasons for all our measures: hand washing, social distancing and confinement – we want each infected person to become a dead end. [for further infections]. “
He added that his greatest concern was the three high-density centers: Greater Johannesburg, eThekwini and Greater Cape Town.
“What we hope is that the number of new cases is constantly decreasing and disappearing. However, this is highly unlikely. A more likely scenario is that we will stop community broadcasting. Once we finish the blockade, and we must remember that none of us have immunity against this virus, we are all at risk. That is why as soon as the opportunity arises for this virus to spread, we will see the exponential curve again. ”
He said that while South Africa had become the first country in the world to keep community transmission at a reasonably low level, he thought it was highly unlikely that the country would escape the exponential threat from the virus.
“Unless we have a special mojo to protect ourselves,” he said.
“This virus has a long period of infectivity. It will spread very quickly if people interact with each other. [Through lockdown] We have gained time. We have a unique component to our response: We are going out and we are proactive: we find the cases before they get to the hospital. ”
Abdool Karrim added that a successful closure strategy had bought time for the country, which would mean possible access to easier and faster tests, a vaccine and treatments.
“Next week is critical. This is when we will see what community transmission of the virus is doing. If these passive cases [patients that seek medical help] is 90 or more on average per day, we will have to continue blocking. If we see that the cases fall between 45 and 89, then we observe active cases [those found by health workers]. If these are 1: 1,000 or less, then we can ease the block. ”
He said that by ending the blockade too abruptly, the country would risk undoing the good that was done.
“We have to plan a systematic relaxation, starting with the transportation hubs and then moving down.”
He added that his response to the epidemic would not end with closure decisions.
“In the next stage, we find the clusters of infections in our communities. I remain concerned about funerals that lead to the spread of the virus. We must deal with these problems. ”
He said the next stage was to make sure that the medical response is as good as possible when patients start arriving at the hospital.
The next stage, he said, was continuous surveillance.
This is best explained using the metaphor of stopping small flames to avoid a raging fire.
“You need people on the ground looking for fires. If we see one, we can avoid it. If we are too late, then we have to put out a raging fire. We will try to stay one step ahead of viral spread. It is a difficult task. We are not going to wait for patients to come to the hospital. ”
He said that aside from the hospital surveillance program, he was also thinking of a monthly national surveillance day in which small samples of people in schools and large companies were analyzed.
Mkhize said the plan was always to flatten the curve for new infections.
“Many models are being made to advise our actions,” he said. “We look at the impact on the economy. Many factors are being considered. This includes the social impact of both the outbreak and interventions such as the blockade. There are many contributions behind the decisions announced by the president. ” DM
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