The chair of South Africa’s Covid-19 Ministerial Advisory Committee, Professor Salim Abdool Karim recently hosted a public engagement on Zoom in order to explain South Africa’s response to the Covid-19 pandemic.

The presentation has been acclaimed for being a comprehensive response to questions about the government’s response and the virus’s unique trajectory in South Africa. Here are some of the key takeaways from Professor Karim’s presentation.

The lockdown is working

Since President Rampahosa first announced the national lockdown in March, there has been some skepticism about the efficacy of this response in fighting the infection rate of the disease.

South Africa’s proactive response in shutting down international travel, and tracing the contacts of international travellers who have tested positive, has meant that the first wave of infection has been dramatically slowed down.

The nationwide lockdown is an attempt to slow down the local transmission of the disease and so far is working. Professor Karim stressed that testing has ramped up in recent weeks and thus the lower infection numbers cannot be attributed to a lack of testing.

The lockdown is based on these numbers

The lockdown is based on models that predict the spread of the disease. According to Professor Karim “This coming week is critical. This is when we will see what community transmission of the virus is doing. If these passive cases is 90 or more on average per day we will have to continue the lockdown. If we see cases fall to between 45 and 89 then we look at active cases [those found by health workers]. If these are 1:1,000 or below then we can ease the lockdown.”

The lockdown will not be abruptly stopped but rather would be a systematic easing of restrictions in order to keep track of new infections.

An exponential curve is still likely

Despite the need for hope and optimism, the country needs to be pragmatic about was is likely for the country. In the absence of a vaccine, exponential growth is still likely post-lockdown, and the government is having to make incredibly difficult decisions that balance the health of citizens with the potentially catastrophic effects on the economy.

By gaining time now, the country hopes to be in a better place to respond to the immense stress that the virus could place on the healthcare system.

There are 8 stages to South Africa’s COVID-19 response

The Covid-19 Ministerial Advisory Committee has outlined an 8-stage plan for the management of the disease in the country. We are currently in Stage 4 – and Professor Karim has indicated that we may only hit our peak number of cases in September of this year.

Stage 1: Preparation

• Community education
• Establishing lab capacity
• Surveillance

Stage 2: Primary prevention

• Social distancing & hand-washing
• Closing schools and reduced gathering
• Close the borders to international travel

Stage 3: Lockdown

• Intensifying curtailment of human interaction

Stage 4: Surveillance & active case-finding

• The Community response: door-to-door screening,
testing, isolation and contact tracing

Stage 5: Hotspots

• Surveillance to identify & intervene in hotspots
• Spatial monitoring of new cases
• Outbreak investigation & intervention teams

Stage 6: Medical Care (for the peak)

• Surveillance on case load & capacity
• Managing staff exposures and infections
• Building field hospitals for triage
• Expand ICU bed and ventilator numbers

Stage 7: Bereavement & the Aftermath

• Expanding burial capacity
• Regulations on funerals
• Managing psychological and social impact

Stage 8: Ongoing Vigilance

• Monitoring Ab levels
• Administer vaccines, if available
• Ongoing surveillance for new cases