South Africa's COVID-19 strategy needs updating: here's why and how
Decision-making at the early stages of the SARS-CoV-2 pandemic (the coronavirus causing COVID-19) was constrained by a paucity of medical evidence and epidemiological data. Knowledge gained over the past two months can therefore inform the next phase of the strategy.
In the context of the initial uncertainty, South Africa’s early lockdown was prudent. It allowed time to prepare the health care system, to ramp up wide-spread testing and to introduce other measures to reduce transmission rates. Extending the lockdown is no longer required. It is also no longer reducing transmission rates and has become unaffordable.
Current evidence indicates that:
- It is impossible to eliminate the virus and the spread will continue. Only a few countries have been able to minimise the rate of spread but they remain highly susceptible to repeated outbreaks.
- The majority, approximately 70%, of people infected with SARS-CoV-2 are asymptomatic, or have a moderate, self-limiting illness (approximately 25%). The 5% who develop severe COVID-19, with the risk of dying, are usually older than 65 years (greater than 80%) or have underlying comorbidities (such as hypertension, diabetes and obesity).
- Children under 18 years are generally spared from developing severe COVID-19 and contribute less than 1% of all COVID-19 deaths (none among the more than 30,000 COVID-19 deaths in Italy).
- It is not likely that a vaccine will become available in the near future. Without this, control of the infection would require about 60% of the population to develop immunity. This will take time and while there is considerable uncertainty over the number of deaths that may occur from COVID-19 over the next two years. Current evidence suggests that it may be less than originally estimated.
- An extended lockdown comes with substantial health costs. These include costs brought about by undermining public health initiatives such as immunising children against threatening diseases and in the impaired provision of health services to those living with comorbidities such as diabetes, tuberculosis (TB), HIV and hypertension. Indeed, there is evidence that currently the gains made over recent years in reducing the rates of, and deaths from TB are being reversed.
- SARS-CoV-2 is highly infectious, with a reproduction rate every four days of roughly 2.5 at the onset of the outbreak. The reproduction rate measures the number of people to whom an infected person will pass on the virus. When South Africa introduced the lockdown, the reproduction rate was low relative to other countries. However, South Africa’s reproduction rate has remained above 1, even under a highly restrictive lockdown. Indications are it will remain above 1 at least for the foreseeable future.
- The hard, extended lockdown has come at significant economic cost. While there is debate about the cost to date, with estimates from 5%-16% of GDP, economists agree that this has been significant.
- The lockdown has also imposed social costs. For example, children are missing out on schooling. This is detrimental for their cognitive development and for many other reasons. Children are at risk of becoming malnourished due to missing out on school feeding schemes, as well as from the increasing number of families that are being pushed into poverty.
South Africa needs to accept that it is not on a unique trajectory. The virus cannot be eliminated. The country’s strategy needs to move away from a hard lockdown. In our view, South Africa should focus on using interventions aimed at slowing the virus’ transmission rate.
The success of these interventions depends on the buy-in and cooperation of citizens. The message to South Africa must be clear: It is not going to be spared deaths from COVID-19. But it is possible to prevent some of these through our own actions and by promoting strategic public health interventions.
South Africa should plan to mitigate the effects of the pandemic using the above strategies for at least two years, or until a vaccine becomes available.