Progress on COVID-19: South Africa’s Public Health Response Yogan Pillay 12 th of May 2020
COVID-19: Global Situation Based on WHO SITREP 111 with data as of 9 th May 2020 ▪ As reported by the WHO, the spread of coronavirus continues to affect more countries, with an increase in the total number of confirmed global cases which is currently at 3 917 366 with 274 361 deaths, 7% mortality rate (9 th May 2020). 2
COVID-19: African Region Based on WHO SITREP 111 with data as of 9 th May 2020 ▪ Within Africa, South Africa has the highest number of cases followed by Algeria (5558), Ghana (4263), and Nigeria (4151); however, Algeria has a higher number of deaths at 494. ▪ Within the SADC region, South Africa has 78% of the total cases and 68% of the total deaths. 3
COVID 19: South Africa Epidemiology and Surveillance Through and including cases and deaths through 11 th of May In South Africa, the total cumulative cases reported on 11 th May is 10 652 reflecting a 6.4% increase or 637 new cases. ▪ The national case fatality rate , based on deaths from 11 th May is 1.9% , with the total number of deaths as of the 11 th of ▪ May being 201 reflecting an increase of 7 deaths (194 to 201). 4
COVID-19 Cases since 1 st reported case National Total # of New Cases since 1st Reported Case Through and including cases and deaths through 11 th of May Total # of Cumulative Cases since 1 st Reported Case (National) Level 4 Lockdown 21 day Community 1 st reported 12000 lockdown Screening case 10652 1 st reported 14 day death 10000 extension 8000 6000 4000 2000 0 05-Mar 12-Mar 19-Mar 26-Mar 02-Apr 09-Apr 16-Apr 23-Apr 30-Apr 07-May 5
Number of Weekly New COVID-19 Cases National Through and including cases and deaths through 9 th of May Total Number of New Cases per week since the 1 st Reported Case (National) 3000 2844 2458 2500 2000 1715 1500 1130 1000 671 660 593 465 500 103 13 0 11-Mar 18-Mar 25-Mar 01-Apr 08-Apr 15-Apr 22-Apr 29-Apr 06-May Last 5 days 6
COVID-19 Cases since 1 st reported case by Province Total # of New Cases since 1st Reported Case Through and including cases and deaths through 11 th of May Total # of Cumulative Cases since 1 st Reported Case by Province 1 st reported 21 day Community Level 4 case lockdown Screening Lockdown 12000 14 day 1 st reported extension 10000 death 8000 6000 4000 2000 0 05-Mar 12-Mar 19-Mar 26-Mar 02-Apr 09-Apr 16-Apr 23-Apr 30-Apr 07-May Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga North West Northern Cape Western Cape Unknown 7
Number of Weekly New COVID-19 Cases by Province Through and including cases and deaths through 11 th of May Total Number of New Cases per week since the 1 st Reported Case (Province) 3000 2500 2000 1861 1624 1500 1057 1000 422 251 143 162 500 152 169 312 184 296 507 146 326 258 252 137 220 30 178 154 56 1 13 30 0 5 0 0 2 11-Mar 18-Mar 25-Mar 01-Apr 08-Apr 15-Apr 22-Apr 29-Apr 06-May Last 5 days -500 Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga North West Northern Cape Western Cape Unknown 8
COVID-19 Deaths since 1 st reported case National Total # of New Cases since 1st Reported Case Through and including cases and deaths through 11 th of May Total # of Cumulative Deaths since 1 st Reported Case 1 st reported 21 day Community Level 4 case lockdown Lockdown Screening 14 day extension 1 st reported death 206 200 150 100 50 0 05-Mar 12-Mar 19-Mar 26-Mar 02-Apr 09-Apr 16-Apr 23-Apr 30-Apr 07-May 9
Number of Weekly New COVID-19 Cases and Deaths National Through and including cases and deaths through 11 th of May Total Number of New Deaths per week since the 1 st Reported Case (National) 60 55 50 45 39 40 31 30 18 20 13 10 5 0 0 0 0 11-Mar 18-Mar 25-Mar 01-Apr 08-Apr 15-Apr 22-Apr 29-Apr 06-May Last 5 days 10
Laboratory Testing Through and including testing through 11 th May 2020 ▪ A cumulative total of 356 067 tests have been conducted as of 10 th May. Of the total number of tests conducted, 14 731 new tests were performed and of those 4 877 tests (33%) were from community screen and testing (CST). Of the new tests conducted, 8 292 (56%) have been in the public sector. ▪ The volume of tests decreased from 17 257 tests conducted on the 09 th of May to 14 731 conducted on the 10 th of May. ▪ The proportion of positive cases is 4.3% today. ▪ The overall proportion positive (new cases/total new tested) nationally has been stable for 7 days with an average of 3.4%. This 7-day average has been gradually increasing. 11
Number of COVID-19 tests performed Private and Public Through and including testing through 11 th May 2020 14000 350000 12000 300000 10000 250000 Cumulative no. of samples No. of samples 8000 200000 6000 150000 4000 100000 2000 50000 0 0 3/9/20 3/16/20 3/23/20 3/30/20 4/6/20 4/13/20 4/20/20 4/27/20 5/4/20 Date reported PRIVATE PUBLIC Cumulative total 12
Number of COVID-19 tests performed to find 1 COVID-19 Case Through and including testing through 11 th May 2020 Overall 33 146 Limpopo 163 Mpumalanga 106 North West Free State 131 111 Northern Cape 59 Gauteng 47 KwaZulu-Natal Eastern Cape 26 Western Cape 13 0 20 40 60 80 100 120 140 160 180 13
Community Screening ▪ As of 9 th of May, 9 192 366 individuals have been screened nationally and 104 778 individuals have been referred for testing . Between May 8 th and May 9 th , total screening figures increased by 1.7% (from 9 038 918 to 9 192 366 ), and total referrals. 14
Contact Tracing As of the 10 th of May, a total of 35 151 contacts have been identified through contact tracing. ▪ ▪ To date, 92% (32 438 of 35 151) of contacts have been monitored in South Africa 15
Hospitalisation Updated as of the 10 h May 2020 16
Hospitalisation Updated as of the 10 th May 2020 17
Quarantine – Number of Activated Sites from Planned Sites Updated as of the 8 h May 2020 18
Quarantine – Number of Activated Beds from Planned Beds Updated as of the 10 th May 2020 19
• Nelson Mandela Bay Metro (n=384) – Findings • Key challenge is in co-ordination and planning to support accountable contact tracing • Current cases reflect uncontained transmission following spreading events at funerals and shopping centres – Interventions • Involvement of DM in daily meetings • Presence of contact tracers at daily meetings • Structure meetings to reflect #new cases, # contact tracing, # results
• Chris Hani (n=113) – Findings • Conflation of contact tracing and mass screening • Two funerals lead to multiplication of cases • Traditional healers not observing lockdown regulations – Interventions • Support for structured data collection • Training to support better understanding of role of contact tracing vs mass screening • Presentation of data to inform contact tracing
Epidemiological assessment Warder attended a funeral in Majola (near Lusikisiki/Port St Johns) • Buffalo City Metro (n=171) – Findings • Massive outbreak in prison which is Offenders ongoing. (n=98, 2 deaths) n=57 • Uncontained spread in Bisho and Mdantsane • Delays in contact tracing due to delay Warders in receiving results n=34 – Interventions • Support for DCS clinical management, cohorting • Reduce communication delays in lab Family results n=7 • Tracking indicators to better understand outbreak
EPI Hotpots: Active Cases Average 2 nd May to 8 th May 41 42 40 43 39 38 49 44 37 50 46 47 45 36 48 52 51 11 23 35 29 30 Legend (Positive Cases per 100k pop) 22 24 10 9 0 to <0.5 34 0.5 to <1 33 28 1 to <5 5 to <10 21 Greater than 10 27 32 20 26 31 8 7 25 19 17 18 16 15 4 6 14 12 3 13 5 1 2 23
Conclusions • Rate of increase in cases and mortality variable by province o FS, LP, LP, NC, NW o GP & KZN o EC and WC • Rate of increase variable by district • Test, isolation, treat, contact tracing, quarantine • Challenges with testing capacity (who to prioritise?) • Clusters of infections with rapid transmission 24
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