South Africa’s Approach to COVID-19:

A Timeline of South Africa’s response to the Coronavirus Pandemic

I have been spending my lockdown researching the approaches of different countries to the pandemic, studying the timelines of their actions and interventions, as well as the statistics of cases and deaths. This is the first in a series of articles. This article was first published on Monday 6 April. Following the implementation of new laws under the Disaster Management Act, the article has been revised to indicate all cited news sources. The article has also been updated to include new statistics. Each article will be presented in timeline format with tables and graphs, which I will continue to update.

TWO WEEKS BEFORE THE 1ST CASE

26 February 2020 – The National Institute for Communicable Diseases (NICD) confirms on their website that the NHLS is the only laboratory performing testing for COVID-19 and that a total of 121 people have been tested, of whom 77 met the case definition for persons under investigation (PUI).⁽¹⁾

One the same day the National Institute for Communicable Diseases (NICD) of the National Health Laboratory Services (NHLS), in association with the Centre for Respiratory Diseases and Meningitis and Outbreak Response, the Division of Public Health Surveillance and Response and the National Department of Health compile the first draft copy of the Guidelines for case-finding, diagnosis, management and public health response in South Africa. Unfortunately, the original document does not appear to be accessible, only subsequent versions thereof: Version 1.1 (8 March 2020)⁽²⁾ and Version 2 (10 March 2020)⁽³⁾. The document sets out guidelines for contact tracing and outlines the qualifying criteria for persons under investigation (PUI), i.e. people who are allowed to be tested, as follows:

Persons with acute respiratory illness with sudden onset of at least one of the following: cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective)] irrespective of admission status AND In the 14 days prior to onset of symptoms, met at least one of the following epidemiological criteria:

  • Close contact with a confirmed or probable case.
  • Recent travel to a high risk country.
  • Worked in or attended a healthcare facility where patients with SARS-CoV-2 infections were being treated.
  • Admission to hospital with severe pneumonia of unknown cause.

WEEK 1

5 March 2020 – First case of COVID-19 in South Africa is confirmed in the South African press.

6 March 2020 – Airport screening is implemented at International Airports with special attention being paid to travelers from high risk countries. However, since this implementation and the so-called “oversight” visit at Oliver Tambo International Airport (ORT) by government officials, there have been reports that screening has relaxed and has been inconsistent. Not all passengers have been approached by airport officials and those have subsequently left the airport without being screened for symptoms and without having their health screening form (which they were told to complete during the flight) collected.⁽⁴⁾

9 March 2020Testing is permitted at private laboratories, if referred by a doctor. Cases that fulfill epidemiological and clinical case definitions are given priority.⁽⁵⁾ Lancet is the first private laboratory that advertises the service, at a cost of R1400 (which obviously excludes the doctor’s fees).⁽⁶⁾ More private laboratories follow, with Ampath charging R990 for the test.

9 March 2020 – Main stream media confirms the NICD’s protocol on testing as follows: If someone tests positive it needs to be confirmed with 2nd test. If that diagnostic comes back negative, then the test will be repeated to verify the result. This kind of repeat testing means it can take up to four days to definitively detect COVID-19.⁽⁷⁾ It is unclear whether this means that, out of the total number of tests done, several of these tests could be for the same patient. This basically means that it is not confirmed whether number of tests = number of people tested. (This question gets answered in a Government media statement on 1 April 2020)

Table of the South Africa coronavirus statistics per week
Table of the South Africa coronavirus statistics per week

WEEK 2

15 March 2020 – SA President Ramaphosa declares COVID-19 as a National Disaster. Several measures are announced, including early closure for holiday of schools (on 18 March), as well as the travel ban from high risk countries (also 18 March) and the ban on gatherings of 100 persons or more (immediate).

16 March 2020 – Private laboratory Ampath is the first private laboratory to launch drive-through testing.⁽⁸⁾

17 March 2020 – Schools close.
WEEK 3

23 March 2020 – SA President Ramaphosa announces 21-day National Lockdown to start at midnight Thursday 26 March/Friday morning 27 March. The lockdown is announced to affect all businesses and persons, with exceptions to Essential Services (food, medicine, petrol). Over the following days more information is provided on exclusions and inclusions, for example: takeaway food delivery services and dog walking are not permitted.

25 March 2020 – NICD spokesperson, Sinenhlanhla Jimoh, confirms that the total number of tests done to date stands at 19975.⁽⁹⁾

Graph of weekly officially reported cases vs deaths
Graph of weekly officially reported cases vs deaths

WEEK 4

27 March 2020National Lockdown starts. Moody’s downgrade South Africa to Ba1, junk status.

01 April 2020 Public Transport and Social Grants. Taxis, having exercised sufficient pressure on the government, are permitted to continue operating with, in my opinion, minor and valueless restrictions ⁽¹⁰⁾:

  • A minibus licensed to carry 10 passengers, limited to carry max. 7 passengers
  • A minibus licensed to carry 15 passengers, limited to carry max. 10 passengers
  • A midi-bus permitted to carry a maximum of 22 passengers, limited to carry max. 15 passengers

Effective only between 30 March 2020 and 3 April 2020, buses and taxis are allowed to operate from 5am until 8pm for the purpose of transporting persons collecting social grants.⁽¹¹⁾ The requirement for these grants to be claimed manually poses a risk due to the large numbers of congregating people.

1 AprilTesting. The NICD confirms that the total number of tests done to date stands at 47541, with 44292 people being tested.⁽¹²⁾ The jump from 19975, only a week before, to 47541 means that more tests, 27566 to be specific, were done in Week 4, than the cumulative number of tests up until Week 3 (19975). This means that the bulk of testing, thus far, has been done during Week 4 of SA’s pandemic. For me, this is disconcertingly and ominously late in the game…

(Why do I say this? I have been spending my lockdown researching the epidemic approaches of – so far – 8 different countries, studying the timelines of interventions and statistics of cases and deaths. I will publish a more detailed article on Italy in the coming days, but can confirm that one of Italy’s downfalls was the fact that they only starting implementing drastic measures in Week 4. South Korea, on the other hand approached a number or their own medical companies to develop a COVID-19 test within days of their first cause, ie Week 1. By Week 2 one company was ready with a fully functional, effective, accurate and efficient test. By Week 3 another company was also ready. Testing started immediately. And it has been free! It gets better, but I will detail this in a future article.)

The Health Minister confirms that, out of the 47541 tests, only 6000 of those (12.6%) have been done by the government laboratory services (NHLS)⁽¹³⁾. The remaining 87.4% (approx 41541) tests have been done by private laboratories, such as Lancet. This is in a period or more than a month with 121 tests being recorded on 26 February 2020.⁽¹⁾ That means that the NHLS has conducted approximately 1500 tests per week, that is approximately 214 per day (if a 7-day week is being worked). This is in stark contrast to the claimed capability of 5000 tests per day.⁽¹³⁾

One the same day, the first 5 of 60 mobile testing units are rolled out by government. These vans do not carry any equipment that can conduct tests. They carry nurses, computers and fridges that store samples that are then to the already backlogged laboratories for testing. (There were previously 6 government laboratories equipped for COVID-19 testing, but these were subsequently increased to 9). The vans go to areas that have been identified as hotspots, where nurses will first screen people and only if they do not pass the screening process, i.e. if they are symptomatic, will they be tested.⁽¹⁴⁾

With regards to laboratory testing, the NHLS’s target of 36000 tests per day by the end of April is quite optimistic, considering prior performance. As noted previously, the NHLS is currently processing approximately 214 tests per day. They will have to process 168 times as many tests to reach their target.

WEEK 5

8 April 2020 Testing: SA Minister of Health, Zweli Mkhize, confirms the total number of COVID-19 tests conducted to date is 63776.⁽¹⁵⁾ This means that 16235 tests have been done during the past week (63776 – 47541). Impressive. Depending on the number of days per week worked, this comes to either 3247 tests per day (5 day working week) or 2319 (7 day working week).

Going into WEEK 6…

9 April 2020 – SA President Ramaphosa announces a 14-day extension to the National Lockdown. This receives a mixed, but mostly negative response from the South African public, as evident on social media. A dominating sentiment is the severity of the lockdown, not the lockdown itself. The already-fragile economy was destroyed with Moody’s downgrade of SA to junk status, which happened on the same day that the lockdown started, 27 March. With most businesses forced to close, no income is being generated. Although many companies were able to pay salaries (or at least partial salaries) at the end of March, very few will be able to do so at the end of April.

The South African public has many questions and they all boil down to this one: What is the government’s strategy?

Is the plan to slow down the infection rate in order for the hospitals to be able to cope and eventually achieve herd immunity? With the case numbers as low as they are now and the lockdown as tight as it is now, this is going to take a long, long time. And it is merely delaying the inevitable. The South African economy, its people, cannot afford it. People are going to die of hunger. The despair, the absolute complete loss of hope, will increase the suicide rate.

Is the plan to out run the spread of the virus by continuously extending the lockdown until we have no more cases and then return to business as usual? This is impossible. Take everything that I said in the previous paragraph and intensify the severity of the outcome beyond your most terrifying nightmare.

In my opinion, the lockdown should be eased in order to allow more businesses, such as takeaway food services, to operate. The ban on cigarette and alcohol sales should be lifted, not only because it was unnecessary to begin with. The tax income lost from cigarette and alcohol sales is huge and this has only opened the door to black market operations. If the infection rate remains low, more and more business should be permitted to operate, with precautionary restrictions in place.

  1. https://www.nicd.ac.za/covid-19-update-25/
  2. https://www.nicd.ac.za/wp-content/uploads/2020/03/NICD_DoH_COVID-19_Guidelines_8_March_2020_final.pdf
  3. https://www.nicd.ac.za/wp-content/uploads/2020/03/NICD_DoH-COVID-19-Guidelines-10March2020_final.pdf
  4. https://www.dailymaverick.co.za/article/2020-03-19-testing-testing-123-unpacking-the-confusion-around-sas-covid-19-testing/
  5. https://www.timeslive.co.za/sunday-times/news/2020-03-08-south-africans-can-get-private-coronavirus-tests-from-monday/
  6. http://www.lancet.co.za/press-release-9-march-2020-covid-19-testing-in-private-pathology/
  7. https://www.news24.com/SouthAfrica/News/coronavirus-testing-in-south-africa-how-it-works-where-to-go-and-what-it-costs-20200311
  8. https://www.heraldlive.co.za/news/2020-03-20-ampath-offers-drive-through-testing-for-covid-19/
  9. https://www.businesslive.co.za/bd/national/health/2020-03-25-state-lab-targets-36000-coronavirus-tests-a-day-by-the-end-of-april/
  10. https://www.moodys.com/research/Moodys-downgrades-South-Africas-ratings-to-Ba1-maintains-negative-outlook–PR_420630
  11. https://www.sanews.gov.za/south-africa/transport-revises-taxi-regulations-during-lockdown
  12. https://www.nhls.ac.za/statement-of-the-minister-of-health-launch-of-mobile-laboratories-national-health-laboratory-services/
  13. https://www.gov.za/speeches/south-africa%E2%80%99s-covid-19-testing-capacity-increased-60-new-mobile-lab-units-launched-1-apr
  14. https://www.news24.com/SouthAfrica/News/covid-19-testing-only-a-fraction-of-mkhizes-60-mobile-units-are-ready-20200402
  15. https://www.gov.za/speeches/minister-zweli-mkhize-confirms-18-deaths-and-total-1845-cases-coronavirus-covid-19-8-apr
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