ITS LEVEL 1 FOR SOUTH AFRICA – Insiders spill the beans on what to expect during Level 1

Insiders hint that lockdown restrictions will be eased, but warn of travellers importing the virus

When President Cyril Ramaphosa addresses the nation later this week, it is highly likely that the national lockdown will be eased again, this time to level 1, which will reduce restrictions, but will keep the usual health protocols in place.

However, health and infectious diseases experts have cautioned that we’re not yet out of the woods.

The strongest hint of a lockdown level de-escalation was given by Health Minister Zweli Mkhize earlier this week.

“We didn’t have any increase in the number of cases when moving from level 3 to level 2, which was good news for us because we do want to get to normal activity. We will have to move to level 1 and get closer to normal activity, and we hope to contain the numbers.

“The past two weeks have been very encouraging as there hasn’t been an upsurge. We hope that if we go to the next level, which is lower, the upsurge will be less,” Mkhize said on Radio Islam.

According to those privy to discussions in the national command council, which coordinates the country’s response to the Covid-19 coronavirus pandemic, South Africa will in a week or two be moving from the current national lockdown level 2 to level 1.

“The general agreement is that South Africa needs to move to level 1 lockdown as part of the country’s economic recovery, especially given that GDP estimates decreased by 51% this week.

“The motivating factors are the weakening economy, decreasing infection rate and the improved recovery rate, which has increased to about 90%.

“We have been considering requests from the sporting fraternity and the entertainment sector, as well as the religious quarter,” said a member of the council.

DO THE NUMBERS GIVE AN ACCURATE PICTURE?

South Africa has experienced a low infection rate and low death rate, but government was wary that “many people are positive but asymptomatic”, said an insider in the council.

People with no symptoms were unlikely to be testing themselves, which could account for the low infection rate.

On the positive side, there is the possibility that our bodies are starting to resist the virus and developing antibodies, which could mean that some could be healing without requiring medical care.

“What is good for us is that we know there are chances of infected people recovering on their own. It is the same thing with the flu virus, which was once a pandemic.

COVID-19 RESPONSE AS NHI DRY RUN

City Press heard that government’s response to Covid-19 was used as a dry run for the roll-out of the National Health Insurance (NHI) system, which will require the private and public sectors to work together to deliver health services.

“The ability to scale up those facilities such as the Nasrec [field hospital] in Johannesburg shows that if there is a will, government could scale up the requisite NHI facilities. And if you check, public hospitals were doing much better in treating Covid-19 than private hospitals,” said a person with intimate knowledge of the matter.

In terms of private and public hospitals working together, the relations have been exceptionally managed during the pandemic, including cases where the private sector would send samples for testing to the public sector when it was overloaded. Doing so did not affect the rate of testing.

“So this thing was a serious dry run for our NHI. And this nonsense that private hospitals cannot use the government rate no longer carries weight because they have just done it,” said the person, adding that there were cases in which patients were transferred from private to public facilities and “there was no disruption of

patient management”.

WHAT CHANGES UNDER LEVEL 1?

According to a senior member in the council, the regulations related to level 1 will be relaxed under strict conditions. Minor restrictions will continue, including the health protocols of wearing masks, social distancing and sanitising.

A condition attached to mass gatherings such as church services would include that venues accommodate only half their capacity to allow for social distancing.

The surge of infections in Europe showed that restriction could not be entirely scrapped.

“We are never going back to the old normal,” said a person serving in the command council.

A CASE FOR INTERNATIONAL TRAVEL

City Press heard that the airline industry had put pressure on government for further relaxation of air travel and the opening of airspace.

It was also expected that, while borders would be opened, international travel to high-risk countries in Europe – which recently experienced a surge in Covid-19 infections due to the arrival of winter in the northern hemisphere – could still be limited.

“In terms of international travel, we are considering opening for the continent because, without South Africa, some economies would not survive.”

“The opening of international travel to countries in Europe would most likely disrupt our ability to stabilise. Also, there is a risk that, because it is warmer this side, the Europeans may flock to us and that would increase the risk of infections going up,” said a government insider.

WAS THE MODELLING WRONG?

The South African Covid-19 modelling consortium – a group of researchers from academic, nonprofit and government institutions across the country – mapped out both pessimistic and optimistic scenarios (within disclosed limitations). In the pessimistic scenario, it was predicted that, by this month South Africa would reach more than 12 million cumulative symptomatic cases, more than

3.5 million cumulative detected cases and a little more than 40 000 deaths.

Even in the optimistic scenario, the numbers were still high, showing a projected 9.5 million cumulative symptomatic cases, 2.4 million cumulative detected cases and more than 24 000 deaths.

As of Friday, according to the health department , the country had a cumulative 646 398 confirmed Covid-19 cases and 15 378 deaths.

South Africa’s lower-than-projected cases thus far have begged the question of whether the initial projections used by government for its Covid-19 response planning were wrong.

“No, the modelling wasn’t wrong per se,” said Marc Mendelson, professor of infectious diseases at the University of Cape Town, and head of infectious diseases and HIV medicine at Groote Schuur Hospital in Cape Town.

“It was a victim of the assumptions that were made at the time, which determine the predictions. This is true for all models – they are only as accurate as the variables that are imputed at the time.

“As the epidemic in South Africa played out, the natural history of the epidemic and the interventions that we put in place affected the numbers and, once new data were available and able to be used in the models, then the predictions changed,” explained Mendelson, who also serves on the health department’s ministerial advisory committee. He was speaking in his personal capacity. Was the country’s response to the pandemic wrong? “It’s not all or none. Some things we did right and some things we did wrong. That’s to be expected in a pandemic related to an unknown quantity like this new coronavirus. The retrospectoscope is a wonderful instrument, but must be seen for what it is. The hard lockdown gave the health system time to prepare, and some provinces did better than others in putting interventions in place.

“Banning alcohol was correct during the surge because any pressure on the health system had to be limited. I do not think that the tobacco ban played any role in mitigating the pandemic in South Africa.”

On school closures, Mendelson said those were inevitable because of the hard lockdown, but knowing what is understood now about transmission among children, schools could have opened up sooner.