Quarraisha and Salim Abdool Karim both serve on the ministerial committee that advises President Cyril Ramaphosa on South Africa’s COVID-19 response. In our recent webinar, we asked them eight questions about what to expect of life between now and September.
1. What will happen between now and September, when our Covid-Peak is expected to occur?
Salim: Because our lockdown regulations have been relaxed and there is now more movement, we can expect to see a slow and steady increase in the number of COVID-19 cases over the next 8 to 10 weeks. Projections are that round about July, there will be an inflection or a sharp increase in cases that will likely peak in late August or early September.
That means that we’ve got two to three months to get back to our lives — to get our children back to school and ourselves to our jobs. When the July inflection happens, we could expect to see alert levels go up again and high lockdown levels would be options that are looked at again, because the government has a risk-adjusted approach. The state adjusts its approach according to the disease burden (how many cases we have and the threat of transmission that the cases pose) and the capacity of our health services to cope with the cases.
2. Can we prevent outbreaks?
Quarraisha and Salim: No, we can’t. Each time when there’s an outbreak, we will try to flatten the curve again. But we cannot stop this virus from spreading. Instead, we have to find a way to live with it. We will almost certainly see outbreaks everywhere: in schools, at work places, at shopping malls — everywhere where there’s movement of people, there is a risk of infection. That risk can be mitigated, but it can’t be eliminated.
3. Is it a wise idea to open schools?
Quarraisha: If we want no risk of contracting the virus, we would have to stay inside our homes for 18 months plus until we have a vaccine. That’s simply not practical, we have to start to do things. Schools, just like workplaces, shopping malls and hospitals, are going to see outbreaks. Although children generally get mild COVID-19 symptoms, many of them live in households with multiple generations, so there would be grandparents or even parents older than 60 and they are vulnerable to serious COVID-19 disease. Children would need to learn to do social distancing at home: less hugging and kissing, constant hand washing and they would need to wear masks.
4. When will we be able to fly domestically and internationally again?
Salim: Because aeroplanes have such limited air circulation, they pose a high risk for passengers to get infected. Should there be someone with the virus on board, it means that almost everyone is going to get exposed and those in the immediate vicinity of that person have a high likelihood of getting infected. I cannot see international travel in the immediate future. Our big concern with international travel is that travellers will be coming in from other countries where the virus is spreading at a rapid rate. In that way, we will re-introduce the virus and we will go back to square one. We’re likely to see easing of domestic travel earlier, but it will come with restrictions about who can fly and there will be precautions to take, for which masks will be central.
Updated comment from Salim Abdool Karim on making air travel safer during the Covid-19 pandemic. This update was added on 12 July 2020:
Risk mitigation measures can make air travel relatively safe during the coronavirus pandemic. After reviewing the information provided by the South African Civil Aviation Authority and the International Air Transport Association on making air travel safe for passengers and crew, this note to Bhekisisa is to confirm that I am of the opinion that the mitigation steps outlined reduce the risks of coronavirus sufficiently that I no longer have reservations about air travel. Some of the mitigation measures include air circulation with high efficiency particulate air (HEPA) filters in the air conditioning systems, masks for crew and passengers, seat pockets containing an alcohol-based hand rub, what to do if someone is unwell and appropriate procedures for routine cleaning and disinfection of the cabin. The steps taken for pre-flight screening, safe boarding, procedures to deal with sick passengers on-board and the ability to identify contacts post-flight, provide a comprehensive approach to reducing the risk of a sick person boarding as well as managing any inadvertent exposures.
5. Will people who are now working from home be able to return to their offices before the end of the year?
Quarraisha and Salim: The coronavirus will pose a threat to us until a vaccine is found. Optimistically, we could have a vaccine by the end of the year, but a far more likely scenario is that we will only have a vaccine available sometime next year. Many companies are likely going to do their very best to get 20-30% of their staff to work from home. The remainder who can’t work from home, would then be working in an environment where there are fewer people, so they will be able to do more social distancing than they otherwise would have.
6. The number of COVID-19 cases has consistently been increasing. Can we compare the data of one week to the next and then come to the conclusion that the rate of infection is increasing?
Salim: No. It was fine to have done that up until April 6th, when the number of tests we did were more or less the same each day and the sources of the samples were the same. Prior to April 7th, all the tests we did were coming from patients who were attending doctors’ rooms or hospitals. But on April 7th that changed, because we started to send community health workers into the field to find people to test. So we’re now testing two different kinds of populations: sick people who go to the doctor and people we go and find by knocking on doors. Because of our community testing, we’re testing far more people now than in March and early April, and when the number of tests increase, the number of positive cases will obviously increase as well. A better measure to use is the percentage of tests that are positive. If we look at that rate, which is about 2.7% of tests, we have seen little difference in the proportion of positive tests over the last five weeks. But we’ll now most likely start to see a slow, but consistent increase in that rate because of the relaxing of the lockdown regulations.
7. How much testing is enough — the National Health Laboratory Service (NHLS) said they have the capacity to do 30 000 tests per day, but we’re doing less than half of that?
Quarraisha and Salim: It doesn’t mean that because the NHLS has the capacity to do 30 000 tests per day, that they should be doing 30 000 tests. We’re still in the early stage of our outbreak. Doing 30 000 tests per day at this point, wouldn’t be the wisest use of our resources. About 2.7% of the tests we do, come out positive – that means we need to do about 40 tests to find one positive case. At this stage, we need to be doing somewhere between 8 000 and 12 000 tests per day. As the positivity rate changes, we will need to start increasing our tests. So the amount of testing is not something that stays stable through the epidemic, we look at it in relation to the overall state of the epidemic. I’d say we’re close to the point where we’re doing about as many tests as we should be doing, although it could be a little more.
8. Will we see different levels of lockdown in different areas?
Salim: It’s possible, because the government’s strategy is all about risk adjustment alert levels. There’s really no reason why a district or ward that has very few cases needs to be at the same lockdown level as a district where there are many cases. We’re also likely to see a constant adjustment of lockdown levels.
Salim Abdool Karim is the chairperson of South Africa’s ministerial Covid-19 committee and the director of the Centre for the Aids Programme of Research in South Africa (Caprisa). Quarraisha Abdool Karim is a Covid-19 ministerial committee member and an associate scientific director at Caprisa.
Bhekisisa’s webinar with the Abdool Karims was held on April 30th.
[12 July 10:10am This story was updated to reflect an updated comment by Salim Abool Karim on the safety of air travel.]