As countries worldwide, including South Africa, plan to reopen their economies after weeks of lockdown and varying restrictive measures, new waves of infections are inevitable.  

“In the next phase, the risk of infection outbreaks will increase as people return to work. We must all be vigilant,” cautioned President Cyril Ramaphosa, in his address to the nation on Wednesday.   

At the end of May, areas with low rates of infections will ease into Level 3, while areas with high infection rates, which at this point are metro areas, will remain at Level 4. There’ll also be a further provincial and district lockdown classification based on risk. “Districts will be individually assigned levels of lockdown to prevent the spread of the virus. This depends on the average active cases per 100 000 people over one week,” explained Health Minister Dr Zweli Mkhize.  

Ramaphosa stressed that “although the lockdown has slowed down the rate of transmission, the virus is very much present, and will be around for a long time“.  

 This is a view held by the World Health Organisation (WHO) too. “The coronavirus is here to stay, and countries must adapt,” said Michael Ryan, WHO’s health emergencies executive director. “This virus may become just another endemic virus in our communities, and this virus may never go away,” he warned in an online briefing.  

 Japan, South Korea, China, Germany and other countries have seen a resurgence in infections after reopening, with new clusters of cases reported. China reinstated travel restrictions while planning to test 11 million residents in Wuhan. South Korea has delayed the opening of schools, and shut down previously re-opened bars and clubs. Ryan clarified there will be a push–and–pull effect where restrictions are lifted then re-imposed.   

 “If you can get the day–to–day case numbers to the lowest possible level, and get as much virus out of the community as possible, when you open, you will tend to have less transmission, or much less risk,” he explained.   

 South Africa  

Until May 1, when Level 4 began, 5 951 cases of Covid-19 and 116 Covid–related deaths were recorded.  

As of May 17, there were 15 515 cases of Covid-19, with the Western Cape having the highest number of cases (9 294) followed by Gauteng (2 329) and the Eastern Cape (1 936) with 264 deaths.   

Mkhize is perturbed by the Covid-19 hotspots that have emerged in Eastern Cape and Western Cape, with more than half the country’s cases emanating from the two provinces. “Cluster outbreaks concentrated in and around Cape Town are driving the pandemic in these regions and require targeted efforts to track and trace contacts in Western Cape and Eastern Cape,” he said. But he’s optimistic the virus can be beaten.  

If protection measures are adhered to, there won’t be a massive spike, said the WHO. “We predict a lower number of Covid-19 infections in Africa, and forecast a slower peak in most countries following the growing success of anti-infection measures,” said Dr Matshidiso Moeti, WHO regional director for Africa. Initial Africa models had forecast a peak 5 weeks after the first recorded infection, and estimated 26% (312 million) of the continent would be infected.   

 Factors that will contribute to transmission  

Public health specialists warned that behaviour challenges and circumstances will contribute to transmission of Covid-19. Speaking to Health-e News, Professor Shabir Moosa from Chiawelo, a community oriented primary health care facility said: “Transmission will naturally spread, given movement and lack of physical distance, not wearing masks and poor hand hygiene.“   

Moosa said some clinics “are bustling with patients, many of whom are sick with coughs and fevers, who mingle freely“. And while more patients and staff are getting tested, the backlog in results is concerning. “The results now take 14-21 days, making them pointless especially for contact tracing unless patients have complied with isolation instructions as if they were positive,” he added, pointing out that not many are self-isolating or are able to do so.   

 Dr Tracey Naledi, deputy dean of health sciences at the University of Cape Town holds the same view. In a statement to Health-e News, she said, “In the Western Cape where the burden is highest the transmission is now mainly in high density, low resourced areas where even self-isolation is challenging, thus it’s difficult to stop the transmission.”  

 Naledi pointed out that “community transmission means that it is not easy to identify the original source of the exposure, and with multiple clusters of infections, contact tracing and quarantine is really challenging“.  

 Hotspots of cluster infections include malls and supermarkets that will attract even bigger crowds during Level 3.   

 Mitigation  

To reduce the risk of community transmission, everyone has a role to play. ““The trajectory is in our hands, and it’s everybody’s business, and we should all contribute to stop this pandemic,” said WHO director general Tedros Adhanom Ghebreyesus.  

Ryan is insistent that lockdowns alone cannot eradicate the virus. The other part of the strategy is testing, contact tracing, quarantine and isolation, social distancing, and personal and community hygiene, which Ramaphosa also reiterated is vital to keeping infections down. “Success will come from the changes in our behaviour and how we move around. Shaking of hands, hugging and kissing is a thing of the past. Wear face masks, wash hands regularly, and avoid contact with other people,” he advised.   

 Moosa urged more education campaigns, and “some fining, especially for not wearing masks in public“. As employees start returning to work, workplaces must ensure that health and safety policies for social distancing, employee screening, hand washing and deep cleaning are followed, cautioned Naledi.  

 She said South Africans have to learn to adapt because there is unlikely going to be a return to normal. For her, an important tool of success is involving communities to be part of the solution. “With such significant behaviour change expected we really need to form much stronger collaborations with communities,” she said.  

She argues government should ask communities to co-create local level solutions for public communication, physical distancing, and quarantine, and that communities cannot be passive recipients of interventions from national level. – Health-e News  

For more information on Covid-19 in South Africa, you can call the toll-free line on 0800 029 999, or you can send a message that says “Hi” on WhatsApp to the number 060 012 3456. You can also visit the SA Coronavirus website.