South Africa flattens its coronavirus curve—and considers how to ease restrictions

Science ’s COVID-19 reporting is supported by the Pulitzer Center.

With South Africa in its third week of a COVID-19 lockdown that will last at least through April, scientists advising the government gave a preview of the next phase of the response in a televised address on Monday evening. They offered “a glimpse at the science behind the decision-making,” Minister of Health Zweli Mkhize said during the briefing—and a road map for reopening the country.

South Africa detected its first novel coronavirus infection on 5 March. For the next few weeks, the epidemic followed an exponential curve similar to those in the United Kingdom, the United States, and many other countries. On 15 March, the country’s president, Cyril Ramaphosa, declared a national state of emergency banning visitors from high-risk countries, stopping large gatherings, closing more than half of its land borders, and shutting schools. On 27 March the country started a 21-day lockdown, closing all borders and confining everyone except those performing essential services to their homes except to buy groceries and medicine or to collect welfare payments.

Based on other countries’ trajectories, disease modelers expected total cases to rise to 4000 by 2 April even with social distancing measures—but after the lockdown, the daily increase in cases slowed abruptly, and the number has remained more or less constant at about 70 new cases daily. On 14 April, the country had 2415 confirmed cases and 27 deaths.

Some people have wondered whether the slowdown in new cases is a result of less testing as the epidemic has moved into poorer areas. However, HIV scientist Salim Abdool Karim, who chairs Mkhize’s COVID-19 advisory group, said at the briefing that the slowdown in new cases actually coincided with increased testing in poorer communities.

Instead, he said, it’s likely that the country’s border closures, social distancing measures, and eventual lockdown worked to slow the spread of the virus. “We can’t say it definitively, but we can say it’s likely,” he said.

However, Abdool Karim had some bad news, too. It is “very, very unlikely,” he said, that the country will avoid a future surge in cases. The added weeks in lockdown were needed to help decision-makers decide on the way forward. “The lockdown has bought us some time to become more proactive,” he said.

The country is using that time to prepare by sending tens of thousands of community health care workers into villages and towns to screen people and refer those with symptoms for testing. By catching small community outbreaks and isolating cases, the South African response hopes to stop small flare-ups from turning into large wildfires of infection.

The country is also erecting field hospitals and expanding its capacity for burials, Abdool Karim said. In the future, South Africa plans randomized screenings in hospitals, schools, and companies to further gauge the community spread of the virus.

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Once new cases decline from one week to the next, South Africa will lift the lockdown in carefully considered stages, Abdool Karim said. It might start by unlocking transport hubs in low-transmission areas and asking vulnerable populations such as the elderly and those with impaired immune systems to continue to stay home—possibly until there are vaccines or treatments. “If we end the lockdown abruptly, we may undo the benefit we’ve achieved,” he said.

Many other sub-Saharan African nations are also wrestling with how to move on from closing their borders and confining their populations to their homes. “Countries in the region will probably take the good pieces from the South African experience, plus good pieces from elsewhere to craft their own response,” Catherine Kyobutungi, executive director of the African Population and Health Research Center, a nonprofit organization in Nairobi, Kenya, told Science Insider.

Wafaa El-Sadr, an epidemiologist at Columbia University, says South Africa’s “energetic and evidence-based” response to COVID-19 “starkly contrasts” with the country’s early halting response to its HIV epidemic in the late 1990s and 2000s, which saw the government obstructing treatment rollout and denying the connection between HIV and AIDS.

But, she says, vigilance will be needed not just to keep an eye on the epidemic, but also to monitor the impact of the lockdown measures on the social and economic well-being of the population, particularly in areas where many people already live hand-to-mouth. “This is the challenge that South Africa and other countries face today.”