South African COVID-19 strategy needs updating

In the context of the initial COVID-19 uncertainty, South Africa’s early lockdown was prudent. It allowed time to prepare the health care system, to ramp up wide-spread testing and to introduce other measures to reduce transmission rates. Extending the lockdown is no longer required. It is also no longer reducing transmission rates and has become unaffordable.

Current evidence indicates that:

  • It is impossible to eliminate the virus and the spread will continue. Only a few countries have been able to minimise the rate of spread but they remain highly susceptible to repeated outbreaks.
  • The majority, approximately 70%, of people infected with SARS-CoV-2 are asymptomatic, or have a moderate, self-limiting illness (approximately 25%). The 5% who develop severe COVID-19, with the risk of dying, are usually older than 65 years (greater than 80%) or have underlying co-morbidities (such as hypertension, diabetes and obesity).
  • Children under 18 years are generally spared from developing severe COVID-19 and contribute less than 1% of all COVID-19 deaths (none among the more than 30,000 COVID-19 deaths in Italy).

It is not likely that a vaccine will become available in the near future. Without this, control of the infection would require about 60% of the population to develop immunity. This will take time and while there is considerable uncertainty over the number of deaths that may occur from COVID-19 over the next two years. Current evidence suggests that it may be less than originally estimated.

An extended lockdown comes with substantial health costs. These include costs brought about by undermining public health initiatives such as immunising children against threatening diseases and in the impaired provision of health services to those living with co-morbidities such as diabetes, tuberculosis (TB), HIV and hypertension. Indeed, there is evidence that currently the gains made over recent years in reducing the rates of, and deaths from TB are being reversed.

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