WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 26: 22 - 28 June 2020
Data as reported by: 17:00; 28 June 2020
...
Coronavirus disease 2019
South Africa
138 134 Cases
2 456 Deaths
1.8% CFR
EVENT DESCRIPTION
COVID-19 was first reported in South Africa on 5 March 2020, with two
cases confirmed by PCR testing in KwaZulu-Natal province in a couple who
had returned from Milan, Italy on 1 March 2020 in a group of ten people.
By 7 March 2020, another woman from the same group had tested positive
and on 11 March 2020, a further six cases were reported, only one of which
had epidemiological links to the first cases, the other five having a travel
history to other parts of Europe. Initial cases were all imported, mainly
from Europe. The first confirmed cases of local transmission were reported
by 17 March 2020 and by 24 March 2020, all nine provinces in the country
had confirmed cases. The first death from COVID-19 was reported on 27
March 2020. Since March 2020 the outbreak has evolved rapidly.
As of 28 June 2020, a total of 138 134 confirmed cases, with 2 456 deaths
(case fatality ratio 1.77%) has been reported. Western Cape Province is the
most affected area in the country, with 60 445 (43.8%) of cases, followed
by Gauteng (36 895; 26.7%), Eastern Cape (25 099; 18.2%), KwaZulu-Natal
(8 433; 6.1%) and North West (3 647; 2.6%). The remaining provinces
(Free State, Limpopo, Mpumalanga, and Northern Cape) have a total of 3
615 (2.6%) cases. There are a total of 68 925 recoveries reported across
the country.
Data from the National Institute for Communicable Diseases (NICD) shows
that females are more affected than males, with 57.3% of confirmed cases
reported as of week 25 (week ending 20 June 2020) in women, with an
overall incidence risk remaining higher among females than in males
(183.1 cases per 100 000 in females versus 144.6 cases per 100 000
persons in males).
The Western Cape has a total of 1 764 deaths, which is 72% of all the
reported deaths in the country. They are followed by Eastern Cape (387;
15.7%), Gauteng (174; 7.1%) and KwaZulu-Natal (101; 4.1%). Free State
(9 deaths), Limpopo (5 deaths), North West (5 deaths), Mpumalanga (2
deaths) and Northern Cape (1 death) have few deaths. The case fatality
ratio in provinces with high numbers of cases is highest in Western Cape,
at 1.3% and lowest in Gauteng, at 0.12%. Most (50.3%) deaths occur
between the ages of 50 to 69 years, with 17.9% occurring in those aged 70
to 79, 8.5% in those aged 80 to 89 and 2.3% in those aged more than 90.
Deaths in people aged less than 49 years account for 20.3% of the total.
Based on the available data for gender, the ratio of males to females among
the deaths is 1 087 (51.7%) male and 1 013 (48.2%) female.
Numbers of hospitalizations continue to rise and as of 27 June 2020, most
hospitalized patients were in Western Cape (36%; 1 629), Gauteng (26%;
1 164) and in Eastern Cape (17%; 775). Nationally, the highest proportion
of patients are in general wards (isolation wards) at 80.1% of hospitalized
patients, 11.3% are in intensive care and of these, 58.6% are ventilated. A
total of 15% of all hospitalized patients are on oxygen.
PUBLIC HEALTH ACTIONS
In March 2020, the government of South Africa formed a Ministerial
Task Team to oversee the response to COVID-19, in collaboration with
the National Department of Health and a scientific Ministerial Advisory
Committee was formed. WHO and other partners are providing
technical support to the various aspects of the COVID-19 response.
Screening at points of entry was instituted and quarantine facilities
were identified across the country.
A National State of Disaster was announced on 15 March 2020, with a
travel ban on people arriving from or flying to high-risk countries as of
18 March 2020; social distancing and hand sanitizing was encouraged;
gatherings of more than 100 people were prohibited and schools were
closed; surveillance and testing systems were strengthened.
On 27 March 2020, a nationwide hard lockdown was imposed for
21 days to 16 April 2020, confining people to their homes except for
those in essential work, or for obtaining essential goods or services,
or medical or emergency care; inter-provincial movement was
banned; most retail outlets closed and the country’s borders were
closed, except for movement of essential goods. This 21 days’ period
was extended by a further 14 days to the end of April 2020.
On 1 May 2020, the lockdown level was eased to allow more economic
activity, but still prohibiting movement away from home except for
essential reasons; further lockdown easing occurred on 1 June 2020,
with further relaxation of regulations on 17 June 2020. Country
borders remain closed and inter-provincial travel is not allowed.
SITUATION INTERPRETATION
The current outbreak trajectory in South Africa is rapid, with
wellestablished community transmission, which has particularly affected
Western Cape Province. However, national authorities expect to see
Gauteng Province overtake Western Cape Province within the coming days.
Factors contributing to this trend are inward migration, the large, dense
population, increased congregation in groups and the level of adaptation
to new behaviour, such as social distancing and mandatory mask wearing.
Daily numbers of new cases have exceeded 6 000 for three days, with
daily deaths showing a rising trend. In spite of this, the country has largely
returned to normal economic activity as a result of the economic fallout
caused by the initial hard lockdowns. People are, however, still encouraged
to stay at home where possible and the use of cloth masks in public places
is mandatory. Social distancing is encouraged and retail outlets enforce
this and the use of hand sanitizers before entering. However, the increasing
number of cases in Gauteng and Eastern Cape province since lockdown
measures were relaxed, and the continuing rise in cases in Western Cape
Province, indicates that the peak of the outbreak has still not been reached.
Hospital wards in the most affected provinces are reaching capacity and
increasing numbers of health worker infections are further straining the
provision of health services. Challenges exist around testing, contact
tracing and quarantining those who have tested positive. Government needs
to provide strong public health messages emphasizing the importance of
social distancing, use of masks, hand sanitizing and isolating or presenting
to medical care in the event of symptoms.
https://apps.who.int/iris/bitstream/handle/10665/332877/OEW26-2228062020.pdf