South Africans may be griping about their cigarettes and booze during the lockdown, but in the outside world, the country and President Cyril Ramaphosa are seen as a beacon of light in the Covid-19 pandemic. Unlike many Western leaders who saw what happened in China and Italy, Ramaphosa used the experience of these countries where health systems battled to deal with the outbreak, to model an early response to the virus. The Financial Times’ Joseph Cotterill has highlighted South Africa’s other defence mechanism against Covid-19: the community health workers who have been working for years with tuberculosis and HIV-patients and have been so successful to test and trace positive cases of Covid-19. What Cotterill also picked up, is that South Africa has another weapon in its arsenal to fight Covid-19. While other countries ask their citizens to opt-in to smartphone tracing, South Africa “already has the power to access data from mobile phone companies on the movements of possible coronavirus contacts”. – Linda van Tilburg
By Thulasizwe Sithole
South Africa has deployed a number of measures to contain the spread of the coronavirus which included mass screening, target testing and what the Financial Times calls a “draconian lockdown” in the early stages of the pandemic. Without this, Joseph Cotterill writes, the virus “threatened to overwhelm the country if left unchecked in densely populated townships”.
___STEADY_PAYWALL___
The FT focuses on the use of 28,000 community health workers to find coronavirus cases which relies heavily on the experience that they have built up in tuberculosis and HIV/Aids. These workers have managed to screen more than 7 million people, which represents one out of 10 South Africans. This active case finding differs from the approach followed by European governments that is relying on its citizens coming forward for tests or to download an app that the United Kingdom government is trialing which then results in contact tracing.
Other countries would have to “hire thousands of people to conduct screening and contract tracing”, Cotterill writes – “the US would require at least 100,000 contract tracers at a cost of $3.6bn according to one estimate”. These kinds of teams are already in place in South Africa to detect TB and supply medications to the millions of South Africans living with HIV. The Secretary of the Gauteng Community Health Care Forum, Tshepo Matoko told the FT that the community workers have been “on the front lines for many years” to fight HIV and educate communities about tuberculosis.
The community workers have found that 3% of the people they tested, were positive “which is similar to the proportion of positive results among patients tested at health centres. The FT says this suggests that cases that may have slipped through the net without the community testing, have successfully been identified. There are however variations from province to province in the approach of the community screening. In the Western Cape, which has the highest number of Covid-19 cases, 6% of tests came back positive compared to the 3% on a national level and that figure jumped to 13% earlier this week.
“The province has detected an especially large rise in cases in the sprawling township of Khayelitsha outside Cape Town.” The premier of the Western Cape, Alan Winde explained to the FT that the province followed the “bush fires” which is the pockets of infections within communities. Asymptomatic cases may not be identified with this approach but “it can point to emerging clusters and help later contact tracing to find asymptomatic carriers, health experts said.”
This approach has also been lauded by the Director of the Africa Centres for Disease Control and Prevention, Dr John Nkengasong, but he stressed the need for Africa “to test more”. More than 10,000 tests a day are being carried out in South Africa and throughout the number of positive tests has remained consistent at 3%, “a sign that while infections are growing, they are not outpacing efforts to find them.” This has been described by the Head of the World Health Organisation’s emergency operations, Michael Ryan as “incredible, that much testing for that return.”
Added to South Africa’s arsenal in fighting the pandemic, is that it does not rely on voluntary smartphone apps to contact tracing. “Under lockdown regulations, subject to regular review by a former constitutional court judge, the state has the power to access data from mobile phone companies on the movements of possible coronavirus contacts. A partner at South Africa law firm Bowmans, Livia Dyer told the FT that it is not an opt-in-app as it is in Singapore and Australia.
The FT said the country however now faces a critical test as a phased lifting of the lockdown began last week and President Cyril Ramaphosa had warned that the country was early in its epidemic.
Cotterill writes that South Africa will have to continue the process of screening, testing and tracing for many months to come as the peak of the number of infections is predicted by health experts to be in September.
