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Infectious Diseases

15 August 2020

Coronavirus morning update: Top expert backs schools being open; and risk of second wave remains

Professor Glenda Gray says as a paediatrician and a parent, she believes schools should be open; and the health minister says the risk of a second wave of infections remains.

WHAT'S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 579 140.

According to the latest update, 11 556 deaths have been recorded in the country.

There have been 461 734 recoveries.

So far, over 3.3 million tests have been conducted, with more than 35 000 new tests reported.

READ MORE | All the confirmed cases of coronavirus in SA

Latest news:

Last month, President Cyril Ramaphosa announced that all public schools would "take a break" for four weeks (27 July–24 August), News24 reported. He said the government believed it was critical to ensure that schools were not breeding grounds for the coronavirus as infections surged in the country.

However, while closing schools can contribute to the flattening of the curve, continuing school closures beyond this may do more harm than good, according to Professor Glenda Gray, president and CEO of the South African Medical Research Council (SAMRC) and a member of the Ministerial Advisory Committee (MAC). She spoke on Thursday during the 2020 Thought-Leader Webinar Series on health and modelling during Covid-19, hosted by the University of Free State.

"Unequivocally, as a paediatrician and a parent, I believe schools should be open," said Gray.

Most Covid-19 data suggest that children are largely spared from infection, severe disease and outcomes. This happens for a number of reasons, including their innate immune systems, the fact that they have lower viral copies than adults, and reduced ACE2 receptors (the "doors" that allow SARS-CoV-2 to enter the body's cells).

However, Gray acknowledged that it didn't mean that children didn't play a role in virus transmission. As they get older, they will gain higher viral copies and will be more likely to transmit the virus.

READ MORE | 'Unequivocally, as a paediatrician and a parent, I believe schools should be open' - Prof Glenda Gray

South Africa has seen a steady decline in the number of new Covid-19 cases over the last two weeks, Professor Salim Abdool Karim, epidemiologist and infectious diseases specialist and chair of the South African Ministerial Advisory Committee on Covid-19 said on Thursday.

Professor Karim was speaking during the 2020 Thought-Leader Webinar Series on Health and Modelling during Covid-19, which was hosted by the University of the Free State.

While in late July, the country experienced a rise of around 12 000 to 13 000 new cases per day, this number has dropped to under 6 000 as we reach mid-August.

Karim drew on hospital data, predominantly from the private sector and several public hospitals, to show the decline in the number of hospital admissions over the last couple of days.

This downward trend in case numbers has occurred consistently and is “very promising”, said Karim, but added that there is still potential for a second wave.

Is the worst over?

“The answer to that is not a clear-cut one,” said Karim. “We are particularly concerned about the risk of a second surge. In fact, if anything really concerns me at this stage, it’s the [possibility of a] second surge and how the epidemic may play out over the next several weeks.”

READ MORE | SA’s drop in Covid-19 cases ‘very promising’, says top expert - but warns against complacency

While an announcement from Cyril Ramaphosa moving the country to Level 2 lockdown - and the unbanning of alcohol and cigarettes - appears imminent, Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma is still justifying the ban in court papers.

On Wednesday, News24 reported the National Coronavirus Command Council (NCCC) and Cabinet were advised to lift the ban on the sale of tobacco products and alcohol and move the country to Level 2.

The NCCC and Cabinet were advised the number of Covid-19 cases reported daily were on the decline and the economic devastation caused by the prohibition could no longer be justified.

In her answering affidavit, dated 7 August, to the application brought by the Southern Africa Agri Initiative (Saai) and others, Dlamini-Zuma acknowledged the ban was expected to reduce the income of producers, suppliers and retailers.

"Unfortunately, we are not in normal times, and it is imperative that government finds the appropriate balance between the constitutional duty to protect lives, and the need to protect livelihoods across the economy," read her affidavit.

READ MORE | Lifting of sales ban on booze considered as Dlamini-Zuma justifies prohibition in court papers

Health Minister Zweli Mkhize says the Covid-19 surge has happened in numbers lower than originally postulated, but that the risk of a possible second wave of infections remains real.

"If we look at the current models, they had had to be revised several times but, on all those models, what has been said was that we'll have the surge at a bit of a lower level than what was originally postulated," said Mkhize on Friday.

He was speaking during a ceremony to welcome the first members of the World Health Organisation's (WHO) surge team sent to bolster South Africa's Covid-19 response.

"We have now been seeing a decreasing number of daily cases go from as high as 12 000 per day to around 3 000. And this is for the whole country, when there were some provinces that [on its own] would raise the numbers by… up to 6 000 in some instances per day," he said.

"[The decrease in infections] for us is good news. We have said we are optimistic but very cautious about it because we don’t know why this has happened."

According to Mkhize, the impact of the nationwide lockdown could be one reason for this.

READ MORE | Mkhize: Daily Covid-19 cases tapering off, but risk of second wave of infections remains

WHAT'S HAPPENING IN THE REST OF THE WORLD 

Cases update:

For the latest global data, follow this interactive map from Johns Hopkins University & Medicine.

Late on Friday night, positive cases worldwide were just over 21 million, while deaths were just over 761 000.

The United States had the most cases in the world - more than 5.2 million, as well as the most deaths - nearly 168 000.

READ MORE | All the confirmed cases worldwide

Latest news:

The day the US mourned reaching a tragic milestone — 100,000 novel coronavirus deaths — people on the other side of the world in New Zealand celebrated a much more hopeful one: No new coronavirus cases over the prior five days.

Uniquely, the country remained coronavirus-free for over 100 days.

In mid-August, however, that changed. The country reported its first new case, which quickly rose to 30. Experts believe it may be connected to imported frozen food packages, Business Insider previously reported. The risk of catching Covid-19 from packages is still thought to be low, according to available evidence.

It comes almost three months after the country celebrated discharging its last hospitalised coronavirus patient.

By then, at the end of May, there were only 21 active cases throughout New Zealand, there had been a total of 1,500 cases and 21 deaths — a far cry from the 1.74 million cases and 100,000 deaths in the US at the time.

This week, Prime Minister Jacinda Ardern said in a press conference that the country has shown it is possible to swiftly control the virus, using the same precautions to address this new outbreak, including a renewed lockdown.

Part of the country's success was natural. New Zealand is a small country, with a population of 4.8 million, and sparsely populated too.

But experts say it was more than luck that got them to zero. Early lockdown efforts, citizen's adherence to the rules, widespread testing and contact tracing, and good communication were the keys to the country's previous success dealing with the virus.

READ MORE | How New Zealand beat the coronavirus for over 100 days, only for the virus to return

LATEST RESEARCH

As the Covid-19 outbreak unfolds around the world, doctors and researchers are learning more about its devastating impact.

Since the beginning of the outbreak, people have been experiencing Covid-19 in different ways – with some experiencing few or no symptoms, while others succumb to the disease. Research has also revealed signs of significant vascular and neurological damage.

But what exactly makes this virus so complicated? Researchers from McMaster University and the University of Waterloo believe that SARS-CoV-2 is not the respiratory disease we think we know.

Previous research in March 2020 pinpointed the ACE2 receptor on cell surfaces as the reason why SARS-CoV-2 spreads so easily and is able to impact so much more than the lungs.

But now, research has found that the ACE2 receptor actually doesn't have a strong presence in human lung tissue – which means that the respiratory aspect of Covid-19 is only the tip of the iceberg. The findings of the research have been published in the European Respiratory Journal.

READ MORE | Researchers find clues to why Covid-19 affects patients so differently

Data released on Wednesday by the South African Medical Research Council’s (SAMRC) Burden of Disease Research Unit, suggests that parts of the country may have reached a peak in Covid-19 infections by the end of July, which could potentially signal a downturn in the country’s epidemic. Excess deaths, in other words, natural deaths that have occurred over and above what would be expected based on historical patterns, declined from the last week of July to the first week of August.

The tally of excess deaths between the beginning of May and the first week of August stood at 33 478, while reported Covid-19 deaths totalled nearly 9 000 on August 4 (the latest date covered in the excess deaths report). This leaves over 24 000 deaths unaccounted for as of August 4.

Professor Debbie Bradshaw, Chief Specialist Scientist from the SAMRC’s Burden of Disease Research Unit, tells Spotlight that they do not yet know the medical causes of these deaths - or if they are related directly or indirectly to Covid-19.

Part of the problem is simply that information has not yet been captured.

When a person dies, a doctor must complete a death notification form showing the medical cause of death. Legally, if a doctor cannot confirm the cause of death, a post-mortem must be done (or can be requested by the family). This notification form is used by the family or their undertaker to register the death with the Department of Home Affairs (DHA), explains Bradshaw.

READ MORE | Covid-19: What we know about SA’s 33 000 excess deaths so far

HEALTH TIPS (as recommended by the NICD and WHO)

• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing

• Practise frequent hand-washing, especially after direct contact with ill people or their environment

• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus

• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.

Image credit: Getty Images