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The ‘real’ number of active COVID-19 cases in South Africa

The South African government’s daily updates concerning the number of COVID-19 infections and its associated death toll have come under scrutiny.

As South Africa continues to carry the burden of the coronavirus-induced lockdown, both public and professional attention has turned to the figures released by government in an attempt to better understand the severity of the local outbreak.

In line with international trends, Health Minister Zweli Mkhize has endeavoured to keep citizens informed and up to date with the latest COVID-19 statistics. The numbers delivered by government on a daily basis have, however, garnered some criticism.

The issue revolves around the total number of cumulative cases versus information on active infections. While data delivered by Mkhize deals almost entirely with the former, the public has called on government to mitigate discrepancies by focusing reports on active cases.

The call for data on active COVID-19 cases
The argument proposed is that while the severity of the outbreak cannot be understated, a well-rounded look at the figures — using active cases as the preferred model — would serve to lessen panic and dread associated with the COVID-19 pandemic.

The formula used to acquire the number of active cases subtracts deaths and recoveries from the overall figure.

However, the problem with using the active case model relates to insufficient knowledge of COVID-19 immunity. The Centre for Disease Control and Prevention (CDC) recently revealed:

“The immune response to COVID-19 is not yet understood. Patients with MERS-CoV infection are unlikely to be reinfected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19.”

Still, if reinfections are a reality, medical experts say that this would only affect a small portion of recovered patients, which lends further credence to the call for reporting on active cases.

South Africa’s active cases: What the data tells us
Mkhize’s latest update — at the time of publication, 20 April 2020 — put the total number of COVID-19 cases in South Africa at 3 158. This figure includes the number of recoveries, 903, and deaths, 54.

This puts the total number of active COVID-19 cases in South Africa at 2201.

Additionally, the current figures offer a glimmer of optimism to South Africans, placing the country’s mortality rate, the number of total deaths compared to the number of total cases, below the global average of 3.4%, as informed by the World Health Organisation (WHO).

Still too early to tell
Unfortunately for South Africa, the worst is yet to come. Salim Abdool Karim, a professor and clinical infectious diseases epidemiologist who continues to offer valuable advice to government, expects infections to peak in September.

Recently, Karim noted that proactive measures undertaken by government, including the lockdown and intensified tracing efforts, had bought the country some time to ready its medical response.

Similarly, until government can drastically increase its testing capacity, data presented, whether relative to cumulative totals or active cases, is still too thin for solid analysis.

According to Mkhize, just over 100 000 South Africans have been tested for COVID-19. In a country with a population of over 57 million people, this equates to less than 0.2% of citizens knowing their status.

As government increases its testing efforts — through door-to-door campaigns and mobile screening facilities — the number of positive cases will, naturally, rise. So too will the number of deaths.

As South Africans attempt to cling onto any sign of positivity in times of unprecedented uncertainty, it is worth viewing the data relative to active cases but, at the same time, understanding that without mass testing, the unknown remains a rounded view’s greatest hurdle.

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