When some years ago, Nigeria’s economy was resized via the reclassification of its GDP (rebasing) which catapulted it to the top in the continent, my friends in South Africa joked about it. Then one day, one them called me and said, “ok you guys want the label. Nigeria can have position of the largest economy in Africa, but we remain number one.” I was taken aback and asked, how? “Oh, we are the most advanced economy on the continent and there is no debate about that”, was the response I got.
Ihave been to South Africa a number of times since then and on each visit, I am as a Nigerian journalist, reminded about the conversation with my friends. However, nothing has brought the immense superiority of the South African economy than the country’s handling of the current Coronavirus pandemic.
The southern African country has used a combination of mass screening, targeted testing and a draconian lockdown to control the early stages of a coronavirus outbreak that threatened to overwhelm the country if left unchecked in its densely populated townships.
In the past month President Cyril Ramaphosa’s government has mobilised 28,000 health workers to screen over 7m people, more than one in 10 South Africans.
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Known as active case finding, the use of community health workers to identify patients with symptoms draws heavily on South Africa’s extensive quality healthcare and its experience battling tuberculosis and HIV.
It differs from the approach of most African and European governments that have relied on citizens coming forward for tests and then tracing their contacts.
John Nkengasong, director of the Africa Centers for Disease Control and Prevention, has lauded South Africa’s aggressive strategy but has warned that Africa overall needs to test more.
From the beginning South Africa brought in its private sector healthcare sector to the party and it is accountable for about half the number of total tests in that country. For lovers of data, South Africa has now increased its level of testing to more than 15,061 tests a day. As at Monday, South Africa had conducted 245,747 tests. Nigeria on the other hand has had less than 20,000 tests in all.
All the while in South Africa, the number of positive tests has remained consistent at about 3 per cent, a sign that while infections are growing they are not outpacing efforts to find them.
“Incredible, that much testing for that return,” Michael Ryan, head of the World Health Organization’s emergency operations, said last month. Recently, the strategy faced a critical test. South Africa imposed one of the world’s strictest lockdowns before it had recorded a single death but is beginning a phased lifting of the most severe restrictions.
The country has had more than 7,200 cases and 130 deaths, and in some townships testing is now picking up a faster spread of the virus. Tough measures, including a nightly curfew, remain in force, and public frustration is rising, particularly after allegations of police violence. “We have not nearly reached the peak of infections in South Africa,” Mr Ramaphosa said on Monday.
“All the scientific models show that the infection rate will continue to rise at a much faster rate in the next few months.” The South African approach to date has relied heavily on an army of community health workers and a network of one the most advanced healthcare system in the world.
Whereas other countries including Nigeria need to hire thousands of people to conduct screening and contract tracing — the US would require at least 100,000 contact tracers at a cost of $3.6bn, according to one estimate — South Africa already had teams in place, detecting tuberculosis, a national killer, and bringing drugs to the millions of South Africans living with HIV.
“We have been on the front lines for many years . . . we were there to fight HIV, we were there to educate communities about TB,” said Tshepo Matoko, secretary of the Gauteng Community Health Care Forum, a body representing workers.
So far about three per cent of tests referred from community screening have come back positive, similar to the proportion of positive results among patients tested at health centres.
That suggests the government’s community health workers have successfully identified many cases that might have otherwise slipped through the net.
But although the screening programme has been extensive, wide variations exist in the approach and the number of tests administered in each of the nine provinces.
The Western Cape, easily one of the more affluent in the country, has tested a higher percentage of its population than other parts of the country and overtaken Gauteng, the most populous region, as the province with the most active infections.
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About six per cent of tests have returned a positive result in Western Cape, compared with the 3 per cent average nationally. For the tests administered in the province on Monday that figure jumped to 13 per cent.
The province has detected an especially large rise in cases in the sprawling township of Khayelitsha, just outside Cape Town.
The findings are “based on our active case-finding approach, where we purposely follow the ‘bush fires’ — the pockets of infections within communities — to ensure that every person who has been infected by Covid-19 is identified as quickly as possible,” said Alan Winde, the Western Cape premier.
Community screening cannot identify asymptomatic cases. But it can point to emerging clusters, and help later contact tracing to find asymptomatic carriers, health experts said.
South Africa has also taken a different approach to contact tracing than many African and western countries, which are largely placing their faith in voluntary smartphone apps.
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.
“The major difference in South Africa is that it is not an opt-in app, as it is in Singapore and Australia,” said Livia Dyer, a partner at Bowmans, a South African law firm.
“It is reflective of the way mobile phones are used in this country,” she said, since the poorest citizens do not have smartphones. South African Covid-19 testing
Mr Ramaphosa’s warning that South Africa is still early in its epidemic means it will have to keep up these screening, testing and tracing efforts for many months to come.
His government has said that different forms of a lockdown could be in force for at least six months and public health experts have predicted a possible peak in the number of infections in September.
That will add to the pressure on the thousands of community health workers on the front line who have battled for years to be recognised as permanent government employees and are now central to the state’s response, said Mr Matoko. “[The government] never saw the importance of these workers until . . . Covid-19,” he said.
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