Before he announced stringent lockdown measures to combat the novel coronavirus, President Cyril Ramaphosa was told that a slow and inadequate response by government to the outbreak, could result in anywhere between 87 900 and 351 000 deaths in South Africa and cause the health system to be overwhelmed.
News24 has seen the epidemiological projections prepared for the department of health and government that catapulted severe state action. These projections formed the basis of Ramaphosa's and the Cabinet's plans to combat the novel coronavirus, which as of Wednesday night had infected 116 South Africans.
Since the projections were presented to Ramaphosa and Cabinet, the government has announced a range of dramatic regulations and interventions to prevent the spread of the virus.
The calculations presented to Ramaphosa are based on an infection rate of 10%, 20% and 40% of the population and factors in a slow or non-existent response by authorities.
** At an infection rate of 10%, 87 900 people could die.
** At 20%, 176 000 people could die.
** And at 40%, 351 000 people could die.
These projections do not indicate a time frame for the spread of the virus. News24 understands that the model is a dynamic one, and is continuously being updated, adapted and rebuilt as new data becomes available. These projections reflect known data at a specific point in time and was still considered accurate by government over the last 24 hours.
The projections are based on data from the outbreak in the Chinese province of Hubei, as well as historical data based on the annual infection rate of "normal" flu in South Africa.
It is informed by a preliminary static model (meaning various factors were not taken into account) with wide intervals, indicating a large amount of uncertainty.
According to a 2019 study titled the Health and economic burden of influenza-associated illness in South Africa, 19% of South Africa's population, or roughly 10 million people, contracted the "normal" flu virus annually between 2013 and 2015.
Covid-19 is far more contagious and deadly than the flu, requiring extreme levels of awareness and strict preventative measures.
It is not immediately clear if co-morbidity (people with underlying chronic illnesses such as HIV, hypertension or cancer) was considered.
The projections were prepared by the South African Centre for Epidemiological Modelling and Analysis (Sacema) based at Stellenbosch University, in conjunction with the National Institute for Communicable Diseases (NICD). It was based on studies of the virology and epidemiology of the virus in Wuhan, the Chinese city at the epicentre of the outbreak.
"I find the increase in case numbers worrying but it is not unexpected based on what has been seen elsewhere. I decline to comment on the modelling and projections at this time," the head of Sacema, Professor Juliet Pulliam, said on Wednesday.
"There are a number of modelling efforts under way. An expert group is being established to coordinate efforts and review these models and their assumptions. Preliminary data from models will be released in the next few weeks," the head of the NICD's Centre for Respiratory Diseases and Meningitis (CRDM) Professor Cheryl Cohen said on Wednesday evening in response to a detailed list of questions.Coronavirus in SA: All the confirmed cases
Ramaphosa on Sunday declared a national state of disaster and announced a range of measures to combat the spread of the virus. This included a travel ban from high-risk countries, the banning of gatherings of 100 people or more and the closure of numerous land and seaports of entry.
Eighteen Cabinet ministers briefed the media on Monday on specific interventions, while regulations enforcing government's interventions were published in the Government Gazette on Wednesday, including a partial ban on the sale of alcohol.
Government has also announced an aggressive awareness campaign to inform the public about the virus and how to prevent its spread. The president has also met with a range of stakeholders in order to garner support for government's efforts, including leaders from opposition political parties.
These interventions mirror those recommended by the epidemiologists contained in the projections made to the Health Department and government.
As of Wednesday morning, the department of health reported 116 confirmed cases, up from 85 on Tuesday night and 62 on Sunday.
No deaths have so far been recorded locally.
According to the projections around 80% of cases will be "mild", while 15% to 20% of those infected may develop pneumonia and may require hospital admission.
A further 5% of people could require critical care, while on average, 2% of people infected would die, a lower estimate then what other projections are showing.
The mitigating factor in the mortality rate in these projections of South African cases is that the country's population has a younger age distribution than areas where large outbreaks have occurred. Young people have a lower mortality rate then the elderly.
The projections show that, assuming 20% of the population is infected, more than 500 000 people could require hospitalisation and 176 000 could lose their lives.
At 40% infection rate, the numbers skyrocket to more than 1 million people needing hospitalisation with 351 000 deaths.
If measures implemented by government manage to contain the outbreak to just 10% (a rate nearly half of the annual infection rate of the less contagious "normal" flu) of the population, hundreds of thousands of people would still require hospitalisation and 87 900 could die.
The projections, however, make it clear these numbers are based on government acting late, or not acting at all.
Call to action
If the projections hold true, and considering a lack of immediate action, hospitals could quickly be overwhelmed, the projections warn.
This would be similar to situations now facing governments and health workers in badly affected countries such as Italy, which by Wednesday reported more than 2 500 deaths. More than 400 people died on Wednesday alone.
Ramaphosa also asked citizens to practice intensified social distancing and hygiene regimes.
Social distancing is, according to experts, a highly effective method of "flattening the curve" – a term used to describe extending the rate of infection spread over a longer time period through active measures to limit contacts.
This would allow health systems facing immediate collapse more time to prepare and handle a predicted high number of patients who would require intensive care.
The measures decided on by Cabinet, coming as early as they have, were praised by one epidemiological researcher News24 spoke with, who asked not to be named. These interventions could prove pivotal in the coming weeks.