- Associated Press - Friday, September 18, 2020

JOHANNESBURG (AP) - South Africa should know its true toll from the coronavirus pandemic within a few weeks, the government’s chief medical adviser says, as the country prepares to almost fully reopen its economy after bringing the first surge in cases under control.

The official death toll from COVID-19 is more than 15,700 but the real number is likely more than 30,000 when deaths not recorded at hospitals are taken into account, Salim Abdool Karim, epidemiologist and chairman of the government’s COVID-19 advisory committee, told The Associated Press in an interview.

He hopes that a nationwide survey for the presence of antibodies to the virus will show results soon. Similar surveys are beginning in other countries across Africa, which has seen far fewer confirmed cases and deaths in the pandemic than health experts once feared.

South Africa makes up roughly half the confirmed virus cases in Africa with more than 650,000. Abdool Karim said the concentration of cases in South Africa is not just because of a much higher level of testing. He, like other health experts in Africa, have pointed to the continent’s younger population and early lockdowns that gave authorities more time to prepare.

“When this virus takes hold, you cannot ignore it or hide it,” he said. “I have spoken to doctors at hospitals in Lagos and other cities and they are not seeing a massive influx of patients with respiratory illness. I don’t fully understand why so many African countries have not had a bigger epidemic. I would have thought that Lagos (Africa’s largest city) would have seen an explosion of cases.”

South Africa reached its peak caseload in mid-July, Abdool Karim said. Now the country is seeing substantial declines in new confirmed cases, deaths and hospitalizations.

“We have a full cascade of indicators going consistently in the same downward direction. This gives me confidence that we are heading for a threshold of low transmission,” Abdool Karim said. “We are now in a good position to relax restrictions while remaining vigilant to respond to any signs of a second surge.”

President Cyril Ramaphosa has said the country will further relax lockdown restrictions at midnight Sunday, enabling the economy to return to about 95% activity, according to business experts.

South Africa also will reopen its borders to travelers after a nearly six-month closure, allowing a resumption of international tourism. Masks will remain mandatory in all public spaces.

“At our peak we were seeing an average of more than 12,000 new cases daily,” Abdool Karim said. “Now we are averaging below 2,000 daily and dropping. We should soon reach 580 new cases daily, which for our population of 58 million is considered by the World Health Organization to be the threshold for low transmission.”

South Africa is already on the lookout for any signs of a second surge, he said - something that Ramaphosa has said would be “devastating” for the country that once ranked fifth in the world in virus caseload.

“It is not inevitable that we have a second surge, but many countries have experienced that, and in some cases it is worse than the first,” Abdool Karim said. “We are working to have early identification of any hotspots and we want to avoid events that can be a super spreader, such as large gatherings of people. We are making a new effort on testing and tracing. When we had 7,000 cases per day, our testing could not keep up but we are working to improve it.”

South Africa recorded more overall deaths during its peak in cases than its historic average, but it still fared better than many. Abdool Karim said the country’s early lockdown - one of the world’s strictest -slowed the spread of the virus and allowed health officials to prepare adequate hospital beds and supplies of oxygen.

“We re-directed oxygen from industries to our hospitals. No hospitals reported running out of oxygen,” he said.

Now South Africa is participating in three international clinical trials for COVID-19 vaccines. Abdool Karim said he is concerned about “the political interference, political pressure to get a vaccine within a set time frame,” such as before the U.S. election.

“Science cannot be rushed,” he said. “The efficacy of a vaccine is often overstated if you are only looking at test results for a three-month period or a short-term trial. Often the results are different over a six-month period. I like a full-year test, I think that gives better data.”

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