The novel coronavirus SARS-CoV-2 and South Africa

Abstract

At the time of writing (27 March 2020), the novel betacoronavirus SARS-CoV-2 has infected 537 808 people, in 176 countries with 24 127 deaths and a mortality of 4.5%.¹ South Africa is rapidly approaching a 1 000 confirmed cases, and has just entered ‘lockdown’ in an attempt to contain person to person transmission. SARS-CoV-2 belongs to the betacoronavirus family, which also includes severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV).² SARS-CoV-2 is spread by human to human droplet spread.³ The virus has a long period of survival on surfaces, and contact exposure is another major mechanism of spread. SARS-CoV-2 has also been identified for prolonged periods in faeces, exceeding 40 days in some patients.⁴ South Africa was one of the countries of highest risk of SARSCoV-2 importation in Africa,⁵ and has now swiftly moved to community transmission. South Africa has implemented the combined intervention of quarantining infected individuals, family members, school closure and workplace distancing which mathematically is the most effective means of decreasing person to person transmission, and the reproduction number (R₀).⁶ SARS-CoV-2 has a R₀ probably between 2 and 3.7 The resulting infectious disease of SARS-CoV-2 is known as COVID-19. In a report from Wuhan, China, the majority of patients had mild infections (84%). Sixteen per cent of patients had severe infections, and 6.1% of all patients required ventilation.² In  Lombardy, Italy, 12% of all positive cases required intensive care admission.⁸ Life-threatening complications exceeding one percent of all infected persons included severe acute respiratory syndrome, pneumonia, respiratory failure, and sepsis.² It appears that patients with a marked cytokine and ‘hyperinflammation’ response to SARS-CoV-2 may be at increased risk of morbidity and mortality.⁹