More of level 4 expected as experts predict 'case rates will overwhelm health systems'

Record Covid-19 infections driven by the rampant Delta variant mean the level 4 lockdown is likely to be extended when the National Coronavirus Command Council meets today to review restrictions and regulations.

This meeting will be followed by meetings of the president's co-ordinating council and the cabinet.

While a relaxation of the alcohol ban is not believed to be on the cards, there are expectations in the education sector that the government may extend the July school holidays.

But basic education department spokes-man Elijah Mhlanga said yesterday the department had received advice from the Ministerial Advisory Committee that schools should still open on July 19.

The record for daily infections set during the second wave - 21,980 on January 8 - has been broken four times in the past nine days.

Wits University professor of medicine Francois Venter said: "Infections are screaming up. Covid is already worse in seven of the nine provinces than in the second wave and deaths are rising fast."

Right to Care CEO and ministerial advisory committee member professor Ian Sanne said he was "extremely concerned" about Limpopo and Mpumalanga in particular, and the North West.

"My view is pessimistic, that case rates will overwhelm health systems," he said. "In my personal view, case rates and hospitalisations will rise in the next two weeks before they decline, and my recommendation is that the lockdown should remain in place."

Professor Wolfgang Preiser, a virologist at the University of Stellenbosch, said: "I would expect the restrictions to remain largely as they are now, for another two weeks or so."

This was because the third wave had peaked only in Gauteng, while other provinces were still seeing sharp daily increases in infections.

Wits biostatistician Lise Jamieson, of the South African Covid-19 Modelling Consortium, said new weekly cases in Gauteng were more than double those of the second wave. "Hospital admissions have also increased substantially, with three districts in Gauteng having higher seven-day total hospital admissions now than the peak in the second wave," she said.

In the worst-affected district, West Rand, hospitalisations were almost double the rate in the second wave. The Johannesburg (up 30%) and Ekurhuleni (up 18%) districts were also outpacing the second wave, and the seven-day totals for Tshwane and Sedibeng were at the same level now as at the peak of the second wave.

Gauteng has a test-positivity rate of 36.8% and is still responsible for half of new infections, but positivity rates in Limpopo (35.5%), North West (30.6%) and Mpumalanga (26%) are also alarming, Jamieson said.

Dr Ronald Whelan, chief commercial officer at Discovery Health, said the number of Covid hospitalisations among members had multiplied by almost 10 in the past two months.

Discovery has also detected a different age pattern. "There is a higher proportion of infections in the younger age groups (0-19 years) with a lower proportion of infections in the slightly higher age groups (30-49) compared with the prior two waves," said Whelan.

The South African Medical Research Council would not comment on the alcohol ban because it analyses data retrospectively and the ban is still in place. But it published a paper that showed bans had a substantially positive impact on the health system.

Professor Tom Moultrie, head of the centre for actuarial research at the University of Cape Town, was lead author on the paper that researchers said produced "compelling evidence that the restriction on the sale of alcohol rather than curfew is associated with the reduction in unnatural deaths". An estimated daily minimum of 21 unnatural deaths were averted with the ban.

Preiser said the alcohol restrictions were not primarily about reducing the spread of Covid but to reduce hospital admissions arising from violence and accidents. He would prefer "a far more nuanced approach [than a blanket alcohol ban]" but knows "it is probably tricky to implement and police".

Teacher unions, governing bodies and a principals' association expressed doubts that schools will reopen next week.

Basil Manuel, executive director of the National Professional Teachers' Organisation, was confident the adjusted level 4 restrictions would be extended and would affect schooling. He said the organisation supported schools reopening but he had "serious doubts" about next week's date.

Ben Machipi, general secretary of the Professional Educators' Union, said if the rate of infections continued, the government was not likely to reopen schools next week.

He said that the director-general of basic education, Mathanzima Mweli, had indicated during a meeting with teacher unions last week that the date for the reopening of schools "was not cast in stone".

"We are aligning with that statement and we are in support," Machipi said.

Cynthia Barnes, general secretary of the National Teachers' Union, said it would not allow teachers to return to work if the infection rate was high and "moving like wildfire".

On Wednesday, basic education minister Angie Motshekga said during monitoring of the teacher vaccination rollout that the official date for reopening was July 19 and "it depends on what cabinet is going to say on Sunday [today] around the lockdown".

Thomas Hlongwane, president of the South African Principals' Association in Gauteng, recommended to the department of basic education at a meeting yesterday that the province's schools should open on July 26 instead of July 19 if Covid-19 infections continue to climb.

Anthea Cereseto, CEO of the Governing Body Foundation, said: "It's too soon to go back because we haven't reached the peak of the third wave yet.

"We are losing learning time but we have got to deal with that in the same way as the rest of the world is dealing with it."

But Matakanye Matakanya, general secretary of the National Association of School Governing Bodies, said schools should re-open next week on Monday because the loss of learning time would never be recovered "even if teachers try to catch up".

The department announced on Friday that the vaccination programme for education sector workers had been extended to July 14.

It was to have ended on Thursday.

Up until Friday, 437,386 of the 782,000 workers, including teachers, targeted for the vaccine had been inoculated.