The Impact of Non-Pharmaceutical Interventions on the First COVID-19 Epidemic Wave in South Africa

Objective: In this study, we investigated the impact of COVID-19 NPIs in South Africa to understand their effectiveness in the reduction of transmission of COVID-19 in the South African population. This study also investigated the COVID-19 testing, reporting, hospitalised cases and excess deaths in the first wave of the COVID-19 epidemic in South Africa. MethodsA semi-reactive stochastic COVID-19 model, the ARI COVID-19 SEIR model, was used to investigate the impact of NPIs in South Africa to understand their effectiveness in the reduction of COVID-19 transmission in the South African population. COVID-19 testing, reporting, hospitalised cases and excess deaths in the first COVID-19 epidemic wave in South Africa were investigated using descriptive statistics.FindingsThe general trend in population movement in South African locations shows that the COVID-19 NPIs (National Lockdown Alert Levels 5,4,3,2) were approximately 30% more effective in reducing population movement concerning each increase by 1 Alert Level. The translated reduction in the effective SARS-CoV-2 daily contact number (β) was only 4.13 % to 14.6 % concerning increasing Alert Levels. Due to implemented NPIs, the effective SARS-CoV-2 daily contact number in the first COVID-19 epidemic wave in South Africa was reduced by 58.1-71.1 % while the peak was delayed by 84 days. The estimated COVID-19 reproductive number was between 1.98 to 0.40. During South Africa’s first COVID-19 epidemic wave, the estimated mean for the COVID-19 general ward, intensive care unit, on oxygen, high care, on ventilator, in isolation ward admission status in South African hospital was 58.5 %, 95% CI [58.1,59.0], 13.4 %, 95% CI [13.1,13.7], 13.3 %, 95% CI [12.6,14.0], 6.37 %, 95% CI [6.23,6.51], 6.29 %, 95% CI [6.02,6.55], 2.13 %, 95% CI [1.87,2.43] respectively. The estimated mean South African COVID-19 patient discharge rate was 11.9 days per patient. While the estimated mean of the South African COVID-19 patient case fatality rate (CFR) in hospital and outside the hospital was 2.06 %, 95% CI [1.86,2.25] (deaths per admitted patients) and 2.30 %, 95% CI [1.12,3.83](deaths per severe and critical cases) respectively.ConclusionThe results from this study show that the COVID-19 NPI policies implemented by the Government of South Africa played a significant role in the reduction of COVID-19 active, hospitalised cases and deaths in South Africa’s first COVID-19 epidemic wave.