Why South Africa’s coronavirus death rate is lower than predicted

Before the pandemic, when tourists flocked to Cape Town, they often ignored Khayelitsha township.

Crammed with more than half a million people — somewhere between the Winelands and beaches of this international destination — it’s now the center of attention.

High-density areas like Khayelitsha are being closely watched because doctors say that places like this are where the battle against Covid-19 on the African continent will be won or lost.

South Africa is, by far and away, the hardest-hit country on the continent. Its confirmed case count is approaching 200,000 and rising fast.

Western Cape is now in the middle of the peak of its coronavirus surge. With more than 69,000 Covid-19 cases and 2,066 deaths, according to July 5 government figures, it is the country’s worst-affected province.

“Nobody knew what the Covid epidemic would mean for South Africa. We had seen Covid rip through Europe, we saw what it was doing in the United States and everyone was terrified of what that would mean in South Africa,” says Dr. Claire Keene, a medical coordinator for the NGO Doctors Without Borders.

“We are being faced with so much failure with Covid. We have used the time well, but we were always going to question whether we used it enough,” she says.

In Khayelitsha, Doctors Without Borders, in partnership with the country’s health department, converted a basketball arena into a field hospital to prepare for this surge. Workers in scrubs walk out the back door and wheel in tanks from the forest of oxygen cylinders outside.

There are 70 beds and just a handful of empty spaces. The patients, most of them elderly, come from the immediate surrounding area, key to gaining trust in the local community. Some walk out after just a few days of oxygen and steroid treatment, while others are not so fortunate.

Keene says their field hospital is a level under ICU care, but it is much more than just a recovery ward. It has become a critical way to lessen the burden on local hospitals as the surge peaks.

Many predicted a catastrophe in South Africa by now, particularly with its high burden of HIV and tuberculosis cases, and its overburdened health system.

But public health officials and doctors here concede that their earlier models -- even those that factored in the aggressive lockdown -- were too pessimistic.

Worst-case scenario

"We have less patients than we have predicted, we have less hospital admissions that we had predicted. And up until now, we have had slightly less deaths than we predicted," says Professor Lee Wallis, Head of Emergency Medicine for the Western Cape Government.

Yet Wallis and his team plan to have 1,400 extra beds ready for the worst-case scenario. He sits overlooking a still-empty ward in the massive repurposed convention center near Cape Town's waterfront. They expect the facility to be near capacity by the end of July.

Wallis says that HIV burden hasn't had the impact that some feared. Far more critical, he says, are the co-morbidities like hypertension, obesity and diabetes that have also worsened outcomes for Covid-19 globally.

The pandemic struck South Africa later than Europe and North America and experts here have had the benefit of learning from both the mistakes and innovations from earlier hotspots.

Wallis says a move away from putting patients on ventilators to giving them high-volume oxygen made an almost overnight difference in the Western Cape's main hospitals.

Now, instead of being placed in a medically induced coma and breathing through a machine, many of the same type of patients are taking in huge volumes of oxygen through masks or cannulas.

"We look at what is done in higher income countries and we adapt that to a lower income setting and make it work," he says.

While the peak in Cape Town is not as high as they expected, he believes that the surge could last longer than predicted by their earlier models -- even for many months -- a situation that will strain both the health system and a population desperate to get back to some kind of normal.

Public health officials warn that it's far too early to declare victory against this disease, and they are wary of predictions on virus that is only just over six months old.

The doctors and nurses in Cape Town are still focusing one day and one patient at a time.

"Every death is heavy on the healthcare workers, but when patients come here gasping for breath and they walk out, it is a massive achievement for everyone," says Keene.

David McKenzie and Brent Swails work for CNN