May 28, 2022

ZIMBABWE’S CRITICAL DECISION MAKING AS THE COVID-19 3RD WAVE
COLLAPSED – WHY SO DIFFERENT TO SOUTH AFRICA?

Zimbabwe’s 3rd wave of Covid-19 reached its peak of cases in mid-July, its peak of deaths 12 days later and then declined rapidly so by the end of August 2021 the wave had all but collapsed. It is interesting to take a look at some of the public health data in an attempt to rationalise Government decision-making and draw comparisons with neighbouring South Africa. At the height of the recent wave our country was placed in Level 4 lockdown, a position from which the authorities progressively eased restrictions as they saw things trending towards improvement. The re-opening of closed businesses, schools, restaurants, fitness centres, resumption of sports activities and local travel followed and as we know, all of these areas impact heavily on peoples’ lives from a socio-economic and ‘health & well-being’ point of view. The key point being that relative delays in normalising these activities have come at a price. When comparing policies around Covid lockdowns and withdrawal from lockdowns between neighbouring countries like Zimbabwe and South Africa one would think that what we should see is a common pathway of stratified, data driven critical decisions at specific points. What we actually see, however, is something quite different.


Covid-19 impact in South Africa (SA), Zimbabwe (Zim) and Africa
When we look at the relative scale of the Covid-19 epidemics in Zim and SA, since it all began in early 2020, we can see how much less affected Zim has been.
• SA’s population at 60 million is only 4.4% of the population of Africa yet the country accounts for 36% of the Covid-19 cases and 42% of the deaths on the continent.
• By comparison Zim has a population of 15 million which accounts for 1% of Africa’s population and only 1.6% of the Covid-19 cases and 2% of the deaths to date.
• On the global scale the continent of Africa, which comprises 17% of the world population, only accounts for 3.6% of global Covid cases and 4% of deaths.


SA vs Zim deaths from Covid-19
When we compare SA to Zim we can also see how much harder Covid-19 has affected SA. Corrected for their relative population size as total Covid deaths per million people since 2020:
• SA has so far recorded a total of 88,429 Covid deaths or 1467 deaths per million (ranking SA at 51st in the world for Covid death rate).
• Zim has so far recorded a total of 4,645 Covid deaths or 307 deaths per million population (ranking Zim at 96th in the world).
• The figures show SA having a 4.8x greater death rate from Covid compared to Zim.
• The reasons for South Africa’s substantially worse Covid-19 statistics compared to Zimbabwe are not clearly apparent but likely lie in their substantially higher rates of poor population metabolic health e.g. obesity, diabetes, and heart disease which account for the greatest burden of severe Covid-19 disease worldwide.


When did SA and Zim each move from Level 4 lockdown and what did their Covid-19 stats look like at that point in time?
• SA: on 26 July 2021 moved to adjusted Level 3 lockdown with businesses, schools, restaurants, gyms & fitness centres open, sports resumed and interprovincial travel restored.
• At that point SA cases were averaging 11,600 a day = 193 cases per million population and deaths were averaging 419 daily = 7 deaths daily per million. The Covid-19 test positivity rate was 24,3%.
• Zim: on 25 August 2021 moved to an amended lockdown level by partially reopening closed businesses like restaurants (access via vaccine passports only), schools and (specified) local travel but gyms/fitness centres remained closed and most sports were not permitted to resume.
• At that point Zim cases were averaging 353 per day = 23 cases per million population and deaths were averaging 22 daily = 1.5 daily deaths per million. The Covid-19 test positivity rate was 5.8%.
• Thus we can see that when each country respectively adjusted downwards from their Level 4 lockdowns:
(i) SA had 8.4x more cases per million and 5x more deaths per million compared to Zim.
(ii)SA’s test positivity rates were 4.2x greater than Zim.


By the end of August 2021:
• SA cases had declined to 57% of the 3rd wave peak, averaging 11,436 cases daily or 190 infections per million people daily.
• Zim cases had declined to 12% of the 3rd wave peak having fallen by 850 cases per day in 3 weeks to an average 278 cases daily or 18 infections daily per million people.
• SA deaths from Covid were averaging 315 per day or 5.2 deaths per million.
• Zim deaths from Covid were averaging 22 per day or 1.5 deaths per million.
• This data shows that compared to Zim by the end of August, SA had 10x the number of cases and 3.5x the number of deaths (per million population) yet South Africans enjoyed far greater ‘freedoms’ to resume normal business, sport and social activities than did Zimbabweans.


Covid-19 deaths as a percentage of average all cause mortality
To provide relativity to the number of Covid deaths it is useful to know average daily numbers of deaths from all causes in SA and Zim.
• In SA 1,540 people die from all causes daily.
• In Zim 321 people die from all causes daily.
The average daily Covid deaths as a percentage of average daily all cause deaths at end of August:
• SA: Covid deaths comprised 18% of average daily all cause deaths.
• Zim: Covid deaths comprised 6.8% of average daily all cause deaths.
• SA’s Covid deaths comprised nearly 1 in 5 daily deaths whilst Zim only 1 in 15.


When is a wave considered over?
There are two accepted epidemiology criteria to judge when a Covid wave is essentially over:

  1. Covid test positivity rates (the percentage of positive tests in total tests done daily):
    The World Health Organisation (WHO) criteria on epidemics determines that when the test positivity rate has reached 5% this is an indication that the country has the epidemic under control.
    Zimbabwe’s Covid 3rd wave declined to this level from the peak of cases on 15 July in just over 5 weeks with test positivity rates at less than 5% by end August. South Africa, whose peak of infections occurred on 9 July took until 26 September to fall to a test positivity rate of 5%.
    At 3rd wave peak (7day average) At end August At 26 September Current (at 13 October)
    • SA: 29.5% (9 July) SA: 17.6% SA: 5% SA: 2.1%
    • Zim: 23.5% (15 July) Zim: 4.3% Zim: 3.5% Zim: 1.7%
  2. When the rate of Covid infections (cases) falls to 15% or less than the peak:
    • SA achieved this on 22 September (73 days from the peak)
    • Zim on 24 August (39 days from the peak)

Covid-19 Vaccination Rates

The proportion of the population fully vaccinated to date is similar
• SA: 16.8%
• Zim:16.2%
The stated Government national vaccination targets
• SA: 40 million persons = 67% of population by end 2021
• Zim: 9 million persons = 60% of population by end 2021


The questions which arise from all this are:

  1. If SA’s policymakers were comfortable to move the country from Level 4 lockdown to adjusted Level 3 after just 18 days from their peak of infections with a prevailing test positivity rate of 24% … then why did Zim’s public health authorities wait 5 weeks from the peak of the 3rd wave and for the test positivity rate to decline all the way down to 5% before easing the Level 4 lockdown restrictions? It would appear that by comparison Zim could have adopted a policy of progressively adjusting downwards at an earlier point in time when it was clear that the threshold of 15% of (peak) cases had already been reached by late August, indicating the end of the 3rd wave.
  2. Why were business hours at the end of August still severely restricted in Zim to 8am-3.30pm with a 6.30pm-6am curfew when in SA normal business hours were in place and a 10pm-4am curfew?
  1. Why were sectors such as sports and gyms/fitness centres still closed in Zim yet open in SA when again Zim was clearly out of the 3rd wave nearly 4 weeks ahead of SA?
  2. Why were restaurants in Zim compelled to only allow vaccinated people to partake of indoor dining when the percentage of the population fully vaccinated at the end of August amounted to merely 10% and currently still only 16% (likely a non-viable number for the formal restaurant sector) when such restrictions are not in place in SA whose vaccination rates are similar?
  3. Where are global health bodies such as the WHO in all this to provide guidelines to countries? It appears that the answer is ‘nowhere’ given the inconsistencies and lack of published science to provide consensus driven decision-making. The WHO has produced conflicting statements on lockdowns, advocating them as short-term measures if deemed absolutely necessary but ultimately destructive to economies, people’s health and lives if used excessively and for extended periods.

To conclude
When one analyses the data on the relative severity and declines of the respective 3rd waves of Covid-19 in South Africa and Zimbabwe and then relates this to the critical decisions and details of the reduction of lockdown measures in these two regional neighbours, the key observation is that what is patently lacking is any consistency or common methodology based on rational risk-benefit indicators with respect to their national lockdown decisions. It could be said that Zimbabwe, despite having been substantially less affected by Covid-19 as indicated by all metrics, appears hesitant to make timeous risk-benefit decisions on easing restrictions. Such hesitancy results in extended Level 4 lockdown measures remaining in place long after clear evidence has emerged that the 3rd wave has rapidly receded and at decision points that appear woefully late in the day when compared to South Africa. Whilst no-one can be critical of a Government’s concern to limit the threats of Covid-19, one can be forgiven for questioning an apparent weakness of pragmatic decision-making and unclear scientific criteria for such decisions. Ultimately this leads to increased threats to already degraded livelihoods, child education, mental and physical health in sectors that remain closed or restricted well past a seemingly comparable and reasonable risk-benefit point in time.

Data Resources:

  1. Reuters Covid Tracker South Africa
  2. National Institute for Communicable Disease (NICD) South Africa
  3. Reuters Covid Tracker Zimbabwe
  4. Ministry of Health & Child Care (MoHCC) Zimbabwe Covid-19
  5. Worldometer coronavirus – World, Africa, South Africa, Zimbabwe
  6. Twenty-eighth post Cabinet press briefing – Zimbabwe Government 25.08.21
  7. Centers for Disease Control and Prevention (www.cdc.gov) – Underlying Medical
    Conditions and Severe Illness among 540,667 Adults Hospitalized With COVID-19

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