COVID-19 WEEKLY EPIDEMIOLOGY BRIEF SOUTH AFRICA WEEK 44 2020

CUMULATIVE DATA FROM 31 31 JANUARY OCTOBER CASES PERSONS

726 823 1 219,0 IN TOTAL INCIDENCE RISK*

9 425 39 THIS WEEK MEDIAN AGE

LIMPOPO PROVINCES AT 17 624 301,1 IN TOTAL /100,000* A GLANCE CASES

NORTH WEST GAUTENG 33 451 814,1 228 948 1 478,2 IN TOTAL /100,000*

IN TOTAL /100,000* CASES CASES

NORTHERN CAPE MPUMALANGA 22 007 1 702,3 29 865 638,2 IN TOTAL /100,000* IN TOTAL /100,000* CASES CASES

WESTERN CAPE KWAZULU-NATAL 117 592 1 678,5 123 257 1 068,9 IN TOTAL /100,000* IN TOTAL /100,000* CASES CASES

EASTERN CAPE FREE STATE 97 021 1 440,8 57 058 1 948,1 IN TOTAL /100,000* * Incidence risk - cases per 100 000 persons IN TOTAL /100,000* CASES ** based on samples collected/received in current reporting CASES week

www.nicd.ac.za TOLL-FREE NUMBER 0800 029 999 PAGE 1 COVID-19 WEEKLY EPIDEMIOLOGY BRIEF WEEK 44 2020 SUMMARY Overview of report

Disease surveillance is a core function of the National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS). This report summarises data from a national laboratory-based surveillance system that is used to monitor the coronavirus disease 2019 (COVID-19) pandemic in South Africa. This report is based on data collected up to 31 October 2020 (week 44 of 2020). Note: COVID-19 is the name of the disease and SARS-CoV-2 is the name of the virus. Trends in numbers of new cases by province and age group may be affected by changes in testing practice and delays in testing of specimens. The numbers reported may change as more data become available.

Highlights

• As of 31 October 2020, a total of 726 823 laboratory-confirmed COVID-19 cases had been INCIDENCE detected in South Africa. Of these, 10 955 were cases reported since the last report. There RISK FOR was a 17.9% decrease in number of new cases detected in week 44 (9 425) compared to WEEK 44 the number of new cases detected in week 43 (11 475). • An additional 443 deaths were reported since the last report. The overall case-fatality ratio was 2.7% (19 411/726 823). 15,8 • To date, five provinces, Gauteng (228 948/726 823, 31.5%), KwaZulu-Natal (123 257/726 823, CASES PER 17.0%), Western Cape (117 592/726 823, 16.2%), Eastern Cape (97 021/726 823, 13.3%) and Free 100 000 State (57 058/726 823, 7.9%) continued to report the majority (623 876/726 823, 85.8%) of PERSONS total COVID-19 cases in South Africa. • In the past week, Eastern Cape Province reported the highest number of new cases (2 741/9 425, 29.1%), followed by Gauteng Province (1 559/9 425, 16.5%), and Western Cape Province (1 346/9 425, 14.3%). • In the previous week, six provinces reported cumulative incidence risk above 1000 cases per 100 000 persons; Free State Province reported the highest cumulative incidence risk 29,1% (1 948.1 cases per 100 000 persons), followed by Northern Cape Province (1702.3 cases per OF CASES 100 000 persons), replacing Western Cape Province (1 678.5 cases per 100 000 persons) REPORTED IN as the province with the second highest cumulative incidence risk, Gauteng Province EASTERN CAPE IN (1 478.2 cases per 100 000 persons), Eastern Cape Province (1 440.8 cases per 100 000 WEEK 44 persons), and KwaZulu-Natal Province (1 068.9 cases per 100 000 persons). • In the past week all provinces reported a decline in weekly incidence risk, compared to week 43, except the Eastern Cape Province. The reduction ranged from 32 cases per 100 000 persons (46.2% reduction) in the Free State Province to 1 case per 100 000 persons (14.7% and 7.0 % reduction) in Limpopo Province and KwaZulu-Natal Province, IN WEEK 44, respectively. THE HIGHEST • In the past week, Eastern Cape Province (40.7 cases per 100 000 persons) followed by WEEKLY Northern Cape Province (38.3 cases per 100 000 persons), and Free State Province (37.7 INCIDENCE cases per 100 000 persons), reported the highest weekly incidence risk. The weekly RISK WAS IN incidence risk in all the other provinces was less than 20 cases per 100 000 persons. CASES AGED 55- • In week 44, the highest weekly incidence risk was in cases aged 55-59 years (33.6 cases per 100 000 persons), followed by cases aged 50-54 years (32.2 cases per 100 000 persons). 59 YEARS (33.6 The lowest weekly incidence risk was in the 0-4-year age group (2.2 cases per 100 000 CASES PER 100 persons). 000 PERSONS) • To date, the majority of COVID-19 cases reported were female (58.2%, 419 431/720 532). This trend continued in the past week, 55.8% (5 224/9 357) of cases were female.

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Methods in the doubling time may suggest a slowing of transmission but this may also be affected by changes in testing strategy Testing for SARS-CoV-2 began on 28 January 2020 at the or care seeking. Until the week 29 report, new cases were NICD and after the first case was confirmed in early March defined as all cases reported since the last report, irrespective 2020, testing was expanded to a larger network of private and of when the sample was collected. Subsequent to the week NHLS laboratories. Respiratory specimens were submitted 29 report, new cases are now defined as cases detected in the from persons under investigation (PUI). Initially, tested past epidemiologic week based on date of sample collection individuals were those who had travelled to countries with or sample receipt. It is therefore possible for numbers reported COVID-19 transmission but the PUI definition was changed as new cases for the current reporting week not to tally with over time. Community symptom screening and referral total additional cases reported since the last report. This will for PCR testing was implemented in April 2020 but the be the case when there was a delay in reporting of cases. strategy was changed to a more targeted approach in May 2020. Community screening was largely discontinued and National and provincial trends of testing efforts then focussed on areas identified as hot COVID-19 cases in South Africa spots and on investigating clusters. Contacts of cases were traced and tested if symptomatic. In some provinces and As of 31 October 2020, a total of 726 823 laboratory-confirmed in certain circumstances (e.g. closed settings, workplaces), COVID-19 cases were reported in South Africa. This is 10 955 asymptomatic contacts were tested. In recent weeks, testing more cases than the number reported in the last report. The has been prioritised for healthcare workers and hospitalised number of new cases detected in week 44 (9 425) was lower patients. Laboratories used any one of several in-house and than the number of new cases detected in week 43 (11 475), commercial PCR assays to test for the presence of SARS- this represented a 17.9% decrease compared to the previous CoV-2 RNA. We excluded specimens collected outside week. In the past week, Eastern Cape Province reported the South Africa. Date of specimen receipt in the laboratory highest percentage of new cases (2 741/9 425, 29.1%), followed was used when date of specimen collection was missing. by Gauteng Province (1 559/9 425, 16.5%) and Western Cape A case of COVID-19 was defined as any person, resident in Province (1 346/9 425, 14.3%) (Table 1). Five provinces, Gauteng South Africa, with a single positive SARS-CoV-2 PCR test. For (228 948/726 823, 31.5%), KwaZulu-Natal (123 257/726 823, reports published from week 41 onwards we used mid-year 17.0%), Western Cape (117 592/726 823, 16.2%), Eastern Cape population estimates from Statistics South Africa for 2020 to (97 021/726 823, 13.3%) and Free State (57 058/726 823, 7.9%) calculate the incidence risk (cumulative or weekly incidence), continued to contribute the majority (623 876/726 823, 85.8%) expressed as cases per 100 000 persons. In historical reports of total COVID-19 cases in South Africa. In keeping with the published from epidemiologic week 10 (during the start of data reported in the previous weeks, there was minimal COVID-19 epidemic in South Africa) to week 40, 2019 mid- change in percent contribution of cases in the different year population estimates were used. Aggregate data on provinces from week 43 to week 44. the number of deaths by province were obtained from the The cumulative incidence risk for the country increased from Department of Health. Data on number of tests conducted 1 203.2 cases per 100 000 persons in week 43 to 1 219.0 cases in the past week as reported in the simultaneously-published per 100 000 persons in week 44. The cumulative incidence COVID-19 weekly testing report was used to calculate tests risk varied by province over time (Figure 3). This is partly conducted per 100 000 population. We estimated the time- explained by testing differences by province (Table 1). The varying (weekly) doubling time of the COVID-19 epidemic Free State Province had the highest cumulative incidence for the provinces with sufficient data and from weeks with risk (1 948.1 cases per 100 000 persons), followed by Northern sufficient number of cases and complete data (week 12to Cape Province (1702.3 cases per 100 000 persons) replacing the week before the current reporting period). The unit of Western Cape Province (1 678.5 cases per 100 000 persons), as analysis (epidemiological week) was defined from Sunday to the province with the second highest cumulative incidence the following Saturday. We first estimated the weekly growth risk, Gauteng Province (1 478.2 cases per 100 000 persons), rate of the epidemic by fitting a linear regression model to Eastern Cape Province (1 440.8 cases per 100 000 persons), the logarithm of the daily cumulative number of laboratory- and KwaZulu-Natal Province (1 068.9 cases per 100 000 confirmed COVID-19 cases. We then estimated the doubling persons). The other provinces continued to report cumulative time for each week using the following formula log(2)/gr incidence risk below 1000 cases per 100 000 persons, with (where gr is the estimated weekly growth rate). An increase Limpopo Province reporting the lowest cumulative incidence

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risk (301.1 cases per 100 000 persons). increase) and KwaZulu-Natal Province (from 524.6 days to In the past week, Eastern Cape Province reported the highest 576.0 days, 9.8% increase) (Figure 5). In week 43, the estimated weekly incidence risk (40.7 cases per 100 000 persons), doubling time of number of cases decreased in two provinces followed by Northern Cape Province (38.3 cases per 100 000 (from 329.5 days to 185.9 days, 43.6% decrease) in the Eastern persons), and Free State Province (37.7 cases per 100 000 Cape Province, and (from 320.3 days to 276.6 days, 13.7% persons). The weekly incidence risk in all the other provinces was less than 20 cases per 100 000 persons. In the past week, decrease) in the Western Cape Province, compared to week all provinces reported a decline in weekly incidence risk, 42. except for the Eastern Cape Province where weekly incidence The case-fatality ratio was 2.7% (19 411/726 823); an additional risk increased by 10 cases per 100 000 persons (31.1% increase). 443 deaths were reported since the last report. The number of The reduction in weekly incidence risk ranged from 32 cases deaths reported in the past week was lower than the number per 100 000 persons (46.2% reduction) in Free State Province reported in the previous week, 443 compared to 537. A crude to 1 cases per 100 000 persons (14.7% reduction and 7.0% case-fatality ratio (CFR) calculated in this way (number of reduction) in Limpopo Province and KwaZulu-Natal Province, respecively (Figure 4). Since the peak of weekly incidence risk deaths/number of diagnosed cases) is subject to numerous experienced at different levels and weeks by the different limitations. Because deaths are delayed in relation to cases, provinces (Western Cape and Eastern Cape peaked earlier in as case numbers decrease rapidly, the crude case fatality week 27 and Northern Cape peaked last in week 30) all the ratio may increase as a result of a more rapid reduction in provinces are reporting an overall gradual decline, some with the denominator compared to the numerator. The CFR may sporadic increases, in weekly incidence risk. be an underestimate because deaths are more likely to be Among the five provinces reporting the majority of cases in reported if a patient with COVID-19 died in hospital and South Africa to date, doubling time of number of cases varied with time, in week 43 it increased in three provinces; Free deaths out of hospital may be missed; in addition, occurrence State Province (from 84.5 days to 112.9 days, 33.6% increase), and reporting of deaths may be delayed to several weeks Gauteng Province (from 451.4 days to 494.4 days, 9.5% after case diagnoses.

Figure 1. Number and cumulative number of laboratory-confirmed cases of COVID-19 by province and date of specimen collection, South Africa, 3 March-31 October 2020 (n=726 823)

20000 Gauteng Western Cape 750000 700000 18000 Eastern Cape KwaZulu Natal 650000 Free State Limpopo 16000 600000 Cumulative number of cases Mpumalanga North West 550000 14000 Northern Cape Cumulative 500000 12000 450000 400000 10000 350000 8000 300000 Number of cases 250000 6000 200000 4000 150000 100000 2000 50000 0 0 ul ul ul ar ar ul ct ct ar ct ar ct pr ay ay ar pr ay pr ay pr ep un un ep un un un ug ep ep ug ug ug ug -J -J -J -J -A -A -O -O -A -J -J -S -O -A -J -J -J -S -O -M -M -M -M -M -S -S -M -M -M -A -A -A -A -A -M 13 27 20 13 11 15 06 19 12 01 21 27 22 26 16 31 14 06 20 18 29 23 10 17 28 05 02 30 08 07 25 09 03 24 04

Date specimen collected*

*Date specimen received where date collected missing

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Figure 2. Number and cumulative number of laboratory-confirmed cases of COVID-19, by testing laboratory sector and date of specimen collection, South Africa, 3 March-31 October 2020 (n=726 823)

20000 800000 Public-sector

18000 Private-sector 700000 Cumulative number private-sector cases 16000 Cumulative number public-sector cases 600000

Cumulative number of total cases Cumulative number of cases 14000

500000 12000

10000 400000

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Number of cases 300000

6000 200000 4000

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0 0 l l t t r r r r r y y n n g g p p ul ct ct ct ct ct ct ul ul ul ul ul ar ar ar ar ar pr pr pr ay ay ay pr pr ay ay ay ep ug ep ep ep ep un un ug ug ug ug ug un un un Ju Ju Oc -J Ap Ap Ap Oc -J -J -J -J -J Ju Ju Ma Se Se Ma Au Au Ma Ma -O -O -O -O -O -O -A -A -A -J -J -A -A -S -S -S -S -S -J -J -J -M -M -M -M -A -A 6- 2- -M -M -M -A -A -A -A -M -M -M -M 1- 2- 5- 9- 6- 10 14 18 4- 8- 2- 22 26 4- 8- 8- 30 3- 7- 13 7- 21 3- 10 14 18 12 11 12 16 17 11 22 16 25 12 16 26 30 31 15 19 28 29 15 19 31 20 24 28 20 24 20 24 28 23 27 23 27 Date specimen colected*

*Date specimen received where date collected missing

Table 1. Number and cumulative incidence risk of laboratory-confirmed cases of COVID-19 and testing per 100 000 persons by province, South Africa, 3 March-31 October 2020 (n=726 823)

Province Cumulative New cases1 Population in Cumulative Incidence risk Tests4 per 100 cases (n) detected mid-20203, n incidence risk of new cases 000 persons, (percentage, n/ in 44 (25-31 (cases per detected 25-31 October total cases in October 2020), 100 000 in week 44 2020 South Africa) n (percentage2, persons) (cases/100 000 n/total) persons)

Eastern Cape 97 021 (13.3) 2 741(29.1) 6 734 001 1 440.8 40.7 171.7 Free State 57 058 (7.9) 1 103 (11.7) 2 928 903 1 948.1 37.7 272.4 Gauteng 228 948 (31.5) 1 559 (16.5) 15 488 137 1 478.2 10.1 207.9 KwaZulu-Natal 123 257 (17.0) 851 (9.0) 11 531 628 1 068.9 7.4 140.7 Limpopo 17 624 (2.4) 353 (3.7) 5 852 553 301.1 6.0 44.4 Mpumalanga 29 865 (4.1) 419 (4.4) 4 679 786 638.2 9.0 117.5 North West 33 451 (4.6) 558 (5.9) 4 108 816 814.1 13.6 103.6 Northern Cape 22 007 (3.0) 495 (5.3) 1 292 786 1 702.3 38.3 280.5 Western Cape 117 592 (16.2) 1 346 (14.3) 7 005 741 1 678.5 19.2 236.5 Unknown 0 Total 726 823 9 425 59 622 351 1 219.0 15.8 168.6

1New cases refer to cases whose samples were collected or received in the current reporting week; 2Percentage=n/total number of new cases (specimen collected or received in current reporting week); 32020 Mid-year population Statistics South Africa 4Data on number of tests conducted sourced from COVID-19 weekly testing report of the same reporting week

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Figure 3. Cumulative incidence risk of PCR-confirmed cases of COVID-19 by province and epidemiologic week, South Africa, 3 March-31 October 2020 (n=726 823)

2000

Eastern Cape Free State Gauteng 1800 KwaZulu-Natal Limpopo Mpumalanga 1600 North West Northern Cape Western Cape ) 1400 South Africa

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0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

Epidemiologic week

Figure 4. Weekly incidence risk of PCR-confirmed cases of COVID-19 by province and epidemiologic week, South Africa, 3 March-31 October 2020 (n=726 823)

300

Eastern Cape Free State Gauteng KwaZulu-Natal

250 Limpopo Mpumalanga North West Northern Cape

Western Cape South Africa

200

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(cases per 100 000 persons) 100

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Epidemiologic week

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Figure 5. Doubling time of number of PCR-confirmed cases of COVID-19 by province (for 5 provinces with the majority of cases) and epidemiologic week, South Africa, 23 March-24 October 2020 (n=616 276)

800 Eastern Cape Free State Gauteng

700

KwaZulu-Natal Western Cape 600

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Doubling time (days) 300

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0 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43

Epidemiologic week

Characteristics of COVID-19 cases in South Africa by age and sex

Cases of COVID-19 were reported across all age groups. The (2.2 cases per 100 000 persons). median age of COVID-19 cases in South Africa to date was To date, the majority of COVID-19 cases reported were female 39 years with an interquartile range (IQR) of 29-52 years. The (58.2%, 419 431/720 532). This trend continued in the past distribution of cases varied by age, with highest number of all week where 55.8%, (5 224/9 357) of cases were female. The cases to date in the 35-39-year (90 905/721 249, 12.6%) and 30- cumulative incidence risk has remained consistently higher 34-year (89 183/721 249, 12.4%) age groups (Figure 6). Similarly, among females (1365.9 cases per 100 000 persons) than among the cases reported in the past week, the highest among males (1026.6 cases per 100 000 persons) (Figure 8). number of cases was in the 35-39-year age group (1 019/9 344, The peak cumulative incidence risk was in the same age 10.9%) followed by the 40-44-year age group (970/9 344, 10.4%). group in both males and females; 50-54 years (2627.1 cases The median age for cases reported in week 44 was similar (40 per 100 000 persons in females and 2300.9 cases per 100 000 years, IQR 28-53), to that of total cases (39 years). The highest persons in males) (Figure 9). In week 44, the highest weekly cumulative incidence risk remained among cases aged 50- incidence risk for males was in the 60-64-, 50-54- and 55-59- 54 years (2 490.4 cases per 100 000 persons), followed by 55- year-age groups (31.9, 31.4 and 31.1 cases per 100 000 persons, 59 years (2 369.1 cases per 100 000 persons) and 45-49 years respectively) and among females in the 55-59-year age group (2 286.9 cases per 100 000 persons). The lowest cumulative (35.2 cases per 100 000 persons). The high prevalence and incidence risk was reported in the younger age-groups, 150.2 incidence risk among females could be explained by the fact cases per 100 000 persons and 181.2 cases per 100 000 persons that females are likely to be more represented in occupations in the 0-4- and 5-9-year age groups respectively (Figure 7 which put them in close proximity to others and thus and Table 2). The highest weekly incidence risk among cases exposing them to a higher risk of infection (e.g. teaching and detected in week 44 was reported in cases aged, 55-59 years health). This may also be partly explained by varying testing (33.6 cases per 100 000 persons), followed by cases in the 50- practices by age and sex (data not shown) and by different 54-year age group (32.2 cases per 100 000 persons) and the health seeking behaviour. lowest weekly incidence risk was in the 0-4-year age group

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Figure 6. Number of laboratory-confirmed cases of COVID-19 by age group and sex, South Africa, 3 March-31 October 2020 (n=720 532, sex/age missing for 6 291)

60000 Female Male

50000

40000

30000

Number of cases 20000

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0 9 9 9 9 + 9 9 9 4 4 4 4 9 4 4 4 4 -1 -1 -2 -3 -5 5- -6 -7 -7 -2 -3 -4 -5 -4 0- -6 80 15 10 25 35 55 65 75 70 20 30 45 50 40 60

Age group (years)

Figure 7. Cumulative incidence risk of PCR-confirmed cases of COVID-19 by age group in years and epidemiologic week, South Africa, 3 March-31 October 2020 (n=721 249, 5 574 missing age)

0-4 5-9 10-14 15-19 2000

20-39 40-59 60 All ages

1500

1000 Cumulative incidence risk (cases per 100 000 persons) 500

0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

Epidemiologic week

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Figure 8. Cumulative incidence risk by sex and epidemiologic week, South Africa, 3 March-31 October 2020 (n=720 532, sex missing for 5 720)

1400 Female Male All

1200

1000

800

600 Cumulatve incidence risk (cases per 100 000 persons) 400

200

0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

Epidemiologic week

Table 2. Number of laboratory-confirmed cases of COVID-19 and cumulative/weekly incidence risk by age group, South Africa, 3 March-31 October 2020, n= 721 249, 5 574 missing age)

Age group Cumulative cases New cases1 detected in Population in Cumulative Incidence risk (years) (n) (percentage, n/ 44 (25-31 October 2020), mid-20203, n incidence risk (cases of new cases total cases in South n (percentage2, n/total) per 100 000 persons) detected in week Africa) 44 (cases/100 000 persons) 0-4 8 627 (1.2) 125 (1.3) 5743 450 150.2 2.2 5-9 10 357 (1.4) 125 (1.3) 5715 952 181.2 2.2 10-14 17 838 (2.5) 239 (2.6) 5591 553 319.0 4.3 15-19 29 799 (4.1) 435 (4.7) 4774 579 624.1 9.1 20-24 41 677 (5.8) 744 (8.0) 4823 367 864.1 15.4 25-29 73 744 (10.2) 933 (10.0) 5420 754 1 360.4 17.2 30-34 89 183 (12.4) 947 (10.1) 5641 750 1 580.8 16.8 35-39 90 905 (12.6) 1 019 (10.9) 4798 293 1 894.5 21.2 40-44 77 870 (10.8) 970 (10.4) 3733 942 2 085.5 26.0 45-49 72 487 (10.1) 859 (9.2) 3169 648 2 286.9 27.1 50-54 64 036 (8.9) 827 (8.9) 2571 263 2 490.4 32.2 55-59 52 388 (7.3) 743 (8.0) 2211 309 2 369.1 33.6 60-64 34 058 (4.7) 494 (5.3) 1796 316 1 896.0 27.5 65-69 21 210 (2.9) 348 (3.7) 1408 665 1 505.7 24.7 70-74 14 563 (2.0) 237 (2.5) 1007 174 1 445.9 23.5 75-79 9 504 (1.3) 150 (1.6) 637 062 1 491.8 23.5 ≥80 13 003 (1.8) 149 (1.6) 577 273 2 252.5 25.8 Unknown 5 574 81 Total 726 823 9 425 59 622 350 1 219.0 15.8

1New cases refer to cases whose samples were collected or received in the current reporting week; 2Percentage=n/total number of new cases (specimen collected or received in current reporting week); 32020 Mid-year population Statistics South Africa

www.nicd.ac.za TOLL-FREE NUMBER 0800 029 999 PAGE 9 this willalsoincrease estimate. time doubling the number of tests conducted; if The fewer tests the are performed, by groups. affected are estimates between time doubling reported numbers case in differences observed to contribute also could sex and group age by behaviour health-seeking in Differences missed. be and deaths which occurred outside health facilities may underestimation as reporting of deaths an may be delayed be to likely is it limitations: numerous to subject is here reported ratio case-fatality crude The results. the explain partially may regiondifferencesby or over time are presented in this report, changes in testing practices area Although geographic by comparisons and time practices.over trends testing on dependent heavily is cases of reported number The cases. PCR-confirmed of laboratory-basedsurveillance on based is report This Limitations for 6291) Figure 9.

Cumulative incidence risk WEEK 442020 COVID-19 WEEKLY EPIDEMIOLOGY BRIEF

www.nicd.ac.za (cases per 100 000 persons) 2000 3000 2500 1000 1500 500 Cumulative 3March-31 incidence risk by October group age 2020 sex, and (n=720 532,sex/age SouthAfrica, missing 0

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15-19 Ma

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30-34 Age group(years)

35-39 numbers ofconfirmed cases. contribute in also tochangestoaccesstestingcould or provinces. In addition, changes in testing practices and/ within transmission viral continued indicate may cases of the majority contribute which provinces five the of two from reported decreased cases of the number of time however doubling transmission, viral of down slowing a true reflect may risk incidence weekly and cases of number in decline sustained The increase. an preceding the week,except to for Eastern Cape Province which reported compared decrease to continued persons 000 100 per cases of risk incidence weekly The some reported. been have deaths 411 from 19 including cases, 823 reported sporadic numbers although provinces in recent new weeks have been noted. To 28 date, 726 in week since increases week, on week cases of COVID-19 in South continued Africa to laboratory-confirmed decrease detected newly of number The Conclusions 40-44

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