Communicable Diseases Communiqué November 2020, Vol. 19 (12)

INTERNATIONAL OUTBREAKS OF IMPORTANCE

An update on the coronavirus disease 2019 (COVID-19) outbreak, Resurgence of COVID-19 cases in Province, December 2020

The Western Cape Province, in South Africa, with an estimated week 21 (114.7 cases per 100 000) where it stabilised until week population of 7 005 741 in 2020, reported its first case of 25, and increased to a higher peak in week 27 (week ending on COVID-19 on 9 March 2020 (epidemiologic week 11). From 4 July 2020) (136.0 cases per 100 000 persons). From week 28 3 March through 5 December (week 49), there were 140 257 there was a steady decline in weekly incidence risk until week cases of COVID-19 reported from the Western Cape Province, of 40 (15.0 cases per 100 000 persons). There has been an ongoing which 128 385 (91.5%) had allocation by district. At the start of resurgence of cases from week 41 to 49 (21.3 to 111.5 cases per the pandemic, the weekly incidence risk of cases was 2.5 cases 100 000 persons), with a steep increase reported from week 46 per 100 000 persons, this increased steadily to a smaller peak in to week 49 (Figure 2).

400 Cape Winelands Central City of Metro Garden Route West Coast Western Cape Province 350

300

250

200

150 Weekly incidence risk (cases per 100 000 persons) 100

50

0 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 45 46 47 48 49 50

Epidemiologic week Figure 2. Weekly incidence risk of PCR-confirmed cases of COVID-19 by district and epidemiologic week, Western Cape Province, South Africa, 3 March-5 December 2020 (n=128 385, 11 872 missing district)

In week 49, Western Cape Province reported the second Central Karoo District (133.1 vs 118.5 cases per 100 000 persons). highest cumulative incidence risk of cases reported in South City of Cape Town District (98.6 cases per 100 000) contributed Africa to date (2 002.0 cases per 100 000 persons) and the the third highest incidence risk in week 49 (Table 1). highest weekly incidence risk (111.5 cases per 100 000 persons). The majority of cases in the first wave (week 11-40) were in the Western Cape Province was the first province to reach a peak 20-39- (46 446/111 585, 41.6%) and 40-59-year (41 530/111 585, during the first wave. The first wave in the province peaked in 37.2%) age groups. Similarly, during the resurgence in the past week 27, incidence risk 136.0 cases per 100 000 persons with few weeks, majority of cases were in the 20-39- (12 005/28 672, highest incidence risk reported in Overberg (160.4 cases per 100 41.9%) and 40-59-year (10 000/28 672, 34.9%) age groups. 000), followed by City of Cape Town (129.8 cases per 100 000), Garden Route (123.9 cases per 100 000) and Cape Winelands Hospital admissions for COVID-19 cases in the Western Cape (121.8 cases per 100 000). Although not peaked yet, the overall Province peaked in week 26 (21.8 cases per 100 000 persons) highest weekly incidence risk of cases from the Western Cape and week 49 (17.6 cases per 100 000 persons) during the first in week 49 was lower (111.5 cases per 100 000) than the peak and second waves respectively. City of Cape Town (14 403/18 in week 27. However, the peak incidence risk reported in week 665, 77.2%) followed by Cape Winelands District (1 916/18 665, 49 from two of the three districts contributing to the current 10.3%) contributed majority of hospital admissions during resurgence in cases was higher than that reported during the the first wave. During the second wave, City of Cape Town first peak, Garden Route (299.4 vs 179.7 cases per 100 000) and (2 437/4 046, 60.2%) and Garden Route (1 016/4 046, 25.1%)

Source: Centre for Vaccines and Immunology, NICD-NHLS; [email protected]

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INTERNATIONAL OUTBREAKS OF IMPORTANCE districts contributed the majority of admissions. City of Cape Garden Route, Central Karoo and to a lesser extent the City of Town reported the highest peak of weekly incidence risk for the Cape Town Metropolitan districts, with incidence risk of cases first wave (27.0 admissions per 100 000 persons). In contrast, exceeding those reported during the first wave in some districts. much higher incidence risk for admissions during the current In addition, the incidence risk of hospitalisation in Garden Route resurgence than those reported during the first wave were and Central Karoo districts is much higher during the second reported by the Garden Route District (43.9 vs 9.8 cases per 100 wave. To date, in-hospital deaths reported during the second 000 persons) and Central Karoo District (30.6 vs. 1.3 cases per wave are higher in Garden Route and Overberg compared to 100 000 persons).1 the first wave; however, the trend in other districts may change due to a delay in deaths and a delay in reporting of deaths. The peak weekly incidence risk of deaths reported in Western With increasing numbers of cases, strengthening the capacity Cape Province was in weeks 26 and 49 for the first and second of facilities to cope with increasing demand for admissions is wave, respectively. City of Cape Town District reported the recommended. majority of deaths during both peaks. Although the second wave has not yet peaked, the highest weekly incidence risk References of deaths was higher during the second wave compared to 1.https://www.nicd.ac.za/wp-content/uploads/2020/12/NICD- the first wave, in Garden Route (10.3 vs 1.3 cases per 100 000) COVID-19-Weekly-Sentinel-Hospital-Surveillnace-update- and Overberg (2.0 vs 1.0 cases per 100 000) districts, and was Week-49-2020_.pdf lower in City of Cape Town District (1.6 vs 5.2 cases per 100 000). Testing rates peaked to 530.5 tests per 100 000 in week 21 (first 2.https://www.nicd.ac.za/wp-content/uploads/2020/12/ wave) and to 467.8 tests per 100 000 in week 46 (second wave).2 COVID-19-Testing-Summary-Week-49-Dec-2020.pdf This summary highlights an increase in the burden of COVID-19 cases in the Western Cape Province currently, mainly driven by

Table 1. Number and incidence risk (cumulative/weekly) of laboratory-confirmed cases of COVID-19, hospitalisations and deaths per 100 000 population during the first wave (week 11-40) and second wave (week 41-49) by district, Western Cape, South Africa, 3 March-5 December 2020 (n=128 385, 11 872 missing district)

District Cumulative Number Number Population First wave Second First wave Second First wave Second number of cases of of mid-2020* peak wave peak peak weekly wave peak peak wave peak of cases in weeks cases in weekly weekly incidence weekly weekly weekly in Eastern 11-40 weeks incidence incidence risk of incidence incidence incidence Cape 41-49 risk of risk of admissions** risk of risk of risk of Province to cases per cases per per 100 000 admissions deaths** deaths** date 100,000 100 000 population per 100 per 100 per population population (week 26) 000 000 100 000 (week 27) (week 49) population population population (week 49) (week 25) (week 49)

Cape Wine- 12 807 10 977 1 830 941 262 121.8 61.8 16.1 14.2 5.0 1.7 lands Central 1 098 786 312 75 113 34.6 133.1 1.3 30.6 0.0 0.0 Karoo City of Cape 89 177 73 344 15 833 4 604 986 129.8 98.6 27.0 16.2 5.2 1.6 Town Metro

Garden 16 577 8 666 7 911 623 658 123.9 299.4 9.8 43.9 1.3 10.3 Route Overberg 4 045 3 166 879 299 908 160.4 92.7 9.0 13.0 1.0 2.0

West Coast 4 681 3 723 958 460 813 74.9 33.9 9.5 2.6 2.0 0.4

Unallocated 11 872 10 923 949

Grand Total 140 257 111 585 28 672 7 005 741 136.0 111.5 21.8 17.5 4.4 2.3

*2020 Mid-year population Statistics South Africa;**Data on hospital admissions and deaths sourced from DATCOV report published in week 49, hospitalisations and deaths are expected to be delayed in relation to cases, in addition there may be delays in reporting.

Source: Centre for Respiratory Diseases and Meningitis, NICD-NHLS; [email protected]

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