Epidemiology of COVID-19 in Tshwane District, South Africa, March–June 2020: A cross-sectional study

  • Vaccine preventable diseases
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Background:
On 30th January 2020 the World Health Organization declared the coronavirus disease 2019 (COVID-19), a novel respiratory disease first identified in Wuhan China, a Public Health Emergency of International Concern. South Africa (SA) reported its first COVID-19 case on 5 March 2020. Gauteng Province, the economic hub of SA, soon became the COVID-19 epicentre and Tshwane District among the areas with high transmission. We describe the epidemiology of COVID-19 cases in Tshwane from March to June 2020 and determine factors associated with hospitalisation and mortality.

Methods:
COVID-19 cases confirmed at public and private public health laboratories in South Africa were reported to the National Institute for Communicable Diseases (NICD). The NICD sent consolidated
surveillance reports to provincial health offices to disseminate to the districts. We analysed surveillance data of laboratory-confirmed COVID-19 cases reported during March–June 2020. Data were analysed using descriptive statistics and a multivariable logistic regression model was used to determine factors associated with hospitalisation and mortality.

Results:
During March–June 2020, 5,020 laboratory-confirmed COVID-19 cases were reported in Tshwane. The mean age of cases was 39.7 years (standard deviation 16.1) and 56.7% were female (n=2,846/5,020). Hospitalisation occurred in 4.9% (n=246/5,020) of cases and 2% of cases died (n=103/5,020). Factors associated with hospitalisation included age >60 years (adjusted odds ratio {aOR} 18.70, 95% CI:11.83–29.55, p<0.001), male gender (aOR:1.38, CI:1.10–1.87, p=0.035); and having a pre-existing comorbidity (aOR:2.89, 95% CI:2.09–3.93, p<0.001). Risk factors for mortality were age >60 years (aOR: 47.13, 95% CI:18.33–121.20, p<0.001), male sex (aOR:1.72, 95% Cl:1.10–2.71, p=0.020), and having a pre-existing comorbidity (aOR:5.58, 95% CI:3.52–8.85, p<0.001).

Conclusions:
COVID-19 affected people of all ages in Tshwane and was less severe among younger cases. Age, gender and pre-existing comorbidities were risk factors for both hospitalisation and mortality. Individuals with these characteristics should be prioritized for management of COVID-19 infections and vaccination.

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