South Africa will now have 3 different coronavirus ‘hotspot levels’ – here’s how it works

 ·26 May 2020

Health minister Dr Zweli Mkhize has explained how government will determine the country’s hotspots areas as part of the country’s new district-based lockdown.

Presenting to the National Council of Provinces (NCOP) on Tuesday (26 May), Mkhize said that high-risk areas will be classified as hotspots and that these districts will remain at level 4 with intensive implementation of screening, testing and restrictions.

He added that the country’s districts will effectively be designated in one of three ways:

  • Areas of ‘vigilance’ (less than 5 cases per 100,000 people);
  • Emerging hotspots (less than 5 cases per 100,000 people, but rapid rise);
  • Hotspots (more than 5 cases per 100,000 people).

“To determine the levels per district, the prevalence and incidence rates of each area should be calculated. However. this is currently not possible because of low testing rates and a lack of serological tests,” he said.

To accommodate this, Mkhize said that the government will be taking more of a statistical approach.

“In the absence of test coverage data, active cases and changes in active cases over 14 days will be used to determine the changes in rate of infection,” he said.

“To determine an ‘area of vigilance’ (less than 5 cases per 100,000) and ‘hotspots’ (more than 5 cases per 100,000), the average active case data per 100,000 population was used for the period 16 May to 22 May.”

To determine ’emerging hotspots’, Mkhize said that government will look at whether a district, which currently has fewer than 5 cases per 100,000 population, has seen a notable increase in cases over the 14 day period.


As part of his presentation, Mkhize provided a list of districts across the country which have currently been defined as needing ‘vigilance’, are an ’emerging hotspot’ or are currently defined as a ‘hotspot’.

The latest data shows that 14 of South Africa’s 52 districts are considered hotspots, while nine have been identified as emerging hotspots.

Mkhize said that this is based on a number of active case per 100,000 between 16 May and 22 May.

His department calculated ‘the delta’ or new positive cases by subtracting the number of cases reported on 15 May from the reported cases on 22 May. It also calculated the % change in new positive cases between the same two days.

While this statistical model will provide an overview of the districts that are hardest hit by the coronavirus, Mkhize indicated that the country’s shortage of test kits was problematic.

He added that in some cases ‘clinical judgement’ will have to be used by doctors to say that there is a ‘reasonable chance’ that a person is positive as the government can’t be delayed by a backlog in tests.


Mkhize said that while the whole country is moving to lockdown level 3, hotspot areas will be subject to further restrictions based on specific interventions.

In vigilance and emerging hotspot areas, government will prevent new infections and keep numbers low by establishing multisectoral, multi-department and community response teams to encourage various protocols.

This includes:

  • Social distancing;
  • Frequent environmental cleaning;
  • Hand hygiene practices, cloth masks and cough etiquette;
  • Symptom screening;
  • Community and contact tracing;
  • Testing, isolation, quarantine and hospitalisation.

In hotspot areas, the districts will be sub-divided into ward clusters so that government can have a more targetted and rapid response.

This will include:

  • Deploying teams of health experts to analyse and support districts;
  • The same measures mentioned above;
  • Extreme social distancing measures (including working from home);
  • Strict health protocols;
  • Return to work phased in;
  • Hard lockdown only to be considered if all other measures fail to contain the spread.

Read: South Africa is running out of coronavirus testing kits: Mkhize

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