Covid-19 – The true test for SA starts now

Even before the echoes had died down around the World Health Organisation declaring Covid-19 infections a pandemic, South Africa was able to add four more cases to the world total of more than 129,977, and even registered a false positive case in the Free State.

Since the first report of a patient who presented with the novel coronavirus eight days ago on 5 March, SA now has 17 confirmed cases, with one patient allegedly on the way to a full recovery, and one more with kidney disease believed to be in a critical condition.

And critically, with the South African Revenue Services customs officials and the Department of Health saying they are on top of things at airports, ports, and border posts, at least two cases are now “in the wild”.

The report by Health Minister Dr Zwelini Mkhize of the first case of a “local transmission”, has proved to be a false positive, but the question remained: how will this test SA’s resources?

“The answer is no-one knows,” said public health specialist and deputy director at the South African Medical Research Council, Professor Susan Goldstein.

“The upside is that we have a lot of information and a great response team to follow up contacts. Also that our population is relatively young.”

Goldstein noted another benefit at the moment was the weather was still quite hot which seemed to affect the virus by allowing it to survive for a shorter period.

“The downside is millions of people with HIV and or TB, a substantial number of whom aren’t on ART or TB treatment. Our facilities are relatively good but could become overwhelmed,” Goldstein said.

“Other major downsides are that many people live in overcrowded conditions – what does self-isolation mean in this context? Many people don’t have running water in their houses or yard, what does frequent hand washing mean in this context,” said Goldstein.

“An upside is that we do have private sector resources that can be used and have been offered, I believe.”

Independent international relations researcher and consultant focused on issues of international security Dr Leaza Jernberg said yesterday she was “very worried” SA didn’t have enough resources.

“If even developed countries are struggling to cope with the demand for ICU and hospital beds, given the high number of immuno-compromised people in South Africa and the realities of high inequality and poverty, the likelihood of high infections with exponential growth overwhelming our systems is a real concern,” Jernverg said.

“We urgently need to engage in Social Distancing and ramping up our preparations.”

According to tbfacts.org, the World Health Organisation (WHO) statistics estimated there to be about 322,000 cases of active tuberculosis in 2017, fortunately down from an estimated 500,000 in 2011.

“Out of the estimated 322,000 incident cases in South Africa in 2017, it is estimated by WHO about 60% (193,000) are HIV positive,” tbfacts stated.

“It is also estimated that of the 123,148 whose status is known, and who are known to be HIV positive, some 89% (109,799) are on ARV therapy.”

In 2018 UNAids declared 7.7 million South Africans were living with HIV, and that SA’s HIV prevalence – the percentage of people living with HIV – among adults (15–49 years) was 20.4%.

It all begged the question, is South Africa ready for Covid-19?

Annie Wilkinson is a PhD research fellow at the Institute of Development Studies in the UK and co-founded the Ebola Response Anthropology Platform during the West African Ebola epidemic which provided rapid response advice and research.

The Democratic Republic of Congo is hoping to announce an end to its tenth outbreak of the dreaded disease in April. Of 3,444 cases, 2,264 people did not survive.

“One billion people live in slums or informal settlements where water for basic needs is in short supply – let alone 20 seconds’ worth [of hand washing] – and where space is constrained and rooms are often shared,” Wilkinson wrote for the IDS.

“Yet discussion about vulnerability in these contexts has been startlingly absent.”

Referring to an International Institute for Environment and Development cautionary note that “Weak infrastructure would leave urban settlements in low-income countries highly vulnerable, should the rapid spread of Covid-19 continue”, Wilkinson said the impact of Covid-19 on people living in densely populated and unsanitary environments needed to be considered.

“This is challenging as the health and social needs of these populations are often invisible.”

Wilkinson noted slums were not “vectors” of disease, “as they are sometimes derogatively cast”.

“Informal settlements and their residents are part and parcel of the city system, often subsidising and contributing to life elsewhere in the city,” Wilkinson noted.

“This makes control efforts built on containment and reductions in movement difficult to implement, especially if they impinge on people’s already threadbare livelihoods. We should beware of slum-wide quarantines, as were attempted ineffectively with Ebola.”

For now, however, it’s a waiting game to see how SA copes with the virus.

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