Prof Karim hits SA with more Covid facts, and why 1 in 1000 is the magic number

Since his presentation at South Africa’s national command centre on Monday, Professor Salim Abdool Karim has become one of South Africa’s most searched names. According to Google trends, he topped the list of searches on Monday with a whopping 20,000 or more searches of his name.

A Twitter account set up on his behalf received no fewer than 7,000 followers within hours of being opened after his presentation.

People have now resolved to learn more about the man who heads up a 45-member committee tasked with advising Minister of Health Dr Zweli Mkhize and the National Command Council.

In an interview with News24 on Wednesday, Professor Karim touched on everything from his newfound favour with the masses, his area of expertise and all things coronavirus.

“I’ve spent my life studying viruses so, in a way, this was an obvious challenge to take up … the coronavirus,” explained the professor after outlining what his day-to-day routine is.

According to Professor Karim, the committee’s job is to acquaint itself with all available info on the virus on behalf of the health department and other health workers who are far too busy doing the work on the ground to sit and sift through the volumes of research published on an almost daily basis.

“Our challenge is to make the best advice available on the limited evidence that is available.

“Everything we’re doing is based on very little evidence relating to the coronavirus. Because it’s only really in the last four months that there is research being done and evidence being generated. So we have to draw on our experience from other viruses, from other epidemics and from what we have learnt over decades from dealing with viral diseases like this, and we are able to do that,” said Karim in praise of the experts on his advisory committee.

This is because the elements of a virus, and how it spreads, remain the same.

He went on to explain how South Africa has built a strong “capacity of science” in dealing with viral diseases such as TB and HIV. This, according to the professor, has allowed the country’s health system to institute nationwide contact tracing in a timeous manner as the framework was already in place from the ongoing fight against these viruses.

“I’ve always said to the minister and our committee that we should expect to make mistakes, we’re going to make mistakes, we are human. And we will learn from those mistakes,” said Karim before adding “our strength is going to lie in how we are able to minimise those mistakes.”

Touching on the contents of his presentation, he repeated the purpose of a lockdown, in addition to outlining the ideal criteria under which it would end.

Since the main aim of the country’s lockdown period was to control community transmission, Karim believes that if there are more than one in every 1,000 people who have this virus, then we should stay in a lockdown.

The professor admits that there is no perfect ratio in this regard but one in 1,000 seems “fairly reasonable”.

He said he also based this number on the fact that it makes it easier to glean the impact of infections in a population of 55 million people.

This was based on the approach taken by Chinese authorities in Wuhan – an approach that Karim says inspired South Africa’s Covid-19 response to some degree – an approach chosen from four identified based on decisions taken by countries throughout the world.

He listed them as the ostrich approach, the herd-immunity approach, the partial herd immunity approach and lockdown.

The first is named after an ostrich’s fabled tendency to bury its head in the sand and pretend things are not as bad as they are. He says this was the option taken by US President Donald Trump.

To illustrate the second concept of herd immunity, Karim used measles as an example. Based on the world’s treatment of measles, he said that in order to achieve herd immunity, measles taught us that we would have to immunise/vaccinate 95% of the population to protect the remaining and vulnerable 5% of the population from infection.

“We don’t know what the herd immunity level is for the coronavirus. You have no idea how many people are going to have to get infected to protect the entire population.”

He listed the UK as a country that had tried this approach, which did not work.

Additionally, he touched on the idea of partial herd immunity where older people could be placed in lockdown while those under the age of 60 were allowed to continue their lives as normal to a point where enough people got the infection and built up some sort of immunity before older people could be allowed out of lockdown. Sweden tried this approach and Karim said they now had the highest coronavirus death rate in Scandinavia.

From the experiences of those three countries, South Africa went with China’s approach of a lockdown instead, as it seemed to be the most effective of the four.

“It remains to be seen whether they [China] have herd immunity. In other words, it remains to be seen whether or not enough people got infected in Wuhan in the first epidemic to see whether or not everyone gets protected if the virus comes back. And it’s going to come back.”

As such, the committee was watching Wuhan closely in order to see how they fared.

“We will have some idea from Wuhan as to what herd immunity levels are going to be.”

Treatments

According to the professor, we are still in the early stages of understanding how to make treatments for viruses. This is unlike what he have learnt about penicillin and the treatment of infections caused by bacteria.

“We don’t have the same historical track record of developing drugs against viruses. Against viruses, we’ve only been successful in the last three or four decades.”

He added that drugs against viruses were not really refined until the advent of HIV.

“HIV, like the coronavirus, is a single-stranded RNA virus, so they have the same basic genetic material. The virus can convert its RNA into DNA and that conversion allows the virus to integrate into the human body.”

Most HIV/Aids drugs have, thus far, focused on that reverse transcriptase enzyme, which Karim says the coronavirus does not have.

Currently, existing drugs and treatments for other viruses are therefore not able to be effective against the coronavirus.

The healthcare system currently manages patients on the basis of their symptoms. If you have a fever, cough or shortness of breath, you are given a treatment to quell that symptom.

“We treat you in a supportive way. We support you in a way that you can develop your own antibodies and fight this virus with your own immune system.

“That immunity that is required against this virus, all of us have it. You don’t need to take vitamins or anything to have good immunity against this virus, you have it. When you get the virus, your body will produce these antibodies. It does so automatically.”

Re-infection

The professor explained that experts had thus far learnt that a very high proportion of the population develops an immune response to this virus (an antibody response).

What they did not yet know, however, was if that response kept you from getting re-infected.

“The evidence so far suggests that that is so.”

Additionally, evidence seemed to point to the fact that people who had been infected once may not get infected again.

Thus far, the committee’s focus had been on how the country could best use the tools at its disposal  to quell the infection rate and Karim said there were four tools at our disposal:

1. Social distancing
2. Hand-washing
3. Using masks (primarily by those who are infected and may be asymptomatic to prevent spreading what they have)
4. Testing and follow-up actions (such as contact tracing, isolation, quarantine etc)

Watch the full interview below:

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