Picture for illustration. Health workers -- from cleaning crews to doctors, in hospitals and nursing homes -- have been hit hard by the pandemic. AFP/File/Dimitar DILKOFF
South Africa has seemingly failed the Covid-19 test, with experts saying data beginning to emerge pointed to the country’s burden of chronic conditions as the potential fuel for the devastation of the epidemic.
Compared to countries such as the US, UK and even Sweden, SA’s death rate is still low at about 2%, and it also ranks 22nd in the global Covid-19 list with 52,991 cases and 1,162 deaths. The US has over two million infections, Brazil is second with 742,084 cases and Russia has 493,657 cases.
Top on the list of virus risk factors for government’s advisor, epidemiologist Professor Salim Abdool Karim, has been the about 2.5 million HIV-positive people not on treatment, as well as TB patients.
As much as the swift closing of the borders and the subsequent hard lockdown was effective in flattening the curve initially and gave SA time to prepare, Dr Emily Wong from the Africa Health Research Institute said there has been an increase in the number of cases, particularly in the Western and, now, Eastern Cape.
The national modelling group predicted that intensive care unit (ICU) beds were likely to be overwhelmed during the course of this epidemic – and this was a “big cause for concern”, Wong said. According to emerging data, “unfortunately it does look like HIV and TB put people at higher risk of death from Covid-19, as well as old age and high blood pressure”.
They were, however, yet to see the raw data and were looking forward to that in published form.
“It is an important milestone for SA because it is the first time we have SA data to actually guide our thinking. For these reasons, we need to be concerned about the population’s high rates of HIV, TB, diabetes and obesity. These are reasons for concern…”
Wong, an infectious disease physician-scientist whose work focuses on trying to understand the impact of HIV infection on TB pathogenesis, immunity and epidemiology, said the emphasis should be on ensuring that people with these conditions accessed primary healthcare during the Covid-19 crisis.
“We have some indication from data that this is what is happening with TB: about 30%-40% fewer TB tests have been done in the last three months than was the case in the last year.
“That does not mean there will be less TB cases. There is going to be much TB not diagnosed and people will get much sicker and transmit it to others,” she said.
Dr Jo Barne, senior lecturer in the Stellenbosch University faculty of medicine and health sciences, said South Africa was the first country, to his knowledge, that opened up its lockdown while still facing the upswing of the outbreak.
“Our numbers have not peaked yet. So, where we will end up is unknown. SA flattened the curve well but we did not use the time gained properly. The country’s health services are not well-prepared, and accessibility for many poor South Africans is a huge problem too.”
Barne said HIV/Aids, TB and other chronic conditions were risk factors for Covid-19 disease and were prevalent in the South African population.
“That is an aggravating factor. But there are also a high prevalence of obesity, diabetes, high blood pressure and heart disease.
“All in all, the population carry a large number of high-risk factors. This makes the outlook for a poor outcome more likely,” she said.
According to Barne, there were local places where the system was already severely strained, but the health services would not totally collapse. There may be certain areas where the need may far outstrip the capacity.
However, the SA population was relatively “young” and “we have a much bigger proportion of young persons than the countries in the northern hemisphere such as the UK, the US”, she said. A large number of the deaths in those countries occurred among the elderly, so “hopefully the fact that we have so many young people will bring down the death rate by quite a margin”.
Professor François Venter of the faculty of health sciences of the University of the Witwatersrand said it was still early days but nothing he had seen has been “reassuring”.
The Western Cape was “on fire and Gauteng is smouldering”, and early data from the Western Cape and the private sector suggests what experts most fear: “that older people and those with comorbidities, especially those with diabetes and hypertension, as well as HIV, appear to have worse outcomes”.
– siphom@citizen.co.za
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