How SA bungled the Covid epidemic and looks set to repeat the mistakes of the Spanish flu

INSTEAD of focusing efforts at containment, the country was transfixed by what President Ramaphosa described as an `exercise to carry the pride and hope of the nation`. Instead of closing borders to the new epicentres of Italy and Spain, the country was welcoming travellers, without so much as a Covid-free certificate. No quarantines for incoming tourists from Spain, Italy or Hong Kong for that matter. Our national effort focused on the plight of less than 150 citizens living in Wuhan. In the process the ruling party sacrificed a massive opportunity to contain Covid-19 until a vaccine could be found.

Our efforts at containment are too little, too late, and will in all likelihood cost the lives of some 3 million citizens once the epidemic is over.

Airport screening is largely futile, research shows. 

Singapore’s MOH has expanded the definition of suspect cases to include ‘persons with pneumonia or severe respiratory infection with breathlessness.’ The country has rolled out a new portble swab test at checkpoints.

Meanwhile in the Cape Metro, our Health MEC issued guidelines that excluded the possibility of Community Infection.  A poster issued by the City 11 March directs persons with Covid-19 symptoms to seek assistance ONLY if they have travelled overseas or have come into contact with a person already diagnosed with Covid-19.  Achieving what other countries could not with a stroke of pen.

The same posters were then translated into several of our national languages with better graphics and type and rolled out this week, in a total waste of resources.

Instead of lowering the threshold of surveillance, MEC Nomafrensch Mbombo raised the bar, excluding assistance to anyone who may have gotten an infection from a traveller or tourist. A public health policy which merely feeds into a testing system overly dependent upon private pathology labs, and where Covid test costs are anywhere R1400 – R900.

It is a policy which appears to also have originated from the previous SARS epidemic in which no tests nor vaccines were available, and where case definitions relied upon excluding various symptoms in the absence of treatment modalities.

Senegal a country with experience  from recent Ebola epidemic, is able to produce 10 minute tests which cost R16.50

Massive testing has been a key factor of successful combat of the epidemic in South Korea and Canada. The linchpin of South Korea’s response has been a testing programme that has screened more people per capita for the virus than any other country by far. ‘By carrying out up to 15,000 tests per day, health officials have been able to screen some 250,000 people – about one in every 200 South Koreans – since January’.

Australia has issued an order directing new arrivals to the country to self-quarantine for 14 days as has Canada and New Zealand.

Independent reports of citizens using the national toll free number, confirm that no Covid assistance will be forthcoming to anyone who suspects community transmission. A report of the country’s first confirmed community transmission in the Free State was withdrawn last week, apparently the result of ‘misinterpretation’.

After dithering on the issue of testing the Trump administration announced sweeping reforms on Friday which included free testing for all citizens, a policy already mandated by congress. The declaration of a state of emergency in the USA has also paved the way for pharmaceutical company Roche to access federal emergency funding for a massive rollout of SARS-CoV-2 Test to detect novel coronavirus.

If one uses German Chancellor Merkel’s estimates that 40%-60% of the population will invariably be infected: South Africa with a population of 52 million must plan for some 20 800 000 to 31 200 000 cases of which 1.8 – 3.4 % will be critical. In other words we stand to lose 561 600 to 1 060 800 and 374 400 to 707 200 people during the course of the epidemic.

Extrapolating stats from the North presents certain difficulties, the least of which is our country has many informal settlements and an under-resourced public health system. The figures therefore need to be corrected by a factor of 3 — we could end up shedding anywhere between 1 200 000 and 3 million people if critical cases do not receive treatment.

Editorial note: Readers please refrain from comparing raw exponential data surrounding an evolving epidemic to events which are static, and without same variance like annual mortality rate for car accidents, since according to statistician, NN Taleb, ‘this introduces a flaw in standard statistics’.

A local epidemiologist Jody Boffa, says she suspects ‘that once COVID-19 is more established in South Africa, the numbers of people requiring hospitalisation for pneumonia and other severe complications will be higher than 1.7 to 4 million if we do not take preventive steps now because of specific health issues in our population that affect the immune system of younger populations as well; specifically HIV, tuberculosis (TB), and malnutrition.’

A guide on ‘Interpreting and using mortality data in humanitarian emergencies’ cautions on the imprecision inherent to all epidemiological models but nevertheless insists such impact data ‘should be used to drive policy decisions’.

The Democratic Alliance (DA) has issued a statement calling on the Minister of Health, Dr Zweli Mkhize, to institute a mandatory self-quarantine period of 14 days for all travelers from high-risk European countries whether the person is symptomatic or not. The party could not explain why the City’s own Covid-19 programme excluded those who have not travelled overseas or have not come into contact with a person already diagnosed with Covid-19.

During the 1918 Spanish Flu epidemic South Africa was one of the five worst-hit parts of the world. About 300,000 South Africans died within six weeks. This represented 6% of the entire population.

In 1918, the city of Philadelphia threw a parade that killed thousands of people. Ignoring warnings of influenza among soldiers preparing for World War I, the march to support the war effort drew 200,000 people who crammed together to watch the procession. ‘Three days later, every bed in Philadelphia’s 31 hospitals was filled with sick and dying patients, infected by the Spanish flu.’

The UK has announced a preventive quarantine programme for the elderly as well as other measures to combat the fast-moving epidemic.

Covid-19 is more infectious and contagious than previously assumed. R0 value is likely to be between 4.7 and 6.6., and not 2.2 to 2.7 as previously reported.

Coronavirus turns deadly when it leads to ‘cytokine storm’; identifying this immune response is key to patient’s survival

The most common symptoms of COVID-19, according to the WHO: fever (in 88% of cases), dry cough (68%), fatigue (38%) and sputum/phlegm production (33%). Shortness of breath occurred in nearly 20% of cases, and about 13% had a sore throat or headache, the WHO said in a report drawing on more than 70,000 cases in China.

Veredus Laboratories has announced development of detection kit for Wuhan Coronavirus. 

The credit card sized kit is a portable Lab-on-Chip application capable of ‘detecting the Middle-East Respiratory Syndrome Coronavirus (MERS-CoV), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and 2019 Novel Coronavirus (2019-nCoV) i.e. Wuhan Coronavirus, in a single test’ in about 2 hours.

See Covid Simulator

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