AS THE COUNTRY prepares for what appears to be an unprecedented lock-down, following the declaration of a national disaster over a week ago, the authorities continue to bungle the epidemic.
Granted a lot has changed since we reported on the failure to close borders to European red zones, our obsession with Wuhan repatriation, and the problematic roll-out of posters with a case definition which excluded the possibility of community transmission.
Since then, our President announced broad-ranging and sweeping measures to contain the spread of the virus, including the shutting of ports and harbours, limitations on groups of more than 100 individuals, the introduction of a drinking curfew and other draconian measures, none of which tackle the central problem that this is a single–stranded, positive-sense RNA virus which hijacks the body in order to synthesise the proteins required to reproduce itself.
Instead of announcing a colloquium or symposium to collect the prevailing scientific and evidence-based research needed to make informed decisions, our government has simply launched the country into a series of drastic actions and interventions via presidential decree, albeit informed by World Health Organisation officials in Geneva.
One action announced on Monday is an unprecedented shelter-in-place directive, in other words a national lock-down, which will require all citizens except those in exempt categories, to stay home for 21 days. A similar order during the epidemic in Wuhan, essentially voluntary self-quarantining, and also currently in the USA, and elsewhere, has had limited success, and will in all likelihood fail.
The measure to use the parlance of the WHO ‘merely buys time‘.
To put this another way, if we simply suppress the virus, it will just come back once we end our lock-down, and the exponential spike we are all hoping to avoid now, will come back in May or July, especially since the virus is more active during Winter.
Public health officials hope that these steps will act to ‘flatten the curve’, but as this video shows, doing so at the wrong time, may risk the situation where the other half of the population will still go on to get the illness.
We can’t go into another lockdown after this one, and the sheer impact upon the economy is causing reverberations and jitters around the continent. While a raft of measures were announced to mitigate the impact on sectors such as the Hospitality industry, the sheer numbers of people affected make life incredibly difficult for scenario planners.
So what are we not doing that we should be doing?
Avoiding crude measures such as mass quarantines and instead relying upon big data as Taiwan and Singapore have done, to manage the spread of the virus, is certainly more preferable.
Creating acceptable risks by rapidly introducing antiviral treatments which act to reduce viral production within the body and thereby infection, transmission and mortality is another option of managing the problem. (To date over a 100 compounds have been identified by computational methods, a veritable Manhattan Project).
Realising that we have an incredible advantage when it comes to data processing that previous generations and pandemics lacked is crucial to the outcome of the crisis.
Cutting the red-tape that prevents the repurposing and redeployment of antiviral medication to fight the virus is going to determine whether or not we win this one.
It is unthinkable that we live in an age of germ-destroying ‘disinfection robots’, artificial intelligence and the sudden re-emergence of the cordon sanitaire, long considered a throwback to the Middle Ages.
Extending force magnification measures already in place such as tele-medicine to virtual visits during the epidemic could assist an overstretched public health system in reaching out to patients in the absence of transport.
Extending drone delivery of blood samples to delivery of medication and home diagnostic kits also could save lives.
Correcting mistakes with health communication by acknowledging the evolving symptoms and vectors of the epidemic as the City of Cape Town has done, is just a start.
So too would be correcting the comparison often made here with the flu.
The Coronovirus is related to the common cold, in essence a Zoonotic Cold or Respiratory Illness from Bats and Pangolins, and has struck down normally healthy youngsters who form some 10% of those in ICU, as well as the aged.
The reason why some people end up in ICU with Acute Respiratory Distress Syndrome (ARDS) while others get away with mild symptoms is not well understood and may have something to do with previous exposure to coronoviruses and the presence or absence of antibodies.
In the near absence of universal testing, (SA will only able to do 30 000 tests a day by mid April) temperature screening of fever suspects at public gatherings, might eliminate super-spreaders, and also buy us more time. Enough time until we are able to roll-out a universal vaccine and immunisation campaign.
To date, South Africa has yet to announce a local vaccine candidate or drug trial.