We will be lucky if we vaccinate 2% of our population

GIVEN the slow pace at which South Africa’s mass vaccination campaign has been rolled out — as yet, not one confirmed public vaccination has been administered — claims by government that 10% of the population, including the vulnerable and front-line workers will receive the jab, must be met with a good degree of scepticism.

We will be lucky if we manage to vaccinate some 2% of our citizens over the coming six months, that’s 1 140 000 or just over 1 million individuals. The recent comments made by the Chief Justice may have already torpedoed the public Covax Initiative.

In the week in which a new more virulent local variant of the virus was announced by Health Minister Dr Zweli Mkhize, with its origin in Nelson Mandela Bay, the country finally paid over its contribution to the UN programme, yet another example of what Dr Carl Venter terms a ‘poor handling of the crisis’.

Health activists had thus already expressed concern that South Africa had missed the deadline, and all this while images of the West’s immunisation campaign already under way were being streamed over our television screens, a local wait-and-see approach if any.

Meanwhile the health system in several provinces was under severe pressure, with no plans in sight to alleviate the lack of oxygen, PPE and high care facilities over the New Year period. Local press appeared unable to present the problematic second wave and our failing vaccination programme in any frame except, ‘we’ve been here already, and don’t want another hard lock-down’.

Readers would have had to find information on the collapse of health care services and lack of critical care in Nelson Mandela Bay, not from the local press, but rather from the New York Times, whose Sheri Fink reported this week on a tragedy unfolding in Port Elizabeth, and thus a troubling lack of credible information from local media houses.

A situation of self-censorship which has its echo in previous fumbling by the Mbeki administration over ARVs and the earlier Botha regime which suppressed news about the SADF invasion of Angola and death toll at Cuito Cuanavale?

While government was announcing it had identified the 501.V2 Variant, Minister Mkhize was thus bizarrely playing down the implications of a sudden shift in the epidemiological picture as the demure Prof Karim continued to spew forth scientific opinion with little impact on the reality and lives of health care workers.

“Clinicians, said Karim “have been providing anecdotal evidence of a shift in the clinical epidemiological picture – in particular noting that they are seeing a larger proportion of younger patients with no co-morbidities presenting with critical illness,” he said.

If Fink’s observations as a journalist are mere anecdotes, then much of what passes for press commentary in the republic is a fraud.

Let her words below sink in, it doesn’t take a rocket scientist to observe the virus isn’t any more deadly, it is rather, more pernicious and disruptive to our health sector:

“At the center of a terrifying coronavirus surge, 242 patients lay in row after row of beds under the soaring metal beams of a decommissioned Volkswagen factory.”

“Workers at the vast field hospital could provide oxygen and medications, but there were no I.C.U. beds, no ventilators, no working phones and just one physician on duty on a recent Sunday — Dr. Jessica Du Preez, in her second year of independent practice.”

“In a shed-like refrigerator behind a door marked “BODY HOLD,” carts contained the remains of three patients that morning. A funeral home had already picked up another body.”

“On rounds, Dr. Du Preez stopped at the bed of a 60-year-old patient, a grandmother and former college counselor. Her oxygen tube had detached while she was lying prone, but the nurses had so many patients they hadn’t noticed. Now, she was gone.”

That medics are having to prioritise who gets treatment while denying others, according to a score card, is a tragedy being repeated all around the world.

Revisiting Eskom Liberalisation and the Energy Commons

ALMOST a decade ago, I started openly talking about an Energy Commons yet plans mooted for splitting up Eskom remain stalled. One plan calls for splitting the parastatel into two units, another into three, but the price of electricity continues to outstrip inflation in leaps and bounds.

The basic idea behind all these proposals is to have Eskom become the main cable distributor of electricity, whilst various regional power utilities compete with each other to produce energy for clients, in an open market that allows competition.

One plan calls for Eskom to go the same way as Telkom, a listed JSE company that until recently maintained a monopoly over copper cable services, that have been supplanted by fibre-to-the-door.

An open energy system would certainly benefit the consumer and allow Independent Power Producers (IPP) to coexist whilst doing wonders for the price of electricity — introducing a range of services such as virtual metering and even leasing of home appliances, that currently do not exist.

But it is not just organised labour and union bureaucrats who are opposed to the opening up of an energy commons, with opposition from misguided ideologues who myopically fear that what they call ‘privatisation’ will mean less jobs. Municipalities and Metros currently earn revenue via the bulk sale of electricity from Eskom which is then routed to consumers, a pyramid scheme if ever there was one.

Not only is such a system uneconomical, but the costs are invariably borne by the poor, the real losers in a stalled economic environment. High electricity prices have been cited as one of the major factors effecting development.

Doctrinaire Socialist think-tanks such as Cape Town’s AIDC routinely produce media attacking energy liberalisation policies, a bugbear of the left, but without providing any evidence that opening up the energy economy will have adverse effects.

Take New Zealand for example, where 82% of energy supplied is renewable, one of the least CO2 producing nations on the planet — its electrical energy generation, previously state-owned as in most countries, ‘was corporatised, deregulated and partly sold off over the last two decades of the twentieth century, following a model typical in the Western world.’

However, much of the generation and retail sectors, as well as the entire transmission sector, remains under government ownership as state-owned enterprises.

An online article states: ‘The Fourth Labour Government corporatised the Electricity Division as a State Owned Enterprise in 1987, as the Electricity Corporation of New Zealand (ECNZ), which traded for a period as Electricorp. The Fourth National Government went further with the Energy Companies Act 1992, requiring ‘EPBs and MEDs’ to become commercial companies in charge of distribution and retailing.’

In 1994, ECNZ’s transmission business was split off as Transpower. In 1996, ECNZ was split again, with a new separate generation business, Contact Energy, being formed.

The Fourth National Government privatised Contact Energy in 1999. From 1 April 1999, the remainder of ECNZ was split again, with the major assets formed into three new state-owned enterprises (Mighty River Power (now Mercury Energy), Genesis Energy and Meridian Energy) and with the minor assets being sold off. At the same time, local power companies were required to separate distribution and retailing, with the retail side of the business sold off, mainly to generation companies.

The result is a plethora of choice where consumers are concerned, the same variety and quality of retail service we find in the world of Mobile Telephony and Internet Service Provision. A liberal energy policy is behind New Zealand’s economic success story.

There is no doubt that if Telkom had remained the sole provider of communication services in South Africa, we would have missed out on the startling technological developments experienced in this sector, instead the reverse has been true so far as energy policy is concerned.

Time to bring innovation and economics back to the energy game?

The far left’s tenuous grip on Covid-19 science

DR MBUYISENI  Ndlozi, a man with a PhD in Political Science from Wits is no expert on epidemics and virology. As a spokesperson for far-left opposition party, EFF, he is a regular guest on national television and a staunch opponent of any relaxation of the hard lockdown.

Like many popular commentators on Covid-19, including myself, Ndlozi was quick to compare the pandemic to the Spanish Flu of 1918. Just how wrong this comparison has turned out, can be seen by the fact that several pandemics have occurred since the Spanish flu, each with their own lesson for humanity.

In February 1957, a new influenza A (H2N2) virus emerged in East Asia, triggering a pandemic (“Asian Flu”).

The Hong Kong flu (also known as 1968 flu pandemic) was a flu pandemic whose outbreak in 1968 and 1969 killed an estimated one million people all over the world. Woodstock occurred during the pandemic.

Nobody remembers these epidemics because there was no social media, no lock-downs and no cessation of economic activity. The world survived and only remembered the Spanish Flu epidemic from 1918.

“Should we be comparing Covid-19 to flu at all?” asks science journalist Laura Spinney. “The viruses that cause the flu and Covid-19 belong to two different families. Sars-CoV-2, which causes Covid-19, belongs to the coronavirus family. And in that, there are greater similarities with SARS (severe acute respiratory syndrome, that originated in China in 2002) and MERS (Middle East respiratory syndrome, which began in Saudi Arabia in 2012).”

“Unlike flu, which spreads rapidly and relatively evenly through a population, coronavirus tends to infect in clusters,”

Spinney writes. “In theory, that makes coronavirus outbreaks easier to contain, and indeed both SARS and MERS outbreaks were brought under control before they went global.”

Most importantly, she says, the world has changed a lot between 1918 and now.

“In 1918, a large number of people chose to follow what religious leaders were saying rather than heed the advice of health experts. For instance, in the Spanish city of Zamora, the local bishop defied the health authorities by ordering evening prayers on nine consecutive days in honour of Saint Rocco, the patron saint of plagues. Churchgoers lined up to kiss the saint’s relics. Zamora recorded the highest death rate in Spain, and one of the highest in Europe.”

Ferris Jabr of Scientific American, writing in Wired agrees and says:”Coverage of the coronavirus pandemic teems with monstrous and sometimes contradictory statistics.

“Among the most vexing figures flitting across our screens, and spreading via text and tweet, is the case fatality rate (CFR)—the proportion of known infections that result in death. Early in the Covid-19 pandemic, World Health Organization officials announced an average CFR of 2 percent. Later on, they revised it up to 3.4 percent. In contrast, numerous epidemiologists have argued that the global case fatality rate is closer to 1 percent. These might seem like small differences, but when multiplied across large populations they translate to significant discrepancies in overall deaths.”

The novel coronavirus pandemic however remains “a major threat that demands a swift and robust response,” writes Jabr. “Even a fatality rate between 0.5 and 1 percent is extremely alarming in a world as populous and interconnected as ours. Another crucial consideration is the virus’s potential to induce severe illness that may not be fatal but lasts for weeks, straining hospital resources and potentially leaving some people with lifelong health issues.”

Ndlozi is therefore right to reiterate the initial concerns raised by persons such as myself, with regard to the virulence and infectiousness of the virus. Its rapid spread took everyone by surprise, and without sufficient controls many lives would have been lost. But he is just plain wrong to suggest without any evidence, that a blanket, hard lock-down applied to the entire country will provide any benefits moving forward.

South Africa has aggressively intervened to contain the epidemic. But it is far from clear which strategic outcome is being pursued. “Is it following the lead of countries such as New Zealand or South Korea and trying to stop virus transmission altogether until a suitable vaccine becomes available? Or is it attempting to manage the infection rates so that extreme peaks in morbidity are prevented? “asks Alex Van Den Heever et al.

The cost of embracing a zero-risk policy is more likely to lead to ‘untold economic misery’ for ordinary South Africans and will prove ultimately futile in areas where social distancing is unworkable, witness the long queues for food across several of our provinces.

Those living in lockdown in South Africa’s townships are bound to experience a double-burden of hardship, not only do they risk losing their jobs, but also family members to the disease. The control measures over the food supply have already backfired.

A recent panel discussion hosted by Francois Picard of France 24, The Debate, highlighted the different approach taken by Sweden which has balanced control measures while avoiding a hard lock-down thereby avoiding an economic situation that ‘nobody will be able to live with’.

So summarise some of the current epidemiological thinking on Covid-19, articulated by Nobel laureates, high achievers in the arena of science as opposed to political studies — in essence the pandemic ‘represents a few extra weeks of average deaths for our population’. A hard lock-down merely pushes these deaths ahead of us, without much benefit. In any event we will still experience waves of the disease moving forward.

Hard lock downs are not the solution. Other ways to control the virus must be found. They might include limiting access to certain districts, keeping entire Cities in one level while other parts of the country are allowed to open up. Fighting the virus wherever it flares up in hotspots but allowing life to continue where it has not.

Hunger must be seen as a determinant of health

YESTERDAYS looting of supermarkets in several South African townships, is unfortunately driven by hunger. These food riots are indicative of an alarming situation unfolding two and a half weeks into the hard lockdown. Gatesville, Manenburg, Tafelsig, Alexandra, are where low-income families have been forced into the lockdown without any tangible relief from government. Hunger must be seen as a determinant of health alongside the burden of disease.

Instead our government appears hellbent on implementing prescriptions driven by the WHO in Geneva. Solutions which may turnout to be wholly unsuited to conditions in emerging economies such as our own. The lockdown may be wrong for Africa.

It is doubtful whether or not the hard lockdown will accomplish any of the supposed objectives laid out by our Health Minister, and should rather be replaced by a smart lockdown, or soft lockdown as soon as possible. Despite experiencing a surge, Japan has implemented a soft lock-down, as have many countries fully aware that completely suppressing the virus risks the situation where one merely postpones and lengthens the epidemic.

According to chief scientist Prof Salim Karim, ‘South Africa will know on 18 April’ if the methodology utilised against the coronovirus is inaccurate or factually correct. The measures may have bought time for our health system to prepare for a coming surge, known as the ‘delayed exponential curve of infection’.

If mitigation measures  to curtail the spread of hunger, are not implemented immediately, the problem of mass starvation could dwarf the current epidemic and grow to haunt South Africans as we move forward during an unprecedented period of economic turmoil. Most households are only able to maintain a two-week supply of food. Without income or food parcels, the situation could quickly deteriorate to conditions seen during wartime, famine and natural disasters.

“Our problem is not that we don’t have enough food in South Africa. Our problem is that the food is only available to those who have cash” writes business strategist Marius Oosthuizen.

The closure of restaurants and hotels has perversely resulted in literal food mountains. Tonnes of produce is being destroyed around the world because of the global pandemic, while ordinary consumers are ironically forced to pay more for fresh produce.

Since 2011, three million more South Africans have been pushed below the poverty line, according to a study by the national data agency, Statistics South Africa. More than 30.4 million South Africans—55.5% of the population—live on less than 992 rand (about $75) per person per month. Yesterdays interest rate cut will assist middle-class households, but the problem remains that most households were already below the poverty line at the beginning of the lock-down.

Ekurhuleni mayor Mzwandile Masina on Tuesday launched a food bank to provide relief to the poor during the Covid-19 outbreak. The same plan alongside further disaster relief is required in every Metro, town and city. School feeding schemes urgently need to be restored. Other relief measures that should be contemplated include once off emergency cash payments to each and every household.

Current relief packages rolled out by national government include  assistance to SMMEs, tax relief, Agricultural Aid, UIF, Health and other support services. More needs to be done if the lockdown continues. As an anonymous author from Iran writes, ‘the difference between barbarism and civilisation is a plate of food’.

It is imperative that food security be seen alongside the burden of disease, as a determinant of people’s health.

 

Getting out of lockdown may be essential to combating impact of the virus

THE LOCKDOWN was never meant to do anything more than buy us time to prepare. Time to allow the public health system to adjust, to stock-up on medication, to initiate testing and special counter-measures.

Unfortunately it appears that many South Africans and government officials are under the impression that the lock-down is some form of a cure-all. It is nothing of the sort. It cannot prevent the second and third wave of infections that will undoubtedly arrive come winter, and it cannot continue being extended if our economy and way of life is to survive.

Although a return to normal is not possible, and social distancing and other measures will be in place for a very long time, the cost of extending the lock-down must be weighed against the inevitable collapse in economic activity that will result. Given that for the majority of South Africans, adapting to a world where the only economic activities will be online jobs, is neither practical nor possible over the short term, nor is it readily apparent what unskilled labour is expected to do during the crisis?

Getting out of lock-down is essential to combat the impact of the virus upon the economy, on people’s lives and livelihoods, and to avoid the continued abuse of state power by the SANDF. Where those on the left including the ANC have supported the extension of the lockdown, it is only the opposition DA which has registered its dismay.

Many of the measures already in place have little scientific or health merit. Preventing people from playing in their yards, from jogging outdoors, or engaging in other activities such as drinking alcohol, that presumably might risk the spread of the virus, is not ideal. A zero tolerance approach to infection has consequences, chief of which is that unless the state can pay its citizens a basic income ,the possibility exists of mass starvation.

There is limited capacity within our country to simply go on dishing out food parcels, to place SMMEs on life support, to postpone bond and debt payments. This while rounding up the homeless, placing such persons in ‘temporary shelters’ that resemble concentration camps. The sheer density of many informal settlements has made such steps seem ludicrous.

One approach to the problem outlined by an Australian virologist, Professor Peter Collignon, is to gradually expose parts of the population to the virus. This controversial approach to developing immunity within the broader population has some merit and should not simply be discarded. In Sweden for example, where there has been no lock-down, admittedly within an excellent health care system, the mortality figures have not been all that different from those countries which have implemented lock-down practices.

In some respects the UK which early on adopted some of the measures in Sweden, before choosing a general lock-down, is an example of the counter-intuitive logic at play. The country at first sheltered the elderly and most vulnerable. Those dying today, would have died tomorrow, argue proponents, dead in future waves of the epidemic. Without a vaccine, the only option for so-called ‘herd immunity‘ is to control the rate of infection, to flatten the curve and stall the onset of the epidemic.

Faced with the prospect that a working vaccine may only be ready in September, in six months time, South Africa has an unenviable task, that of weighing up all the options, examining the case for and against an extension of the current five week lock-down.

published in part by Natal Mercury Letters

 

 

South Africa’s controversial Chloroquine Phosphate adoption

WHY ANYONE would prescribe a substance such as Chloroquine Phosphate for the treatment of Covid-19 is a mystery. For starters the anti-malaria drug is an amebicide, ‘an agent used in the treatment of amoebozoa infections, called amoebiasis’ and is not an anti-viral as such.

It has a low LD50, the lethal dose at which rats and patients die (low is more toxic). It has been touted by both the Trump administration and the World Health Organisation as a treatment for the disease but has been lambasted by critics. Chloroquine: Trump’s misleading claims spark hoarding and overdoses reads one headline.

On the March 19, South Africa adopted Chloroquine Phosphate in its guidelines for the clinical management of Covid-19, published by the Department of Health and the National Institute for Communicable Diseases. A local pharmaceutical company has received permission from the medical regulator to import half a million chloroquine phosphate tablets.

New research published on Wednesday however, ‘suggested that “off label” re-purposing of drugs such as hydroxychloroquine could lead to “drug-induced sudden cardiac death”. The paper by the Mayo Clinic, a nonprofit medical organisation, found that ‘chloroquine and Kaletra, a HIV drug also being used against coronavirus, can cause the heart muscle to take longer than normal to recharge between beats.’

Most RNA viruses develop solely in cytoplasm (a thick solution that fills each cell and is enclosed by the cell membrane.) Unlike plasmodium malaria (amoebozoa ) viral populations do not grow through cell division, because they are acellular.

Coronaviruses are enveloped positive-stranded RNA viruses that replicate in the cytoplasm.

‘To deliver their nucleocapsid into the host cell, they rely on the fusion of their envelope with the host cell membrane. The spike glycoprotein (S) mediates virus entry and is a primary determinant of cell tropism and pathogenesis.’

There are over 100 known drug compounds capable of disrupting the viral replication of Sars-CoV-2, the coronovirus responsible for COVID-19. These substances have been located via an unprecedented bioinformatics search by two groups of scientists working round-the-clock on the equivalent of the Manhattan Project.

Their findings were published less than three weeks apart and must be considered required reading by anyone working in the field of coronovirus medicine. Unfortunately due to politics surrounding branded drugs and the Trump administration, and the machinations of the World Health Organisation, and our own government, these findings are being ignored.

Local use of the drug appears to pre-empt a WHO trial already underway in Norway and Spain.

Although Chloroquine Phosphate, ‘the phosphate salt of chloroquine, a quinoline a compound with antimalarial and anti-inflammatory properties’ appears on one of the lists provided by the researchers, the substance is not recommended by doctors as anything more than a last resort.

The chief executive of Novartis cautioned on Friday that it is “too soon” to be sure whether the anti-malaria drugs could be a definitive treatment for the coronavirus.

“Researchers have tried this drug on virus after virus, and it never works out in humans. The dose needed is just too high,” says Susanne Herold, an expert on pulmonary infections at the University of Giessen,

The latest list of potential coronovirus drugs discovered via an unprecedented bioinformatics search, include many compounds already approved for administering by doctors, some are already in preclinical trials. Among them is a 1971 antiviral drug, Ribavirin capable of disrupting the RNA synthesis of the coronovirus itself, the bug responsible for the biggest health crisis event of the 21st Century.

The drug is described in a paper aptly entitled ‘Broad-spectrum coronavirus antiviral drug discovery‘. It escaped media attention, perhaps due to its patent rights lapsing, while Lopinavir–Ritonavir, a relatively new HIV drug has received a lot of press, alongside Favivlavr a drug from China approved by the National Medical Products Administration of China .  Clinical trials of a promising COVID-19 antiviral, Remdesivir, which gets incorporated into viral RNA and prevents it being synthesised, halting viral replication, are currently underway.

Ribavirin, also known as tribavirin, is an antiviral medication used to treat RSV infectionhepatitis C and some viral hemorrhagic fevers.

A team lead by Nevan Krogan of the Gladstone Institute, working around the clock have identified more than 300 human proteins that interact with SARS-CoV-2 during infection.

Since the Trump announcement there has been attempts to classify coronovirus medicine research and restrict any adverse criticism of Chloroquine, with EPA announcing broad restrictions.

Efforts to raise awareness amongst local organisers of a Peninsula community coronovirus response team were instead met with ridicule, and the writer threatened with prosecution. The lack of debate amongst local authorities is reminiscent of the HIV-denial era, since anyone publishing coronovirus information ‘not authorised by the DOH ‘ may run foul of recently gazetted regulations governing the spread of information.

It is safe to say when this epidemic broke, we were dealing with denialists who refused to believe there was an epidemic. Overnight, these same folk have turned into gatekeepers of what can and cannot be said. Now even government officials are denying there are any antiviral treatments capable of bringing down the epidemic to manageable proportions and urging us all to use Chloroquine  the most widely used drug against malaria.

The safety issues here are also reminiscent of the thalidomide disaster,  one of the darkest episodes in pharmaceutical research history

Although the mechanism of action is not fully understood, chloroquine has been shown to inhibit the parasitic enzyme heme polymerase that converts the toxic heme into non-toxic hemazoin, thereby resulting in the accumulation of toxic heme within the parasite.

Chloroquine may also interfere with the biosynthesis of nucleic acids. However the coronovirus is not a microbial parasite and more research on the use of the substance in symptomatic treatment of a condition associated with an RNA virus would be required.

The most important lesson of the 1918 influenza pandemic: Tell the damn truth

As South Africa fumbles COVID-19 testing, WHO warns social distancing is not enough

AS SOUTH AFRICA continues to struggle to ramp up basic testing for COVID-19, experts at the World Health Organization on Monday emphasized that countries should prioritize such testing— and that social-distancing measures are not enough.

“We have a simple message for all countries: test, test, test,” WHO Director General Tedros Adhanom Ghebreyesus (aka Dr. Tedros) said in a press briefing March 16.

Dr. Tedros noted that, as the numbers of cases and deaths outside of China have quickly risen, many countries—including the US—have urgently adopted so-called social-distancing measures, such as shuttering schools, canceling events, and having people work from home. While these measures can slow transmission and allow health care systems to better cope, they are “not enough to extinguish this pandemic,” Dr. Tedros warned.

What’s needed is a comprehensive approach, he said. “But we have not seen an urgent-enough escalation in testing, isolation and contact tracing, which is the backbone of the response,” Dr. Tedros said.

“The most effective way to prevent infections and save lives is breaking the chains of transmission,” he went on. “And to do that, you must test and isolate. You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.”

SEE: US testing response flounders 

SEE: Singapore’s Portable Covid-19 Swab Test 

SEE: Covid-19 Facts: Surviving the Covid-19 ‘Immunity’ Disaster

Covid-19 Facts: Surviving the Covid-19 ‘Immunity’ Disaster

1. What is SARS-CoV-2 and Covid-19?

“Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)” is the name of the new virus according to the International Committee on Taxonomy of Viruses (ICTV). “COVID-19” is the name of the new disease caused by SARS-CoV-2 following guidelines previously developed with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO).

This means it is related to the coronovirus responsible for the 2003 SARS epidemic. ‘Based on phylogeny, taxonomy and established practice, the CSG recognizes this virus as forming a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus, and designates it as SARS-CoV-2.’

2. What are the Symptoms?

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.

3. How Infectious is SARS-CoV-2?

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. This places it in the realm of Smallpox which has an R0 of 5–7.

It can survive for up to 3 days+ on surfaces and remain airborne for hours.

It is most infectious during incubation, and first week of symptoms and less infectious during post-symptomatic recovery period. Incubation period averages 5.1 days.

It follows that since SARS-CoV-2 is related to the SARS 2003 virus, the same protocols should apply, ‘avoid direct contact with respiratory secretions or body fluids.’

Note: It is well worth reading up on predecessor SARS 1

Can We Learn Anything from the SARS Outbreak to Fight COVID-19?

The problem is that since the coronovirus is a new pathogen, we do not possess natural immunity. South Africans will eventually gain ‘herd immunity’ which is ‘the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination’.

4. How many South Africans are likely to catch COVID-19?

If one uses Boris Johnson and Angela Merkel’s estimates that 40%-60% of the population will invariably be infected: South Africa with a population of 56+ million must plan for some 22 400 000 to 33 600 000 cases of which 1 904 000 will be critical according to WHO average mortality rate of 3.4. This makes it a major problem for the public health system. See Coronavirus: Simple statistical predictions for South Africa

Luckily we have a relatively young population. Age of a population is a factor in mortality rate.

5. How many hospital beds does South Africa have?

There are currently some 80 000 beds in the public health system, and 5000 beds in the private health care system according to MOH Dr Zweli Mkhize today. This means a potential shortfall of 1 819 000 beds. Nationally, there is only 1 hospital, 187 hospital beds and 42 surgical beds per 100 000 population.

6. Which groups are most at risk from SARS-CoV-2?

Most reports suggest that the elderly, infirm and those already possessing co-morbidity, i.e underlying disease such as HIV, Diabetes, Cardiovascular disease are particularly at risk from falling critically ill from the disease.

COVID-19 update: What you need to know now that it’s officially a pandemic

7. Why should I be concerned about SARS-CoV-2 & COVID-19?

Patients with SARS-CoV-2 infection are presenting with a wide range of symptoms. Most patients seem to have mild disease, and about 20% appear to progress to severe disease, including pneumonia, respiratory failure, and, in some cases, even death, according to the Lancet.

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

Since COVID-19 may also reduce lung function, opportunistic infection from Pneumococcus, Streptococcus and Mycobacterium Tuberculosis within the South African context may also be inferred. This presents a substantial and heretofore under-reported risk.

Unless we think globally and act locally to contain and prevent transmission, new waves of the pandemic are likely to hit the sub-continent.

8. What can I do to prevent transmission?

Social distancing, avoiding large crowds, hand-washing, the Covid “handshake” and sneezing into ones elbow are all behavioural changes suggested by our MOH.

Providing hand-sanitation stations at Taxi ranks, Metro-Rail and public venues is another suggestion, so too providing UV lights and/or latex gloves and hand sanitiser to those who deal with money at checkouts, and also pump jockeys at Petrol Stations.

Disinfection of Public Transport and Taxis should be prioritised!

Predecessor SARS 1 showed sensitivity to UV light, renders inactive.

Traditional burning of Imphepho or African Sage may assist poor households in removing bacteria and viruses from the air, as inferred from Journal of Ethnopharmacology, since havan samagri has the potential to kill 94% of bacteria.

9. Is there a cure?

Treatment is currently symptomatic. Several treatment therapies have been advanced, including the use of chloroquine phosphate to treat fever, antivirals such as protease inhibitors to treat viral reproduction and other therapies. Anecdotal evidence suggests that codeine and ibuprofen exacerbates the fever and should not be taken without doctor supervision. Favipiravir, a Japanese flu drug has also proven effective.

Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists

See Could an old malaria drug help fight the new coronavirus?

Warnings issued on lethal dose of Chloroquine 

Nvidia is calling on gaming PC owners to put their systems to work fighting COVID-19 by assisting projects already  ‘simulating potentially druggable protein targets from SARS-CoV-2

Avoid Coronophobia, the fear of Coronoviruses killing you. Rational thinking rather than fear, panic and denial is the key here.

10. Can I test for SARS-CoV-2?

Yes, currently the only tests available are via pathology labs, designated public hospitals such as Tygerberg and the private health system and cost anywhere between R1400 to R900. Local tests have a 48 hour turnaround. This is a significant downside to an otherwise excellent disaster plan. Singapore for instance has rolled out a four-hour turnaround swab-test at entry points, while Senegal is working on a 10-minute PCR test.

Demand better screening, lowering of threshold of surveillance and access to free testing.

11. Is there a Vaccine?

South Africa has no candidate vaccine at this time.

See: How can AI help biotech companies seeking vaccines?

Passive antibody therapy, an Antibody Method from the 1890s is being used to provide stop-gap immunity.

A Phase 1 clinical trial evaluating an investigational vaccine designed to protect against coronavirus disease 2019 (COVID-19) has begun at Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle.

Immunisation will take time, we need to be vigilant and patient until then.

Everything You Need to Know About Coronavirus Vaccines

12. Which borders are closed?

A travel ban has been enforced on foreign nationals from high-risk countries such as Italy, Iran, South Korea, Spain, Germany, the United States, the United Kingdom and China. There is currently no word on Japan,  Spain and other places of concern.

13. How will this effect the global economy?

In 2004 Jong-Wha Lee and Warwick J. McKibbin in ‘Estimating the Global Economic Costs of SARS’ published in ‘Learning from SARS: Preparing for the Next Disease Outbreak‘ produced a global model to simulate the economic impact of a long-term SARS epidemic using the period 2002–2081. The so-called ‘G-Cubed (Asia-Pacific) model’ is eerie and prescient in its description. I reproduce it here:

First, fear of SARS infection leads to a substantial decline in consumer demand, especially for travel and retail sales service. The fast speed of contagion makes people avoid social interactions in affected regions. The adverse demand shock becomes more substantial in regions that have much larger service-related activities and higher population densities, such as Hong Kong or Beijing, China. The psychological shock also ripples around the world, not just to the countries of local transmission of SARS, because the world is so closely linked by international travel. Second, the uncertain features of the disease reduce confidence in the future of the affected economies. This effect seems to be potentially very important, particularly as the shock reverberates through China, which has been a key center of foreign investment. The response by the Chinese government to the epidemic was fragmented and nontransparent. The greater exposure to an unknown disease and the less effective government responses to the disease outbreaks must have elevated concerns about China’s institutional quality and future growth potential. Although it is difficult to measure directly the effects of diseases on decision making by foreign investors, the loss of foreign investors’ confidence would have potentially tremendous impacts on foreign investment flows, which would in turn have significant impacts on China’s economic growth. This effect is also transmitted to other countries competing with China for foreign direct investment (FDI). Third, SARS undoubtedly increases the costs of disease prevention, especially in the most affected industries such as the travel and retail sales service industries. This cost may not be substantial, at least in global terms, as long as the disease is transmitted only by close human contact. However, the global cost could become enormous if the disease is found to be transmitted by other channels such as through international cargo.

14. How will this effect the local economy?

Our economy is so intertwined with the rest of the world that the impact is bound to last for a very long time. In the meantime, think about the benefits and opportunities of buying local, sharing with your neighbour, lending a hand and being prepared. Household responsibility dictates that it is up to individual households at the end of the day to provide for oursselves and to figure out how best to move the economy forward.

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

Towards an African, humanist environmentalism for South Africa

IT WAS during the dying days of apartheid, that I wrote a series of articles promoting ‘ecological sustainable development’ and deep ecology. The pieces published by Grassroots and South Press were extraordinary, the least of which is that they were published by a working class imprint shortly after the state of emergency.

They dovetailed my criticism of race-based conservation efforts by elements within the regime, for example the Rupert Family, and addressed perceptions that the emergent environmental justice movement in the country was, to put it crudely, an all-white affair.

The result was the ‘First National Conference on Environment and Development’, in which academics and activists from all quarters joined hands on a broad eco-justice platform which included both the ANC and PAC, and which resulted in the placing of Earth Rights at the centre of our Constitution, in the form of article 24.

Today’s political pundits Carilee Osborne and Bruce Baigrie , conveniently ignore the history of environmentalism in South Africa, preferring to situate their respective struggles within the contemporary milieu of the Climate Strike — the recent Cape Town March which saw some 2500 people from various organisations and civic structures take to the streets in what they view “as one of the largest environmental protest actions in South Africa’s history.”

This is no mean feet and without wishing to downplay the successes of these epic events during the course of the past year, one should always remember that the environmental justice movement arose as a foundation stone of our Constitution during a period of mass democratic action, the likes of which have yet to be repeated. And thus a struggle which was situated not upon my own writings, nor the writings of any one particular individual, but rather the Freedom Charter, which (within the colour of the time) called upon people black and white, to “save the soil”, whilst sharing the land, and assisting the tillers of the land.

A similar mistake in historical proportion and misreading of history occurs within the various articles penned by one Farieda Khan. She writes in “Environmentalism in South Africa: A Sociopolitical Perspective”, (an otherwise excellent paper written over the turn of the millennium): “The first extra-parliamentary political organization to commit to a formal environmental policy was the Call of Islam, an affiliate of the United Democratic Front (the South African front organization for the then-banned African National Congress).” She goes on to state: “The Call of Islam had a formal environmental policy since its inception in 1984, due in large measure to the efforts of its founder, Moulana Faried Esack.”

If only history were so convenient as to claim environmentalism on behalf of any one religion or individual, whether Islam, or the Church, as many within SAFCEI and SACC would have it, or on behalf of one or more important groups or class formations formulated by those on the left, as those within AIDC would have us believe.

Rather, I think it more accurate and best to take a broader arc of history — one that includes the Freedom Charter and reaches forward to the essential humanism espoused by the deep ecology movement of the 1970s, whose distinguishing and original characteristics are its recognition of the inherent value of all living beings: “Those who work for social changes based on this recognition are motivated by love of nature as well as for humans.” And by extension, as much of my writing and published work from the 1980s suggested, an African environmentalism which realises that Ubuntu is not simply being human because we are all human, but rather, a common humanity contingent upon the necessary existence of our habitat, without which we could not exist as a species.

Instead of situating the environmental movement within so-called ‘working class’ struggles, or working class factions as Osborne and Baigrie attempt in “Towards a working-class environmentalism for South Africa”, and thus the binary of a grand populism vs narrow neoliberalism which simply perpetuates the idea of man’s dominion over nature and thus a struggle which of necessity is juxtaposed alongside the authoritarian grip of party politics, another path must be found.

It is all too easy to issue anti-capitalist prescriptions, leftist directives and cadre-based imperatives calling for the end of free markets whilst, forgetting that it is Eskom’s captive market, Eskom’s socialist ambitions, and Eskom’s coal barons which have pushed South Africa ahead of the UK in terms of GHG emissions, a country with 10-15 million more people. Although only the 33rd largest economy, South Africa is the 14th largest GHG in the world. Our national energy provider, Eskom has yet to adopt GHG emissions targets.

All the result of  the boardroom compromises of the statist, authoritarian left, whose policies have seen our country embrace ‘peak, plateau and decline’ alongside a COP-out strategy excluding South Africa from the Paris Agreement, and thus a national environmental policy which is not based upon empirical science and evidence-based research but rather class driven kragdadigheid and Big Coal.

If those on the far left expect us all to reject secular humanist values alongside Norwegian philosopher Arne Naess who introduced the phrase “deep ecology” and thus an environmentalism which emerged as a popular grassroots political movement in the 1960s with the publication of Rachel Carson’s book Silent Spring, simply because these persons are lily-white, or tainted by the liberal economics of the West, then they are sorely mistaken.

Instead, I believe, that it is far better to formulate an African-centred response, and rather a Pan-African struggle which is broad-based and inclusive of our collective humanity and common habitat. Such a broad-based struggle out of necessity includes an African-Centered Ecophilosophy and Political Ecology.The draft Climate Justice Charter is one such vehicle and deserves our full support.

The struggle for survival during the collapse of the Holocene, includes those already involved in conservation and preservation efforts and those who now join because of concerns about the detrimental impact of modern industrial technology. When one talks about climate justice we thus need to include the voices of those who have not been given an opportunity to speak, and remember that without mass mobilisation, nothing would have changed during apartheid.