The “faulty” lock has served its purpose and should …

It is time for the government to realize that there is nothing more it can do. It is now up to South African citizens to take responsibility. This was the message from the infectious disease specialist and member of the Ministerial Advisory Committee on Health, Professor Shabir Madhi.

While the blockade has taken time for South Africa’s health system to prepare, the wrong time, the lack of evidence, the wrong type of evidence, and the slow release of the results have taken away the government’s chances of significantly reducing infections in the community, Madhi said.

Instead, the continued strategy is causing more harm as people are struggling to access basic medical tests for South Africa’s deadliest tuberculosis. Hospitals are starting to see cases of malnutrition and the future of children is being jeopardized by keeping schools closed, he said.

Referring to the collateral damage caused by the ongoing blockade, Madhi said the government’s current response was “to prepare for increased mortality from non-Covid-related diseases.”

As an example, he mentioned that there was a 50% reduction in TB tests and a late diagnosis. Tuberculosis remains the leading cause of death in South Africa.

He said that by imposing the blockade before South Africa was ready for mass testing, the country’s chances of fighting the spread of community transmission had been further damaged and damaged by continuing an unsustainable test-and-trace strategy as it The test results take up to two weeks to release, allowing the number of contacts to be tracked to skyrocket and creating impossible workloads for healthcare workers as cases reach 10,000.

“Whether it’s over a six-month period, or over a two-year period, this infection will be with us until at least 2021 or 2022.”

Madhi’s comments come when Health Minister Dr. Zweli Mkhize announced Sunday that South Africa has more than 10,015 confirmed coronavirus infections, and that the Western Cape and Eastern Cape are responsible for 84% of new cases.

“The only thing that will help us is for citizens to take responsibility. The government can come with all the policies in the world. If citizens are not going to take responsibility, we are going to fail, ”said Madhi.

Madhi was discussing future strategies after five weeks of confinement in South Africa. The blockade was imposed by President Cyril Ramaphosa on March 22 as a strategy to “flatten the curve” and curb the spread of coronavirus infections in the country.

But Madhi said that what the blockade had not done and that no future intervention is going to do is reduce the number of people who will become infected in South Africa.

“Whether it’s over a six-month period, or over a two-year period, this infection will be with us until at least 2021 or 2022,” he said.

“There is no way to escape,” he said, referring to the wave of cases caused by community transmission.

For the past few weeks he has been questioning the wisdom of continuing the blockade.

“A blockade is not a magic bullet … unless citizens take collective responsibility, there is nothing the government can do … If citizens do not do what they are asked to do … we will have a transmission faster and higher peak, “he said.

Madhi added that it was time to open schools while observing preventive measures such as personal distancing, hand hygiene and the use of masks, and the phase in classes.

What we know about Covid-19 in children is that they rarely develop serious illness. As an example, in Italy there were 30,000 deaths from Covid-19, of which none were children under the age of 18. In the United States, less than 2% of cases were children and only three died. All three had underlying medical conditions.

“Children are being punished for a problem that they are not [creating]. They are not the vectors of disease spread. The transmission is not the same. What is the compensation for jeopardizing your future? I ask.

“In my circles, we all sing from the same hymn sheet. These issues are discussed in hospitals. I have not met someone who tells me that I am talking nonsense. Let’s be clear: There are no Covid-19 experts in the world. Otherwise, we will not be in this mess. I am basing my message on scientific evidence. I’m not sucking my thumb.

While the shutdown has served its purpose, he said, the government should focus on gaining community acceptance.

“Collective responsibility will be key. But we must protect ourselves from the collateral damage that is being done. [by lockdown].

“The children are not being vaccinated. People are not being diagnosed with TB. There are cases of children developing malnutrition, “he said.

“An increase in cases is coming … the only thing that will help is that the citizens of South Africa take responsibility. The government can come up with all the policies in the world … I am talking about non-therapeutic interventions: wearing a non-surgical mask, personal distance and hand hygiene, “he said. “It will not protect people completely, but it will help us reduce the infection rate.”

This strategy, he warned, carried some risk.

“If people don’t follow these recommendations, we will fail. It doesn’t matter what level of confinement we are at.”

Madhi added that he is convinced that schools should be opened, with all necessary precautions, but also that classes should be gradually faster than planned.

“What we know about Covid-19 in children is that they rarely develop serious illness. As an example, in Italy there were 30,000 deaths from Covid-19, of which none were children under the age of 18. In the United States, less than 2% of cases were children and only three died. All three had underlying medical conditions.

“For the first time that I have come across 25 years of studying respiratory pathogens, children are being saved from serious illness by a respiratory virus. We do not fully understand the reason … but worldwide only a few children died of Covid-19. The other concern is that children may be an important vector of transmission, but it was an extrapolation from what we know about influenza as we experience it each year. “

He said a study from the Netherlands and one from Australia showed that there were almost no cases of children infecting adults.

“We are not protecting children by not sending them back to school.

“The first lesson from educators should be that educators should tell students what to do to reduce the transmission rate and why it is important, and they should be evaluated based on their knowledge.”

We are seeing three to four waves of infections. We must plan. That is the message that must penetrate. Approximately 60% of SAs will become infected regardless of what we do before developing herd immunity

He added that the blockade was not a sustainable strategy to combat the pandemic.

“We are seeing three to four waves of infections. We must plan That is the message that must be assimilated. Approximately 60% of SAs will become infected regardless of what we do before developing herd immunity, “he said.

This, Madhi had difficulties to point out, it was not an end of the world scenario, since 70% of those infected will be asymptomatic, 25 to 26 out of every 1,000 will need to be hospitalized and unfortunately three to four people could die. Of these, he added, 90% will be over 65 years with comorbidities.

“I am not saying that we should not have entered the running of the bulls. The timing of the crash, relative to what should be the primary target of the crash (containing the community feed), was not correct … If our testing capabilities had been intact and if we had the correct criteria of who should If tested, we would have been more successful in identifying infected individuals and preventing transmission, “he said.

“The main reason the blockade was important was that the health facilities were not ready. It gave them time to prepare bed capacity, oxygen points, personal protective equipment, etc. We can mark this [off] because we are not quite sure what will happen to us. But, as far as possible, it can be accomplished in a period of three to five weeks. It does not build health systems in three to five weeks. It probably took a lot more time for health centers to equip themselves to deal with what will be an inevitable problem: there will be an increase in cases, ”he said.

He said that continuing the blockade as a way to deal with community broadcasts will not be successful.

“Interrupting the community transmission rate is not the same as eliminating the virus. In all of human history we have only been successful in eradicating a virus and that was smallpox. We achieve this through vaccination. ”

He said that no respiratory virus had been completely removed.

He added that before the crash, less than 20% of infected people’s contacts were tracked.

“The modeling data shows that to reduce virus transmission at an early stage, it must be effective in tracking 80% of contacts. If you can’t track 80% of contacts, you won’t be able to control the spread of the virus, “he said.

“The reality of what is happening right now is that the test results take between five and 14 days. If we can’t get a result within 12 to 24 hours, those tests don’t make sense. The most important metric should be how many of these tests return in 24 hours; how many contacts are identified and what percentage were tracked and tested and placed in isolation and quarantine. This is a gigantic task. It works at the beginning of a pandemic when there are few cases. You reach a tipping point when it becomes implausible, ”he said.

“It was believed that we could have interrupted community transmission through the blockade. We cannot do this, but there was a perception that this was the purpose of the blockade. It is not about interrupting community broadcasting. Every year we have influenza and other viruses. You cannot interrupt them. You can try reducing the transmission speed. We reduced community transmission, there was some reduction, although the exact nature is difficult to quantify. It is difficult to quantify because the number of tests decreased in the first two weeks of closing. ”

Madhi explained that during the first two weeks of confinement, the number of tests decreased to less than 1,000 per day across the country. Before the blockade was imposed, 2,000 to 3,000 tests were conducted, Madhi said. He added that there was a drop in cases due to a drop in evidence, but also because the cases were in the incubation period.

He said that towards the end of the forced shutdown period (which ended April 30) there was a tenfold increase in the number of tests and then around 400 new cases were diagnosed per day.

“If you do more tests, you will find more cases.”

Madhi further explained that in South Africa, people, especially those using public transport, could have up to 120 contacts who would have to be tracked if the test results are supposed to be available within 24 hours.

The analysis takes five to 14 days for the tests to return, he said. He said that if the results return after the first seven days, the patient will already be much less infectious.

“If we can’t get results within 12 to 24 hours, those tests don’t make sense,” he said, explaining that with a large number of new cases and delayed results, it is impossible to trace and isolate the contacts.

In his opinion, he said, it would be more important to limit testing to those in hospitals to protect health workers and provide doctors with the best treatment strategy, and make sure they are available in one day.

Instead, he added, rapid antibody tests should be implemented to test in the community and identify critical points.

He questioned the wisdom of the government’s current strategy that uses health workers to make home visits and evaluate people.

“The reason why no other country in the world does this is because we are talking about a respiratory virus. People can develop symptoms of the virus the next day. The strategy is fundamentally flawed. We need better access for test facilities in communities. If we are serious about identifying this, our window of opportunity is closing in on us, if it had not passed us by yet.

“I am not saying to throw community tests out the window: the tests available in the country do not lend themselves to what we intend to do. With a rapid antibody test, you can map how an epidemic is evolving. We must change the strategy. ” DM / MC