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JOHANNESBURG, SOUTH AFRICA – APRIL 18: The South African National Defense Force (SANDF) patrols the streets in Vosloorus on 18 of 2020 in Johannesburg, South Africa. (Photo by Gallo Images / ER Lombard)
The ongoing “hard block” is likely to cause much more suffering in the short and long term than the pandemic itself. As doctors at higher risk, we do not request that the blockage be relieved lightly. But we see much more damage to our health system and our economy by further delaying the inevitable spread of the virus.
Dear President Ramaphosa,
We, the undersigned physicians, admire the leadership they have shown in managing the Covid-19 outbreak. You have successfully galvanized unanimous support for the tremendous challenge we face as a country and specifically as the health profession.
It has given the medical community time to prepare for the expected increase in seriously ill patients. The public has also been given a clear indication of the seriousness of the situation. However, it has not eradicated the anticipated pandemic from our country, it has simply delayed it. While in Europe and North America, funds may be available to balance the number of critically ill patients with the number of hospital beds and ventilators, we do not see this as a viable option for South Africa.
Our healthcare system and economy were already on our knees before the Covid-19 explosion. The negative effects of keeping the country in the present “hard” blockade, or even in a relatively “light” blockade, are innumerable. We ask that you lift the hard lock as soon as possible.
Many patients without Covid-19 do not receive the treatment they require because hospitals empty for patients with Covid-19. Many of these patients avoid hospitals and cancel their outpatient appointments. Disruptions in regular prevention programs, such as vaccination schedules for babies or the promotion of sexual and reproductive health, will weaken our few health gains that we have made with so much effort since democracy. Together, they are constantly accumulating a backlog of healthcare that is potentially a crisis in itself.
Unfortunately, doctors in South Africa had to get used to the harsh realities of limited funding and limited beds for very sick patients. This means providing less than optimal care and even letting patients die as comfortably as possible on a regular basis. As a country, we have acquired international rhetoric that is not tailored to local circumstances. We are fortunate that the present Covid-19 virus does not predominantly kill youth as the 1918 influenza virus did. Sadly it kills many elderly people, but this is still a relatively small percentage of the population; At this stage, we do not know the effects on people living with HIV who are not on treatment and people with tuberculosis. In any case, it is unlikely that a vaccine will be developed and distributed in less than 18 months. Our economy and health system will be destroyed if we expect much more and, as always, our poorest citizens will suffer the most.
Although current mortality estimates are more than six times lower than initially estimated, at 0.5%, we are approaching winter and there are countless reasons why the pandemic will hit South Africans more in the winter months. We cannot afford to stay in the “hard” block any longer. Each week we delay is likely to worsen the outcome of the pandemic.
As social, financial and health-related side effects begin to increase, we strongly urge that most people return to work.
Those who can work from home or in isolation should be encouraged, but we believe it is critical that fit and robustness get back to work, in a staggered fashion whenever possible. Particular attention should be paid to ensuring that public transport operators comply with the revised regulations to minimize the risk of transmission to their passengers. It may be wise to keep certain forms of business closed, especially where people congregate, including bars, clubs, and any gathering of groups of people, including faith-based meetings. Restaurants may be allowed to prepare takeaways or arrange for home deliveries.
Some restrictions on the sale of alcohol during this crisis are likely to continue to make sense, as they are likely to reduce the burden on hospitals for alcohol-related car accidents and violence resulting in trauma. Limited family budgets can be spent on food instead of alcohol. People who quit alcohol can see doctors for help.
Schools (and higher education institutions) that can teach online can continue to do so if they wish, but the vast majority of children cannot and their parents must return to work to earn money to feed them. Many of these children need to go to school to access feeding programs.
All South Africans should be encouraged to continue washing their hands, maintaining physical distance and taking other measures to curb the spread. Those at greatest risk, the elderly and people with health problems, should continue to try to isolate themselves socially as much as possible and receive help from their communities. Clear guidelines should be established that describe how access will be prioritized to different levels of health care interventions and will be widely disclosed in a transparent manner. This will allow South Africans who are at risk to be warned and take additional precautions to reduce the risk of contracting the virus.
We have a limited number of healthcare workers, so it is important to prioritize your healthcare. Personal protective equipment (PPE) for health workers must be a national priority throughout the pandemic, and we hope that the government is actively encouraging local industries that can manufacture them to specifications to do so immediately.
Last and by no means least, it can be helpful to reassure the public, as there is an unfounded fear that the Covid-19 contraction is fatal and the misconception that a crash would purge us of Sars-CoV-2. This current fear has caused many people to dismiss the future of our country, which is currently at risk.
Sars-CoV-2 is here to stay. The truth is that people will die, but even more will recover. We will do our best as a country and medical fraternity to treat infected patients, but we must also begin to pay attention to the other diseases that have continued to progress relatively untreated.
As those who are most at risk once the pandemic takes off in South Africa, we do not ask lightly. We see far greater harm to our health system and our economy by further delaying the inevitable spread of the virus. The ongoing “hard block” is likely to cause much more suffering in the short and long term than the pandemic itself.
Sars-CoV 2 and Covid-19 have given us a moment of pause to reflect on many things. We have examined our priorities. We have refocused on important issues such as medical care and support for the underprivileged.
While we hope the lessons learned will positively contribute to our new normalcy, it’s time to hit the play button again. If we start spinning the wheels soon, we have a chance to recover. If we languish at the bottom of this well, we will do irreparable harm to our future and that of our children.
Life must go on if we want to survive in any respectable way. DM
Signed: Graduates of the UCT MBChB 1993 class: The argument of this letter was informed by extensive discussions and the exchange of experiences and evidence of our WhatsApp class group with doctors working in South Africa and around the world.
In alphabetical order:
- Zunaid Barclay, Nephrologist, Cape Town;
- Ingrid de Beer, general practitioner, Cape Town;
- Perrin Hansen, pediatric neurologist, Johannesburg;
- Chris Hofmeyr, ENT surgeon, Cape Town;
- Riaz Ismael, general practitioner, Cape Town;
- Hilary Johnstone, Clinical Research, George;
- Ebrahim Kader, Neuro and General Interventionalist, Cape Town;
- Tracy Kilborn, Pediatric Radiology, Cape Town;
- Feizal Majiet, general and occupational physician, Cape Town;
- Thane Munting, orthopedic surgeon, Cape Town;
- Simon Pickstone-Taylor, psychiatrist, Western Cape;
- Jenny Potts, specialist physician and rheumatologist, Port Elizabeth;
- Neil Richards, family doctor, Cape Town;
- Nandi Siegfried, Public Health Physician, Cape Town;
- Chantal Simonis, Consultant in Reproductive Medicine, Southampton, UK;
- Kerstin Simons, Vascular Surgery Consultant, Tutzing, Germany;
- Paul Sinclair, pediatrician, Cape Town;
- Fred Tyler, urologist, East London; and
- Kathleen Van der Westhuizen, general practitioner, Cape Town
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