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A SANDF soldier has a 24-hour roadblock on the N2 near Khayelitsha. (Photo: Roger Sedrus / Gallo Images via Getty Images)
While the vast majority of South Africans hiring Covid-19 will survive, the continued blockade is destroying the livelihoods of millions of people. It is not rising fast enough, and we are not yet obtaining enough data to determine the actual risk of the pandemic.
Governments around the world have imposed blocking regulations to curb the spread of Covid-19. They worked initially, but it has become clear that strict blocking regulations are wreaking economic havoc.
Professor Shabir Madhi, an infectious disease expert who is part of the South African Ministerial Health Advisory Committee, said in a Daily maverick webinar on Sunday, May 10 that “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. “
However, “continuing the blockade will not stop the wave of community broadcasts hitting South Africa, and will continue to prolong the collateral damage it is causing.”
In a contribution to The Lancet Global HealthProfessor Wolfgang Preiser, chief of the Division of Medical Virology at the Faculty of Medicine and Health Sciences at Stellenbosch University (SU), joins others in warning of the “deprivation and hunger that will result from economic disruption prolonged. “
Clearly we have reached the stage where the threat to livelihoods due to job loss and increasing poverty is much greater than the threat to lives due to Covid-19. President Cyril Ramaphosa’s announcements last night, May 13, did not go far enough.
Dr. Nick Spaull, from SU’s Department of Economics, describes the coronavirus pandemic as the “greatest shock of our generation,” one that is “having profound social and economic impacts in our country.” He is the lead investigator for a large new study to track the economic impacts of Covid-19 in South Africa, a collaboration between SU and the universities of Cape Town and the Witwatersrand.
His colleague, Dr. Nwabisa Makaluza, a member of SU’s Socioeconomic Policy Research Group, argues that the most important question right now is how Covid-19 is affecting the lives of the most marginalized people in South Africa.
In addition to the growing economic and humanitarian crisis caused by strict closure restrictions, there is also the disruptive effect of the current situation on access to essential health services. This includes access to childhood immunization for the prevention of serious diseases, such as measles, and the diagnosis and treatment of conditions, such as HIV, tuberculosis, and diabetes. Ultimately, this can lead to more suffering and death than that caused by Covid-19.
What are more distant opinions? Dr. Johan Giesecke, a Swedish physician and professor emeritus at the Karolinska Institute in Stockholm, writes in The Lancet Global Health“There is very little we can do to prevent this spread: a blockage can delay serious cases for a while, but once the restrictions are relieved, the cases will reappear.”
In a recent interview, Sweden’s state epidemiologist Dr. Anders Tegnell defended his nation’s approach of not imposing a blanket closure, but focusing on high-risk areas such as the elderly and nursing homes, along with guidelines for voluntary social distancing and emphasis on hand washing in the general population. They trusted the cooperation of the population, and obtained it, because the levels of public trust are high in Sweden.
Dr. John Lee, a recently retired professor of pathology and a former pathologist consultant to the National Health Service in the UK, agrees that the Swedish model appears equally effective, but at a much lower cost. Knowing that Covid-19 affects children less, they kept schools open. And they kept the economy going.
Blocking is not sustainable, writes Dr. Lee in The viewer: “No country has improved the health of its population by becoming poorer.”
He notes that the blockade directly hurts those who will not be greatly affected by the coronavirus: “The vast majority of people under the age of 65, and almost all people under the age of 50, will be no more bothered by this disease than for a cold. “
Scientific data shows that age plays an important role in Covid-19. The older you are, the higher the risk of mortality, especially if you have an underlying disease. Among people known to be infected with the coronavirus, the risk of death if they are over 80 years of age is 14.8%, but for those under 60 it falls to 1.3%, and decreases to less than 0.4% if they are younger. 50 years.
Let’s put that in context. The average age of South Africans is 27, with 10 million people under the age of 10 (near-zero risk), 40 million people under the age of 40 (risk of death 0.2%), and approximately two million people over the age of 70. years. About 90% of deaths in South Africa from Covid-19 have been from people over the age of 70.
Given this, the vast majority of the South African population that contracts the disease will survive, and by far the majority will either be completely asymptomatic or have only mild symptoms.
Currently we only receive a small amount of descriptive data on those affected by Covid-19. This means that we get the total number of new infections daily and the total number of deaths. This is far from what is needed to determine the actual risk of the pandemic.
It is not helpful to give a cumulative daily number of confirmed infections, unless the total number of tests for a particular day is also provided so that the percentage of positive tests can be calculated.
Because more tests are conducted in the Western Cape than elsewhere, it means there will be more positive tests. This does not make the province the epicenter of the disease, it simply reflects greater efficiency in monitoring the disease.
Epidemiology is much more than just descriptive. What is lacking at this time is analytical epidemiology, which assesses risk factors for disease outcomes and explores causal relationships. All factors other than age play a role in determining risk, including health status and socioeconomic and environmental factors.
According to South African official statistics, the overall case fatality rate among those testing positive for Covid-19 is 1.9%. Those who undergo coronavirus screening probably represent people with severe symptoms and worse outcomes. The true population-based death rate, which includes all infected people regardless of the presence or severity of their symptoms, can be expected to be much lower. Therefore, we need more information to better understand this risk.
Tim Harford, economist and journalist, writes in The Financial Times that systematic serological surveys are vital to determine the true spread or prevalence of the disease in the community.
“Serological tests look for antibodies that suggest that a person has already been infected. These antibody tests should give more clarity, but the first results are still a statistical mosaic for now. “
The average mortality in South Africa due to Covid-19 is currently three per day, a total of 206 since March 5. [at the time of writing this on 12 May]. If we compare that with other causes of death, we see that 194 of the 7.7 million people living with HIV-AIDS in our country die daily, 80 daily as a result of TB, 69 as a result of diabetes and 26 as a result of diabetes. flu result.
While we are dealing with insufficient epidemiological information about the real risk posed by the new coronavirus, one of the only certainties right now is that the pandemic is destroying the livelihoods of millions of people.
That is why President Ramaphosa’s announcements last night were too small and too late. Dragging the lock further is not a good idea.
Informed decisions need to be made about when and how the economy and education sector reopen. We cannot continue to make decisions, some of which seem irrational, about the information that is currently presented and used. DM
Professor Wim de Villiers, gastroenterologist, is rector and vice rector of the University of Stellenbosch. Professor Eugene Cloete, a microbiologist, is vice chancellor for research, innovation and graduate studies, and chair of SU’s Covid-19 medical advisory committee.
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