Shivani Ranchod | March 2020
Paradoxically, wide-spread panic about the spread of the SARS-Cov-2 virus, and the associated covid-19 illness does not necessarily lead to sufficient preparedness and action. Wise action extends beyond that taken by government to all sectors of society – employers (large and small), private healthcare facilities, schools and, most importantly, individuals. We need to put aside self-interest in favour of protecting the collective. The most vulnerable members of society, the elderly, those with compromised immune systems and the poor, need everyone else to minimise their chances of infection.
An overload of information does not translate into informedness
Wise action requires a certain clear-headedness – difficult in a fast-changing situation, and one where there is an enormous amount of noise and panic. We need to be able to re-assess and adjust strategies on a daily basis as our understanding evolves, using a high degree of discernment in relation to news sources. Employers and other institutions play an important role in supporting a well-informed society. We need to be community minded, which means keeping fear in check.
Right now, our mantra has to be to slow down the spread of the virus as much as possible. This is because our health system cannot cope with a large number of cases at the same time. The spread of the virus is complicated by the vast majority (80%) of cases being mild and the mild cases are the most mobile and least-ill members of society. It is critically important that anyone who suspects they have the virus to self-isolate – even if doing so feels silly. Not all symptoms present in all patients. If you have ANY of the symptoms, the responsible thing to do is to stay at home. Symptoms include:
- Fever (88% of cases)
- Dry cough (68% of cases)
- Fatigue (38% of cases)
- Phlegm (33% of cases)
- Shortness of breath (19% of cases)
- Muscle or joint pain (15% of cases)
- Sore throat (14% of cases) – although early indications from the NICD indicate that a higher proportion of SA cases are presenting with sore throats.
- Headache (14% of cases)
I prefer the term “physical distancing” to social distancing, because there remain numerous ways to connect socially without close physical contact. Physical distancing isn’t a realistic choice for many South Africans, particularly those who live in close confines and rely on public transport. Those of us who have the resources to apply distancing measures must to do so to protect those who cannot.
It is important to recognise that economic and social trade-offs are different in a low-income setting. The decisions made in other countries may not be the right decisions for us. For example, in poor communities, children often rely on school to be safe and to be fed – closing schools for an extended period of time may has serious second-order consequences. The closing of schools for a slightly longer period that the planned school holidays makes sense in terms of buying us time.
However, any longer term closing will need to carefully considered with a lens broader than immediate health consequences, particularly given that children are not particularly vulnerable to covid-19 but are vectors of transmission.
In a society with high levels of informal employment the consequences of missed days of work are devastating for households. Again, those of us who are more resourced must prepare to step in with feeding programmes and other measures to alleviate the impact.
Mortality rates will depend on the speed of spreading and health system strength
The mortality rate of covid-19 is lower in a well-functioning health system where an exponential rise in cases requiring hospitalisation can be slowed. However, it is important to keep in mind, that 20% of cases will require some engagement with the health system. All of these cases will be at risk if we do not manage our health system effectively – this means minimising elective use of the system, using telehealth solutions where possible and to keep healthy in all other respects. Close co-operation between the public and private sectors will help to maximise available resources.
My sense is that we will benefit enormously from being able to switch to a command and control mode, something that a state of emergency enables. Things like a well-run NICD, co-ordination between public and private sectors, the establishment of a national hotline to deal with queries and wide-spread testing are all excellent. There are also huge opportunities for the permanent strengthening of our health system. The best example for me is tele-health, the adoption of which has been slowed down by outdated HPCSA rules. This is not to say that the service delivery failures in our system are not going to be accentuated – they are going to be. In a scenario where 40% of South Africans contract the virus (i.e. when the virus becomes endemic), and 5% of those cases are serious, we will have over a million patients requiring acute care. This is an “all-hands-on-deck” scenario, one that will hopefully avoid BUT one that we MUST prepare for.