South Africa can become a country that rationally adapts to a COVID-19-integrated world, taking into account all healthcare priorities, to the benefit of all her people, write academics from the University of Cape Town (UCT).
When a novel coronavirus now known as SARS-CoV-2 (Covid-19) first entered the world stage on the heels of the Chinese New Year in January 2020, little was known about it and its impact on people, health systems and countries. This was understandable given its recency, novelty and unknown transmission dynamics.
Early on, in an anxious and data-sparse time, models were relied upon in order to guide country responses to the menace of a new pathogen. The lockdown that began in South Africa 52 days ago was both rational and a necessary response. It bought the country precious time in which to prepare the health system to deal with an anticipated surge in demand on clinical services by “flattening the curve”.
However, over the last five months, a tsunami of information has been gathered with modelled extrapolations from other pandemics, experiences from other countries and increasing data from our own country.
Now that the Covid-19 pandemic in South Africa has entered the phase of wide community spread, we must re-evaluate and balance risks against benefits, moving from an acute to a more medium- to longer-term response, informed by what has been learnt, but remaining cognisant of the many remaining uncertainties.
Globally, 4.6 million people are known to have been infected with Covid-19, with more than 310,000 deaths from the virus to date. While the scale of the global pandemic is truly alarming and every single death from Covid-19 is a tragedy, it is necessary to benchmark our response to the South African pandemic against the harms of other diseases and the ongoing draconian measures to contain Covid-19.
The global impact of Covid-19 is starkly highlighted by images of lines of ambulances, patients in corridors, patients dying alone, bodies in makeshift morgues and mass graves. Yet deaths resulting from the extreme measures employed to contain Covid-19 will not happen in front of the cameras. These “excess” deaths will go largely unrecorded among vulnerable people in poor communities, and among those unable to access routine care for TB, HIV, surgical conditions, cardiometabolic disease, cancer and other chronic conditions.
Given the scale of infections already reported, and experience elsewhere, it is possible that many tens of thousands of South Africans will die from causes directly attributable to Covid-19. Although this may appear to be a large number, it represents around 10% of the number of deaths that would be expected in the country annually from all other causes.
In South Africa, close to 200,000 people of all ages die every year from TB and HIV. In addition to the twin scourges of TB and HIV, our country is grappling with epidemics of non-communicable diseases (NCDs) and increasing prevalence of mental health conditions are already being reported.
The Stop TB Partnership estimates that a three-month lockdown could cause an additional 1.4 million TB deaths globally from 2020 to 2025. If we extrapolate to South Africa, this could result in an additional 60,000 deaths due to TB alone. In the past two months, thousands of patients whose chronic conditions would have been managed electively in clinics and with planned interventions have now started presenting acutely with more severe organ failure because of a lack of elective clinical services.
Children, whose rights should be prioritised by our Constitution, are suffering increasingly from malnutrition and preventable infectious diseases, including TB and measles, due to missed vaccinations. We must consider the possibility that the continued economic lockdown, increased poverty, decreased access to health services and diversion of public health resources to focus on Covid-19, may cause greater loss of life.
In protecting the health system, we must not fail to maintain the continuing health of the people that the system serves. We have a responsibility to ensure that a “successful” Covid-19 response does not cause more suffering than Covid-19 itself.
We strongly support the call of others to rationalise South Africa’s Covid-19 strategy. This includes an end to the exceptional focus on Covid-19 to the exclusion of other public health challenges. Public health resources should be immediately prioritised, and integrated with the control of other infectious diseases and NCDs that may kill more South Africans than Covid-19.
We will tragically and inevitably continue to lose South Africans to Covid-19. However, for the last century we have waged war on epidemics and pathogens, and will undoubtedly need to do so again in future. We need to ignite the agency of communities to co-create community-based integrated mitigation measures.
We are in solidarity with those who fight daily to reduce the suffering and death in our clinics, wards and facilities. They must be protected through effective personal protective equipment and infection control measures. Field hospitals and additional emergency facilities that can provide reasonable healthcare to most Covid-19 cases have been established and should be extended as required, recognising that intensive care units may not be feasible in all.
Other essential health services should be encouraged to continue, integrating Covid-19 into well-established services and thereby building a public health approach that does not exceptionalise Covid-19. Likewise, other essential services, such as the registration and capturing of data on births and deaths must continue to function.
South Africa can and will play a significant role in research to find other effective and innovative ways to reduce the impact of Covid-19 on individuals and communities. Perhaps in the months and years to come, we will be fortunate enough to find a vaccine that may lead to the eradication of Covid-19; early signs give us reason for hope. Until then, South Africa can become a country that rationally adapts to a Covid-19-integrated world taking into account all healthcare priorities, to the benefit of all her people.
The authors are infectious disease, public health specialists and demographers at the University of Cape Town.
COVID-19 is a global pandemic that caused President Cyril Ramaphosa to declare a national disaster in South Africa on 15 March 2020 and to implement a national lockdown from 26 March 2020. UCT is taking the threat of infection in our university community extremely seriously, and this page will be updated with the latest COVID-19 information. Please note that the information on this page is subject to change depending on current lockdown regulations.
Minister of Health, Dr Joe Phaahla, has in June 2022 repealed some of South Africa’s remaining COVID-19 regulations: namely, sections 16A, 16B and 16C of the Regulations Relating to the Surveillance and the Control of Notifiable Medical Conditions under the National Health Act. We are now no longer required to wear masks or limit gatherings. Venue restrictions and checks for travellers coming into South Africa have now also been removed.
On Wednesday, 20 July, staff from the University of Cape Town’s (UCT) Faculty of Health Sciences came together with representatives from the Western Cape Government at the UCT Community of Hope Vaccination Centre at Forest Hill Residence to acknowledge the centre’s significance in the fight against COVID-19 and to thank its staff for their contributions. The centre opened on 1 September 2021 with the aim of providing quality vaccination services to UCT staff, students and the nearby communities, as well as to create an opportunity for medical students from the Faculty of Health Sciences to gain practical public health skills. The vaccination centre ceased operations on Friday, 29 July 2022.
With the closure of the UCT Community of Hope Vaccination Centre, if you still require access to a COVID-19 vaccination site please visit the CovidComms SA website to find an alternative.
“After almost a year of operation, the University of Cape Town’s (UCT) Community of Hope Vaccination Centre, located at the Forest Hill residence complex in Mowbray, will close on Friday, 29 July 2022. I am extremely grateful and proud of all staff, students and everyone involved in this important project.”
– Vice-Chancellor Prof Mamokgethi PhakengWith the closure of the UCT Community of Hope Vaccination Centre, if you still require access to a COVID-19 vaccination site please visit the CovidComms SA website to find an alternative.
UCT’s Institute of Infectious Disease and Molecular Medicine (IDM) collaborated with Global Citizen, speaking to trusted experts to dispel vaccine misinformation.
If you have further questions about the COVID-19 vaccine check out the FAQ produced by the Desmond Tutu Health Foundation (DTHF). The DTHF has developed a dedicated chat function where you can ask your vaccine-related questions on the bottom right hand corner of the website.
IDM YouTube channel | IDM website
“As a contact university, we look forward to readjusting our undergraduate and postgraduate programmes in 2023 as the COVID-19 regulations have been repealed.”
– Prof Harsha Kathard, Acting Deputy Vice-Chancellor: Teaching and Learning
We are continuing to monitor the situation and we will be updating the UCT community regularly – as and when there are further updates. If you are concerned or need more information, students can contact the Student Wellness Service on 021 650 5620 or 021 650 1271 (after hours), while staff can contact 021 650 5685.