SA’s COVID-19 response is hurting other health priorities

28 May 2020 | Story Linda-Gail Bekker, Valerie Mizrahi, Ntobeko Ntusi, Tom Moultrie, Tracey Naledi, Mark Hatherill, Debbie Bradshaw, Rob Dorrington and Robin Wood. Photo Flickr. Read time 6 min.
Essential health services, including vaccinations, should be encouraged to continue.
Essential health services, including vaccinations, should be encouraged to continue.

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.

This article was originally published by the Daily Maverick.

For licensing information please visit the source website.

UCT’s response to COVID-19

COVID-19 is a global pandemic that caused President Cyril Ramaphosa to declare a national disaster in South Africa on 15 March and implement a national lockdown from 26 March.

UCT is taking the threat of infection in our university community extremely seriously, and this page will be updated regularly with the latest COVID-19 information.

Frequently asked questions

 

Daily updates


Friday, 11 September 10:05, 11 September 2020
Monday, 31 August 12:20, 31 August 2020
Wednesday, 12 August 10:20, 12 August 2020
Friday, 7 August 11:24, 7 August 2020
Thursday, 6 August 18:26, 6 August 2020
Monday, 27 July 14:00, 27 July 2020
Wednesday, 15 July 09:30, 15 July 2020
Monday, 13 July 14:25, 13 July 2020
Monday, 6 July 16:20, 6 July 2020
Thursday, 25 June 10:15, 25 June 2020
Tuesday, 23 June 12:30, 23 June 2020
Thursday, 18 June 17:35, 18 June 2020
Wednesday, 17 June 10:45, 17 June 2020
Tuesday, 2 June 12:20, 2 June 2020
Friday, 29 May 09:25, 29 May 2020
Monday, 25 May 14:00, 25 May 2020
Thursday, 21 May 12:00, 21 May 2020
Wednesday, 6 May 10:00, 6 May 2020
Tuesday, 5 May 17:05, 5 May 2020
Thursday, 30 April 17:10, 30 April 2020
Tuesday, 28 April 10:30, 28 April 2020
Friday, 24 April 09:35, 24 April 2020
Thursday, 23 April 17:00, 23 April 2020
Wednesday, 22 April 14:25, 22 April 2020
Monday, 20 April 17:45, 20 April 2020
Friday, 17 April 12:30, 17 April 2020
Thursday, 16 April 09:45, 16 April 2020
Tuesday, 14 April 11:30, 14 April 2020
Thursday, 9 April 09:00, 9 April 2020
Wednesday, 8 April 15:40, 8 April 2020
Wednesday, 1 April 15:50, 1 April 2020
Friday, 27 March 11:40, 27 March 2020
Thursday, 26 March 18:30, 26 March 2020
Tuesday, 24 March 15:40, 24 March 2020
Monday, 23 March 15:40, 23 March 2020
Friday, 20 March 16:00, 20 March 2020
Thursday, 19 March 09:15, 19 March 2020
Wednesday, 18 March 16:00, 18 March 2020
Tuesday, 17 March 12:50, 17 March 2020
Monday, 16 March 17:15, 16 March 2020

Campus communications


Call for proposals: TLC2020 10:15, 26 August 2020
SAULM survey and other updates 15:30, 5 August 2020
COVID-19 cases and other updates 15:26, 5 August 2020
New UCT Council and other updates 15:12, 15 July 2020
Upcoming UCT virtual events 09:30, 15 July 2020
Pre-paid data for UCT students 14:25, 22 April 2020
Update for postgraduate students 12:55, 20 April 2020
UCT Human Resources and COVID-19 16:05, 19 March 2020
UCT confirms second COVID-19 case 09:15, 19 March 2020
Update on UCT COVID-19 response 13:50, 11 March 2020
Update on COVID-19 17:37, 6 March 2020

Resources

Video messages from the Department of Medicine

Getting credible, evidence-based, accessible information and recommendations relating to COVID-19

The Department of Medicine at the University of Cape Town and Groote Schuur Hospital, are producing educational video material for use on digital platforms and in multiple languages. The information contained in these videos is authenticated and endorsed by the team of experts based in the Department of Medicine. Many of the recommendations are based on current best evidence and are aligned to provincial, national and international guidelines. For more information on UCT’s Department of Medicine, please visit the website.


To watch more videos like these, visit the Department of Medicine’s YouTube channel.

Useful information from UCT

External resources


News and opinions


Statements and media releases


Media releases



Read more  

Statements from Government



 
 

In an email to the UCT community, Vice-Chancellor Professor Mamokgethi Phakeng said:
“COVID-19, caused by the virus SARS-CoV-2, is a rapidly changing epidemic. [...] Information [...] will be updated as and when new information becomes available.”

 

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.

 

TOP