The world is grappling with a new pandemic in the form of Covid-19 (coronavirus disease 2019), which is caused by the virus SARS-CoV2. On the 30 January 2020, the World Health Organisation (WHO) declared a global health emergency, otherwise known as a Public Health Emergency of International Concern. By doing so, the WHO acknowledged that this virus poses a risk to other countries beyond its point of origin in Wuhan, China and that there needs to be a more coordinated international response to the outbreak.
There are currently 48 010 laboratory-confirmed cases and there have been 2 618 deaths, with cases in 29 countries (accurate as of 09:34am, 24 February 2020). However, there is still concern that China is underreporting the number of cases, especially if patients with milder symptoms are not being tested or treated. Given the growing list of countries with confirmed Covid-19 cases, the interconnected nature of the global economy, and the amount of air travel today, it seems like a matter of time before it spreads to African countries. South Africa, and Africa, is working with the WHO, in anticipation of the arrival of Covid-19 on the continent.
Healthcare workers on the frontlines
Infectious diseases are not new to South Africa. In fact, Rietfontein Hospital in Johannesburg, renamed Sizwe Hospital in 1995, opened in 1895 and drew patients from across Africa for treatment of communicable diseases including the Spanish Flu, Bubonic Plague, and Smallpox. It was here that nurse Emily Blake comforted a small sick child crying for his mother, and in the process became infected with the Bubonic Plague, and died shortly thereafter at the age of 27.
Once again, it is the healthcare workers who are on the frontline, risking infection as they strive to deal with this pandemic. One of the doctors who tried to raise the alarm about a new SARS-like virus, Dr Li Wenliang, died as a result of Covid-19. He caught the virus while treating patients in Wuhan. The China National Health Commission Vice Minister Zeng Yixin stated on the 14 February 2020 that, so far, 1716 health workers have been infected and six of them have died.
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The highly infectious nature of Covid-19 was confirmed when a quarantine official, collecting surveys on the Diamond Princess cruise ship, docked at Yokohama, Japan, tested positive for the disease. Early research indicated that the SARS-CoV2 virus is spread primarily via human contact and cough and sneeze droplets, although it is too soon to rule out other means of infection. Scientists also warn that the virus could remain infectious on surfaces for up to 9 days.
Worryingly, there has been some anecdotal evidence of patients being infected by asymptomatic people. Furthermore, the virus appears to have an incubation period of between 2- 24 days, unlike the 2-10 days initially thought, and is infectious during this time. Should this prove to be the case, it would render the WHO recommended quarantine period of 14 days meaningless.
SA’s plan of action
While the early sequencing of the SARS-CoV2 genome allowed for the development of nucleic acid tests to detect the virus, there is growing concern that these tests are producing a large number of false negatives. This is raising questions about how many times a patient will have to test negative in order to be considered recovered from the infection. China changed its diagnostic criteria to account for clinical diagnosis based on symptoms and CT scans, which resulted in a massive increase in the number of infected with 15,152 new cases of Covid-19 overnight. However, even CT scans of infected patients lungs miss signs of the infection in approximately 50% of the patients scanned.
South Africa’s Health Minister, Dr Zweli Mkhize, has stated that the national health department has contingency measures in place to deal with Covid-19, including active screening at the main ports of entry into South Africa. However, this is far from a fool-proof measure to stop the spread of the disease into South Africa. Early analysis indicates that thermal entry screening would only identify 9 out of 100 infected travellers coming off a long-haul flight.
Currently, the coronavirus 2019 appears to be most severe in the elderly, the immune-compromised, and those with pre-existing conditions. The WHO is recommending that the response to the virus should focus on early recognition of suspected patients, isolation, appropriate infection prevention and control measure and the provision of optimised supportive care.
South Africa indicated that it will follow this approach, with the National Health Laboratory service offering 24-hour lab services to detect the virus, and the National Institute for Communicable Diseases (NCID) having set up a 24/7 operation centre to deal with any cases that have been detected. So far, 63 samples have been tested and all have been found to be negative. However, given the high number of false negatives being experienced with these tests, this is not as reassuring as it ought to be.
What are the lessons learnt so far?
The difference between the number of infected, and the number of resolved cases, whether through death or recovery, indicates that those who catch Covid-19 are ill for weeks and may only become severely ill after a few weeks of displaying symptoms.
All but three coronavirus disease deaths have taken place in China. This can be partially explained by the fact that the high number of infections has strained the resources of the local Chinese healthcare system to breaking point. There are simply not enough doctors, nurses, respirators, oxygen or protective clothing and masks to deal with the number of new cases they face daily. This means that people are turned away from hospitals and clinics, increasing their chances of infecting others.
African countries, including South Africa, already have strained state healthcare systems. If this is the calm before the Covid-19 storm, South Africa needs to focus on increasing stock of protective masks and clothes, as well as oxygen supplies. Health professionals need additional instruction on Covid-19 and infectious protocols need to be updated for this new virus. So far, NCID has started training an additional 130 health professionals as part of the response.
With no single accepted treatment protocol in place and a vaccine at least 18 months away, a public health campaign, focusing on good hygiene is essential. Individuals should wash their hands frequently, cover their mouths when coughing and, if sick, wear a mask to prevent infecting others.
Businesses are already being affected by the disruptions to global supply chains that the pandemic is causing, and need to start developing contingency plans for possible quarantines, including allowing employees to work from home.
How would the government respond should this disease reach a township or informal settlement? Local, provincial and national government need to start contingency planning for responding to a number of Covid-19 scenarios. This includes the possibility of enforcing a quarantine or accommodating large numbers of infected patients under quarantine conditions.
Now is not the time for pandemic panic, but rather for realistic pandemic preparation.
Dr Leaza Jernberg has a PhD in International Relations from the University of the Witwatersrand and an MPhil in International Relations from the University of Cambridge. She has previously worked at the South African Institute of International Affairs (SAIIA) and has lectured at the University of the Witwatersrand. She is currently an independent researcher and consultant, who focuses on Cities and International Security. She can be contacted at Leaza.Jernberg@gmail.com