FIRST TAKE: Mkhize sounds ominous warning about the calm ‘before the devastating storm’

2020-04-01 21:40
Health Minister Zweli Mkhize at the launch of mobile testing and screening units on Wednesday.

Health Minister Zweli Mkhize at the launch of mobile testing and screening units on Wednesday. (Twitter via @DrZweliMkhize)

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Health Minister Zweli Mkhize declared the lower rate of infections here heartening on Wednesday night, but could be the "the calm before the devastating storm".

"These will flood our hospitals and clinics and create a fertile ground for [the] coronavirus to spread or to be masked in its presentation. We need to be aware that there may not be many further warnings before the pounding descends," he warned ominously.

As a nation, we are watching and waiting for "it", the storm, to hit.

In a letter to the UK from Italy, published in The Guardian last Friday, acclaimed novelist Francesca Melandri described to fellow Europeans what their future would look like, laying out the range of emotions people are likely to go through over the coming weeks.

Across the world, including here at the bottom tip of Africa, we have been watching the deadly crisis unfold in China, in northern Italy and now in the US. It is as if it may be a premonition of our own futures and that has been the warning from the Italians to other nations - act now to flatten the curve before it hits.

"I am writing to you from Italy, which means I am writing from your future. We are now where you will be in a few days. The epidemic's charts show us all entwined in a parallel dance. We are but a few steps ahead of you in the path of time, just like Wuhan was a few weeks ahead of us. We watch you as you behave just as we did. You hold the same arguments we did until a short time ago, between those who still say 'it's only a flu, why all the fuss?' and those who have already understood," wrote Melandri.

Similary, Dr Daniele Macchini, an Intensive Care Unit physician in Bergamo, a city near Milan, shared his experience of the lead-up to the Covid-19 crisis.

"I myself watched with some amazement the re-organisation of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly 'emptied', elective activities were interrupted, intensive care were freed up to create as many beds as possible.

"All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many [including me] were not so sure would ever come with such ferocity."

The war has now exploded for Macchini and in Italy they are fighting uninterrupted battles, day and night.

Here in South Africa, we just do not know what our future looks like. Will we track the same path as those a few weeks ahead of us or will the lockdown and social distancing measures implemented an early pay-off?

It is as if we are holding our collective breath, waiting for the surge of infections and the wave of dying to overrun our medical facilities but hoping that it will not. Sitting at home, consumed by the coronavirus crisis, we are watching and waiting for "IT" to happen.

The truth is that right now, most of our public hospitals are eerily, spookily quiet. Patients have been cleared out to empty enough beds for the impending influx. Elective surgeries have been cancelled.

Those who would normally have appointments to see doctors are avoiding this out of fear of being exposed. Doctors are gearing up, prepping, making sure they have enough personal protective equipment (PPE) to keep them safe. Health officials are strategising about field hospitals and venues for temporary treatment sites. 

As a Boston doctor, Clayton Dalton, described in the New Yorker last week, it is like the suck of ocean before a tsunami hits.  

"Everyone is talking about how few patients have been coming in and how strange it feels. A colleague on my shift pulled up a clip from the disaster movie Deep Impact, from 1998. The movie is about an asteroid impact on Earth; the scene depicts a massive tsunami, generated by the force of the asteroid, rushing toward two characters on a beach.

"As the towering wave approaches, it sucks the water backward off the beach, exposing the reef beyond it. That was us on the beach: we weren't seeing any patients because they were all being sucked up into the vast Covid-19 tidal wave that was about to break on top of us.

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"Some are expressing hope that the slowness is evidence that social-distancing measures, such as closing bars, limiting restaurants to takeout, and discouraging non-essential social contact, may be limiting the spread of the virus. I hope so, but I'm not so sure," wrote Dalton.

On Monday, Mkhize tweeted "the reality is we have not admitted many patients. We have admitted 55 so far. But we must be ready".

He said they have "noticed a trend in the past week. The rate of increase is not as high as anticipated. We are observing the trend. We anticipated 4 000 to 5 000 but we haven't reached that".

This may be an indication that measures are working. It may also be a reflection of low testing. It is too early to say. We know mobile testing is being ramped up next week. 

On Wednesday evening, Mkhize announced an increase of just 27 cases. He ascribed this to "closing the borders, enforcing quarantine on inbound travelers as well as the lockdown which slowed internal transmission by reducing the spread during large gatherings and overcrowded transport routes".

He said they were hoping for the best, but planning for the worst.

One week into the lockdown and we are still awaiting the worst. It is an anticipatory anxiety of the storm that is to come as if we are the cusp of the crisis.

Some doctors in the public sector whom I have spoken to are extremely terrified about a complete devastation of the healthcare system. This is compounded with fears of a lack of PPE, as if they are "going into war without armour".

'People have feelings of foreboding'

These fears of foreboding are also fuelled by media reports such as Sky News' dispatch from hospitals on the frontline in Bergamo. While that is a slice of reality, it may not be what will be our reality.

Clinical psychologist Leanne Stillerman says anticipatory anxiety is a real thing in the country now. The difficulty, she adds, is establishing if it is anxiety based on our worst fears, or if it is based on reality.

"People have feelings of foreboding. The situation can elevate fight or flight or anxiety-related feelings in us, as we imagine impending catastrophe. At a time like this, we can all ricochet between positions of optimism and pessimism.

"I think it's very normal in a crisis, but the question is how do you arrive at a position in the middle where you're holding the hope and the despair and is there reason to hope? It's a very paradoxical in-between state that we are in," says Stillerman.

She also makes the point that anxiety is contained by good, strong leadership and political will.

Many would have looked at President Cyril Ramaphosa's steady hand on the tiller over the past weeks and the decision to lock down the country, as giving some comfort and calm. If it begins to show that the lockdown and social-distancing measures in place are contributing to flatten the curve in South Africa, we will feel better about it all.

"People will feel relieved if they know that the lockdown is working because they will feel a sense of agency rather than helplessness," says Stillerman.

I, like many others, read Melandri's letter from the future and feel anxious in anticipation of what is to come. I am consumed by news media out of New York and feel compelled to shout in warning – let us not get to that point! Listen to Macchini in Bergamo and his prescient warnings.

The storm, we pray, will not come to South Africa and that we continue to do enough, collectively, to ensure the worst does not strike.

But for now, we hold our breath, and wait, and the anxiety builds.

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Read more on:    zweli mkhize  |  coronavirus  |  health
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