Prof Salim Abdool Karim: SA is fortunate to have politicians who value scientific input

Epidemiologist and infectious diseases specialist Salim Abdool Karim
Epidemiologist and infectious diseases specialist Salim Abdool Karim

While the response to Covid-19 affects livelihoods in adverse ways, it is informed by solid scientific research that seeks to prevent otherwise guaranteed fatalities

On Monday night, he had millions of South Africans glued to their screens, collectively eating out of the palm of his hand.

After the presentation on the Covid-19 coronavirus epidemic in South Africa by Salim Abdool Karim – a professor, clinical infectious diseases epidemiologist and global industry heavyweight who has for years led from the front in scientific contributions to HIV prevention and treatment – there was a palpable shift in the public’s understanding of what informed some of government’s decisions around its response.

“When [Health Minister Zweli Mkhize] felt that we should have a public engagement, I think he had a sense that the public should be taken into our confidence and they should be made to see some of the backroom stuff that we do.

“I think he wanted people to have a clearer sense of how the scientists are providing information, and if it’s useful to the politicians maybe it’s useful to the public,” Karim told City Press this week.

But he could not have imagined the overwhelming response and keen engagement the South African public would have to the presentation.

“I was taken aback … I mean, I made the explanation simpler than I would normally do, but I was quite taken aback by how many people followed it,” he said with a chuckle.

I think there is confusion; I am not leading anything. I’m just the person giving the advice
Salim Abdool Karim – Epidemiologist and infectious diseases specialist

Karim, who is a director at the Centre for the Aids Programme of Research in SA (Caprisa) and is Caprisa professor of global health in epidemiology at Columbia University in the US, is also pro-vice-chancellor of research at the University of KwaZulu-Natal.

He is ranked among the world’s most cited scientists by citation index Web of Science and serves on the boards of several journals.

Over and above the many roles he serves, Karim’s latest major task is being chair of the ministerial advisory committee on Covid-19, on which he serves with about 50 other scientists, epidemiologists, virologists and researchers.

He quickly quashed any notion that his adulation at the moment meant that he was the central figure behind the decision-making in the country’s response to Covid-19.

“I think there is confusion; I am not leading anything. I’m just the person giving the advice. I don’t work for the government, I make no decisions. I simply provide information, that’s all, and I’m very happy to do so,” he said.

The pandemic has seen many South Africans clamouring for any bits of new information they can get, as government decisions affect all aspects of their livelihoods.

Little is known about the virus since it was first reported as a cluster of pneumonia cases in Wuhan in China’s Hubei province last year.

Read: Covid-19: What do South Africa’s numbers mean?

Its causative pathogen has been identified as a novel coronavirus identified as Sars-Covid-2, which has infected more than 2 million people worldwide leading to more than 140 000 deaths so far.

South Africa has not been spared by the rapidly spreading virus.

Just over a month since the first patient was identified in KwaZulu-Natal on March 5, more than 2 600 people have been confirmed as infected and more than 40 have died.

However, the virus has a high recovery rate, with at least 903 people having recovered from the respiratory infection in South Africa.

Karim says Covid-19 is different from any other epidemic he has worked on, including HIV.

“Perhaps the most prominent way in which it is different is the rapidity in which things are moving. Things change on an hourly basis and we’re sort of always on the back foot.

“We receive multiple requests from the health minister on things to respond to. We put teams together, collect information and provide advice based on the best science available. And we try do it on a rapid turnaround of within 12 to 24 hours so that the ministry has the right information and can make the right decisions when it needs to,” he explained.

Karim says South Africa is fortunate to have politicians who, this time around, actually value and want scientific input on which to base their decisions.

“When I look at what’s going on in other countries [referring to US President Donald Trump’s response to the pandemic], I think back a short while ago when we were in the same boat as the scientists further afield, trying to ensure that scientific information would be dominant in the response to HIV/Aids and we had politicians who thought otherwise.

“The tables have turned now; the politicians want the science, they are asking for it and are saying: ‘Give us the best approach.’

“Our job sometimes is to look at all the bad options and give the least bad one, saying: ‘Of all the bad options we have, this one is probably the one we should go with. Here’s the scientific evidence for it.’”

Bubbles burst 

While explaining South Africa’s “unique epidemic trajectory” – in part because of the proactive interventions by government, such as imposing a travel ban as well as a nationwide lockdown, which has seemingly worked in curtailing community transmission – Karim didn’t mince his words on what was still to come.

In his address he said South Africa couldn’t escape the worst of Covid-19 and he reiterated this in an interview on Friday.

“There’s a difficult truth we have to reckon with. We can’t escape this bullet. We can’t find a path to avoid the problems [that come with the pandemic].

"We just have to accept we will get it and have bought some time with the lockdown. I think that is probably the basis to work with, that it’s coming and we need to prepare. We need to take the worst-case scenario and prepare for that. If it’s not as bad as it was in the US or Italy, then we are lucky, but we need to plan on that basis,” he stated.

Karim explained that the first wave of infections was from travellers, the second from those who had been in contact with travellers and the third was widespread community transmission.

In explaining why South Africa was not following the expected epidemic curve as seen in other countries, he said the introduction of measures such as hand-washing, social distancing and a lockdown were important in making each infected person a “dead end” for transmission.

If passive cases [patients who seek medical help] are 90 or more on average per day, we will have to continue the lockdown

As government considers easing lockdown restrictions, community transmission levels will be the all-important guide in response to the virus.

“If passive cases [patients who seek medical help] are 90 or more on average per day, we will have to continue the lockdown. If we see cases falling to between 45 and 89, then we look at active cases [those found by health workers]. If [the ratio of] these is 1:1 000 [one patient in every 1 000 people] or below, then we can ease the lockdown,” he said on Monday.

But Karim cautioned against ending the lockdown too abruptly, as this would run the risk of undoing all the good that has been done.

He said they should soon know if their community transmission interpretation was accurate.

On Thursday night, Mkhize released that there had been an increase in cases from 2 506 on Wednesday to 2 605 that night.

“I’m still working on that, still waiting on complete data to make an analysis. When all that comes in, we will inform the minister on what the data are saying and we will deal with that when data are available.”

On his opinion on whether we could expect to be returning to our favourite pastimes before year-end, Karim said coyly and with a chuckle: “I have no idea. I don’t make those decisions, thankfully. It’s my job to give advice, plus government receives advice from many different people such as economists and others. Its decisions aren’t simply based on medical reasons. I have no idea, sorry.”

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