On the topic of whether South Africa’s focus on resources against the Covid-19 fight is coming at the cost of tackling other diseases in the country, Health Minister Dr Zweli Mkhize said it is a matter the health sector battles with every day, but they are striving to keep a balance.
Speaking at the WHO Media Briefing on Covid-19 in Africa on Thursday, Mkhize explained that the reality is that the health sector has to mount an immediate response to the Covid-19 challenge, but at the same time, there is an understanding that unless the country’s health services are able to balance this in the management of other comorbidities, it may bring about a new challenge.
“We grapple with that matter every day. A huge number of our people who have diabetes, hypertension, chest infections, tuberculosis (TB), HIV and AIDS, and cancers – all of these need to be managed as well, while we are dealing with this [Covid-19 crisis].
“That is the reason there has been an additional allocation of resources – to actually help the department get additional human resources and additional structures, in terms of hospital beds and field hospitals, so that we don’t actually have the Covid-19 patients displacing other patients who need it,” Mkhize said.
Chronic conditions are particularly in the spotlight at the moment, as many Covid-19-related deaths in the country have seen victims also suffering from underlying chronic illnesses.
People not on ARV treatment at risk
Proper control of chronic illnesses, especially when treatments are available, is paramount – even more so as the Covid-19 virus spreads.
Health24 has previously reported on concerns from experts, about individuals with chronic illness.
Earlier in March, a Bhekisisa story quoted Professor Salim Abdool Karim as saying, at the time, that the novel coronavirus was too new to know much about its potential impact on people with HIV, but other viruses – such as measles or influenza – can give us a clue.
If those viruses are anything to go by, he said, those with HIV, and who are not on treatment, will be among the most at risk.
“If an HIV-positive patient is on antiretrovirals, then their response will be pretty similar to what an HIV-negative patient’s response would be based on what we know from other infections,” he said.
“I think what we’re going to see is that the young people who have HIV and low CD4 counts will have… death rates similar to what we’re seeing in patients who are 60 years old and 70 years old.”
CEO of Right to Care, Professor Ian Sanne agreed with Abdool Karim. “People on antiretrovirals need to make sure they’re taking their antiretrovirals and then I think there’s no reason to worry more than the general population.”
“What we’re worried about are people who are HIV positive and not yet diagnosed.” In a statement earlier last month, Sanne explained: “Now is the time to know your status and start treatment."
During the WHO briefing, Mkhize also mentioned his concern that over five million people are on antiretroviral treatment in South Africa, and stressed that their treatment programme cannot be undermined.
“That’s going to create a new problem on the side, and as a result of that, therefore, we have encouraged and empowered our community workers to continue the message of the importance of continuing and getting your treatment,” he said.
According to the World Health Organization (WHO), TB is the ninth-leading cause of death worldwide, and the leading cause from a single infectious agent, ranking above HIV/AIDS. In 2018, 87% of new TB cases occurred in the 30 high TB burden countries: among them South Africa. In this same year, TB caused around 63 000 deaths in South Africa.
“It’s really important that we don’t forget how bad TB is,” Prof Harry Hausler, CEO of HIV/TB Care (an NGO), and a member of the World Health Organisation’s civil society task force, told Spotlight.
But the concerns were not only for patients with HIV and TB.
Diabetics also at risk
Nasheeta Peer, a senior specialist scientist with the South African Medical Research Council’s NCD Research Unit, explained that people with diabetes will be at increased risk compared with the general population, “but if their diabetes is uncontrolled, which is possible even when taking medication for diabetes, then the risk may perhaps be greater”.
The International Diabetes Federation estimates that about 450 million adults were living with diabetes worldwide in 2017, but almost half these cases were undiagnosed, according to Bhekisisa.
Data from Stats SA notes how diabetes is the second leading cause of natural death in South Africa after TB, with about 25 000 people who died from it in 2016. People with diabetes are three to four times more likely to develop TB, a 2010 research review published in the journal Tropical Medicine & International Health showed. This is why the country’s latest national TB plan recommends increasing TB screening among people with diabetes.
But this may also be true the other way around, according to an article from 2000 published in the Indian Journal of Tuberculosis. TB can temporarily reduce the body’s ability to handle glucose, or sugar, leading to increased blood sugar levels - which is a risk factor for developing diabetes, the Bhekisisa report said.
Most Covid-19 deaths as a result of comorbidities
As of 30 April, South Africa has 5 350 confirmed Covid-19 cases and 103 confirmed deaths. A total of 2 073 people have recovered. According to Mkhize, most of the deceased patients had comorbidities.
Mkhize added that, at the time of the briefing, six million people in SA have been screened in areas that are densely populated. Currently, Mkhize said, about 30 patients are in ICU, and about 15 are on ventilators, while most people are being treated and self-isolating at home.
“Scientific research and projections have been guiding the activities of the government. We have been preparing for a large number of cases, and we estimate we will be expecting a much higher rate. There should be a proactive approach… We don’t want to wait for the avalanche to descend on our health facilities,” Mkhize said.
*Additional reporting from Bhekisisa