Through a combination of predictive tools and known drug treatment, we should be confident that we can minimise death rates among critically ill Covid-19 patients, Professor Burtram Fielding and Morgan Morris write amid concerns that South Africa, the African continent's hotspot may be next in line for a resurgence.
In an April report, the United Nations Economic Commission for Africa (Uneca) predicted that, depending on interventions, "anywhere between 300 000 and 3.3 million African people could lose their lives as a direct result of Covid-19".
In a modelling exercise that same month, researchers from the UK and the South African Centre of Excellence in Epidemiological Modelling and Analysis (Sacema) at Stellenbosch University projected, with the same proviso, that "all of the 45 African countries reporting cases prior to 23 March 2020, were likely to pass 1 000 reported cases by the end of April 2020 and 10 000 within another few weeks". Likewise, Melinda Gates – of the Bill & Melinda Gates Foundation – had African blood boiling when, in a 10 April interview with CNN, she commented that Covid-19 "is going to be horrible in the developing world", with bodies put out into the continent's streets.
In South Africa, similar doomsday scenarios were being flouted. Running some of its own numbers, Mail & Guardian predicted on 12 March that, based on infection growth rates elsewhere in the world and in South Africa at the time, 100 000 people would require hospitalisation within a month and case numbers could rise to as high as 12 million.
Off the mark
If in hindsight this doom-and-gloom crystal balling proved to be way off the mark. There were, arguably, some tenable grounds for them. For one, public health systems in Africa are famously under-resourced. Overall, the continent had only a handful of viable testing facilities, which threatened to delay diagnosis and treatments, and social distancing and basic hygiene were always going to be difficult, especially in poor communities where households are crowded and access to running water and proper sanitation are limited at best.
Why did these harrowing predictions not come to pass, especially in South Africa?
There are a number of possible and intersecting explanations. One could be that the country's largely youthful population was its saving grace. And regarding the immunocompromised, there is growing evidence linking the harmful levels of inflammation associated Covid-19 to the overreaction of a healthy immune system; ergo, it's plausible that a weakened immune system is not able to trigger the level of response that will lead to elevated inflammation.
But we must also consider that as we learnt more about the disease as time passed, a power arsenal of potential treatments was developed.
There's also hope that even more deaths can now be prevented through a combination of early diagnosis and clinical management.
We know with some certainty that advanced age, being male and the presence of pre-existing medical conditions, such as obesity, diabetes, heart disease, certain chronic lung diseases and kidney disease, are among the major factors linked to severe disease and death. (The young can and do contract the disease, and can likely pass it on to others even though overwhelmingly, their symptoms are mild or even undetected.)
Some research suggests that through a simple analysis of the most common Covid-19-related symptoms, such as fever, cough, and shortness of breath, doctors can predict the likelihood that a critically ill patient will succumb to the disease. One team of researchers from King's College London have now categorised these symptoms into six separate clusters, with important implications for treatment. Using this clustering, doctors can now potentially predict who is most at risk and most likely to need hospital care. Using all of these predictors, we should be able to predict 8-10 days in advance, with high accuracy, who are more likely to develop severe Covid-19 symptoms and who will require hospitalisation.
At the same time, treatments have vastly improved. Excessive blood clotting – leading, in the case of Covid-19, to clots in the small blood vessels of patients' skin, kidneys, hearts and lungs – can now be prevented with an over-the-counter aspirin, which acts as a blood thinner or anticoagulant. This can be used in combination with a cheap and widely available steroid (to combat the inflammation) known as Dexamethasone, described by University of Oxford scientists as a "major breakthrough" in the treatment of Covid-19.
As second waves of Covid-19 hit Europe and the US, there are concerns that South Africa, the hotspot in Africa, could be next in line for a resurgence.
I suspect that fears of a second or third wave in the country are not premature, especially as "pandemic fatigue" sets in among our population. But I believe we're better prepared than we were in February or March when we instituted our national lockdown.
Through a combination of predictive tools (understanding who's at risk) and known drug treatment, we should be confident that we can minimise death rates among critically ill Covid-19 patients.
This also allows for more targeted interventions, rather than blanket measures.
- Professor Burtram Fielding is the director of UWC's Research Office and forms part of a team of global experts researching the Coronavirus and SARS virus since 2003.
- Morgan Morris is a freelance journalist.
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