Why SA (and the world) won’t cope with a coronavirus outbreak
Authorities are ready for the inevitable first case reaching SA, but a large outbreak will overwhelm ‘any health system in the world’
It is no longer a case of if the coronavirus comes to SA but when. By Tuesday, the virus, which causes the disease Covid-19, had made its way to about 70 countries outside China. South Korea, Italy and Iran, among others, have been hit hard.
Reassuringly, critical-care physician and professor Guy Richards believes SA is ready. He is an expert at the quarantine treatment of highly infectious patients. Richards supervised treatment of an Ebola case at Charlotte Maxeke Johannesburg Academic Hospital, a designated Covid-19 quarantine hospital, and no health worker was infected.
But his comment refers to isolated imports of infected people. What would happen if Covid-19 were to spread widely in SA, in the way that it has in Iran and Italy?
Simply put, SA wouldn’t cope, says Richards. But he adds: "No country will."
About 18%-20% of infected patients need hospitalisation, with 5% of those needing intensive care. Richards says these numbers "will overwhelm any health system in the world".
SA Medical Association president Dr Angelique Coetzee says a local intensive-care unit (ICU) bed shortage would be a problem in a full-blown outbreak. "In 2013 only three provinces met the international standards for ICU beds per 100,000 people."
Coetzee says: "Some of the isolation units in public hospitals are really state-of-the-art, but they are tiny and can only accommodate a few patients."
Tembisa Hospital’s designation as one of three Gauteng facilities earmarked for treatment of Covid-19 patients remains controversial, because of a suspected increase in Klebsiella deaths in babies at the hospital — after 10 deaths last year.
It suggests a lack of decent infection control. The National Institute for Communicable Diseases (NICD), which has investigated the deaths and always speaks on this issue, refused to comment on Tembisa’s inclusion. It said: "The NICD thinks it might be better to refer your question to the department of health."
Reports from some epidemiologists suggest that 70% of the world could get Covid-19 before its spread slows, but it’s worth noting that the Chinese data of the World Health Organisation (WHO) shows that just 6% of patients have a severe form of the disease.
In a swift change of fortunes, Shanghai and China’s Guangdong province are now imposing quarantine restrictions on travellers coming from countries such as Italy, where the spread of the virus is uncontrolled. The number of new daily cases outside China is now higher than inside it.
China has managed to contain the spread. Authorities instructed residents of Wuhan — the epicentre of the outbreak — to remain in their homes for a month, and there are videos circulating of police welding closed apartment blocks where infected people live. New hospitals built in record time in Wuhan resembled prisons.
A WHO report described China’s successful containment as possibly "the most ambitious, agile and aggressive disease containment in human history".
But it is unclear if Italy, which had more than 2,000 infections by Tuesday, can do the same. Italy is a democratic country that has free access to the rest of Europe.
Richards says authoritarian governments are better able to enforce severe lockdowns.
"I am sceptical that the world outside Asia can contain it. Can you imagine Johannesburg in lockdown?"
Some reports suggest the Chinese government monitored the movement of people using WeChat, the Tencent-owned messaging service used by most Chinese to communicate and pay bills.
The WHO report tactfully refers to the use of "big data and artificial intelligence" by authorities to track quarantined individuals.
SA may be a long way off that. But the NICD’s Kerrigan McCarthy says the country is highly prepared for the inevitable first cases.
"A great deal has been achieved to date — including finalising and costing of a response plan, development and distribution of treatment and testing guidelines, and the setting up of a 24-hour hotline to deal with health-care worker calls. There is a public hotline and a data management system to record inquiries."
Recording medical and public queries could help epidemiologists pick up a hot spot if a large number of unusual queries stem from a particular place.
Perhaps most assuring is that a hospital readiness assessment is under way in the provinces; training is taking place across the private and public sectors; and authorities are drafting provincial response plans.
One may have expected the NICD’s budget to be given a boost, in recognition of its leading role in testing for the disease. But the National Treasury allocated just 2% more to its surveillance budget for the 2020 financial year.
The NICD has no emergency budget for outbreaks.