Inside Covid-19: WC Premier on SA’s first deaths; Many ignore Day One of lockdown – Ep 6

In episode six of Inside Covid-19, South Africa records its first deaths, two women in the Western Cape whose Premier Alan Winde tells us what happened and how prepared the province is for the coming onslaught. We’ll also hear about concerns from Discovery’s chief clinician that too many South Africans are not taking the lockdown seriously, but as our Biznews colleague in London shares, that’s not the case in the UK after Prime Minister Boris Johnson was confirmed as having the disease. Also in this episode, a Ted Talk guru on how to deal with lockdown-inspired anxiety, and the trade-off between lives and restarting economic activity. – Alec Hogg

First, today’s Covid-19 headlines:

  • On Friday morning, South Africa reported its first deaths from Covid-19, women aged 28* and 48, both in Cape Town hospitals. Western Cape Premier Alan Winde told us the deaths came as a surprise as nine of the three Covid-19 patients in hospital on Thursday appeared in danger. By Friday evening there were patients in Cape Town hospitals. This episode features an in-depth interview with Winde on the deaths and the province’s state of preparedness after three weeks of intense focus.
  • Global infections of Covid-19 rose above 550,000 on Friday, with cases in the US rising a further 25% after Thursday’s 48% surge. At just over 86,000, there are now more confirmed American infections than any other country. Italian infections continue to rise strongly, with the number now close to the near 82,000 of China. With more than 700 Italian deaths on Thursday, the country now accounts for a third of worldwide mortalities of above 25,000. Confirmed South African infections continue to rise at 30% a day and by Friday had broken above 1,000. Despite the country officially entering a 21 day lockdown, many citizens continued to congregate in public places. More in that in an interview with Discovery’s Dr Noluthando Nematswerani.
  • UK Prime Minister Boris Johnson confirmed Friday morning that he tested positive for Covid-19, joining a number of members of his cabinet. The UK is now in day five of its lockdown, but infections continue to rise at over 20% a day. A call for volunteers to assist its National Health Service received support from over 600,000 people. The UK is the biggest supporter to CEPI’s drive to develop a Covid-19 vaccine, having pledged £544m to the project. Later in this episode, Biznews’s UK correspondent Linda van Tilburg shares with us what it is like living in London right now.
  • After a strong week for shares, supported by the promise of massive cash injections from the US Government and its central bank, prices eased back on Friday. Analysts note, however, that the 20% bounce in prices means that technically stocks are back in a Bull Market after what was theoretically the shortest Bear Market in history.

Doctor Noluthando Nematswerani joins us now. She’s the head of Clinical Excellence at Discovery. Nolu, bad news today. First day of the lockdown and South Africa has had its first deaths.

Yes, indeed it’s a sad day but not unexpected and as the epidemic unfolds – unfortunately we’ve hit the 1,000 mark of confirmed cases – I think we’re going to start seeing some fatalities coming through. It’s also a huge eye opener specifically for the general public. People have not been heeding the call to actually prevent the spread of the virus. They said the death of the two patients is going to be a wake up call to the broader public – in terms of adhering to all the recommendations that have already been outlined – specifically when we think about the most vulnerable population.

But the reality is that South Africa is now on this leaderboard that you don’t want to be on, which is put together daily by the John Hopkins University and I see that the first two deaths here – same as Mauritius, Singapore, UAE, Iceland, Cuba – this virus is going everywhere.

It is going everywhere. It’s day one lockdown but you are still seeing volumes of people on the streets, there is no appreciation and realisation of the severity of the situation that we are facing. Our numbers are also still underreported because of the current backlogs in terms of the testing. So we are anticipating that a lot more people are confirmed positive and they are currently roaming the streets, still continuing to interact with people and potentially spreading the virus even more.

Where does that come from?

If you take lessons from Italy, I think even with them, when the initial restrictions were imposed, the young people felt invincible. They felt they are not really affected by this – it’s a disease of the old people – we are seeing similar trends in South Africa. Right now people continue to have parties, life as usual. The sad part is that this virus also has a long incubation period. So you can feel fine at your party but the problem is, that we don’t know much about the asymptomatic spread. There are studies indicating that there might also still be asymptomatic spread. The major concern is that if you’re to spread this disease – and yes older people are affected the most because of the underlying chronic conditions, their weakened immune status – but it doesn’t mean that young people will not be affected as severely. Some young people might be living with chronic lung disease like asthma, so there really needs to be a change of mindset on our part, specifically young people who may be staying with these vulnerable people. Those that go out act irresponsibly and continue to spread their infection in their families.

I spent time with Yabonga a couple of weeks ago – that’s an HIV/Aids outreach initiative – in Khayelitsha – where the children are born with HIV/Aids and they’ve always been on medication. Are they vulnerable -these Aids orphans – or indeed anyone who has HIV?

Because there isn’t much data that has come out of China and other countries, what we know about HIV is that if you’ve got a low CD4 count and are not on treatment – or you may not have been tested – you may actually be at risk of severe disease because your immune system is not functioning. What we have done is to reference the flu data – where HIV patients are usually impacted severely, (which is why we actually advocate the vaccinate against influenza) – even in the absence of data, we are still very concerned that our HIV population might be hit the hardest, specifically those who already have a lung disease like TB. So with HIV/TB coexisting, you are more likely to have a more severe disease. The health professionals are all – and even our government – everybody is really very anxious about what this could do to our patient population and also to our health care system considering that we are sitting with one of the largest HIV programs in the world.

We also heard overnight that China has closed its country. It’s not allowing anybody in. It’s closed all of the borders. Is this something that South Africa has implemented yet? 

Yes I think we have. I think the president announced that people who are not South African citizens will not be allowed into the country. The reason why China has actually adopted that stance – if you look at the new cases that they’ve been reporting – the latest numbers were the imported cases, so they’ve managed to reduce local spread within China and now they are seeing that the new cases are those coming into the country. With us, most of the cases in the initial stages, were imported from other countries before we started seeing local transmission. Now we are seeing some very irresponsible behaviour of people who are confirmed positive who are not isolating and are roaming the streets. So there is the component of containing the infected, but also preventing new cases coming into the country. If you look at our stats, 75 were imported cases. So it’s important to limit new cases coming in from outside the country. South African citizens will be allowed into the country, but there will be stricter measures to make sure that once people have entered the country they are quarantined and monitored appropriately to ensure that they don’t continue spreading the disease.

On the day before the president made his announcement we were sent a clip of a meeting that the acting chief of the Defence Force held and spoke to the army and the generals and he said this is a very serious situation that we’re in. They outlined exactly how the military were going to be deployed around the country to presumably enforce the lockdown. But this irresponsible behaviour that you’re talking about sounds like the police and the military are not able to enforce what needs to be done.

This is day one of the lockdown and I would really like to see how they are being deployed into the various areas. We have seen some reports that in Alexandra township, people are just continuing as normal so we would like to see how they’re going to enforce that. One of the WhatsApp groups that I’m in, a person knows that they’ve tested positive but they are continuing to have contact with others. I don’t know whether it’s intentionally spreading the virus in the area where I live, yesterday we saw one family having a party. There’s still some behaviour that is not aligned with what we are saying, with what the media is portraying, with what the government is saying, with what the health professionals are saying, there’s still some misalignment in terms of how people are receiving this message and how they are carrying on with their lives. We were having a conversation with one of our colleagues – around how some of these parties can actually result in the massive spread of the virus – whether the two cases that have lost their lives are going to be enough for the people who still think this is a joke, to bring that awareness to the forefront . 

Maybe you can just unpack for us again what the symptoms are.

It’s been quite interesting because in the early days, we were highlighting three major symptoms. Fever, a temperature of more than 38 degrees celsius, a dry cough and shortness of breath. As the epidemic unfolds, we start seeing and hearing about other symptoms that had not previously been documented or spoken about. We’ve heard from some patients that they had loss of smell and loss of taste. This has been one of their early symptoms of Covid-19. There were some other reports around a sore throat and also some reports of diarrhoea and severe tiredness for some people. People will have different ways of presentation. Obviously once the disease becomes severe with pneumonia symptoms, people who have real breathing difficulties will be admitted. But I think it can be as mild as just a sore throat with a fever and major tiredness. These new symptoms that have been reported, seem to be more prevalent in the milder cases of the disease but also need to be noted. When people start experiencing them they can be alerted to a potential diagnosis of Covid-19 and seek care from their doctors and get tested for the virus.

So how do they do that physically, given that certainly my GP said don’t come into our rooms because if you do, you’re going to put me on a 14 day suspension, let’s talk over Skype. So she’s one of the more progressive people. But how does someone living in an underprivileged community act when they’ve got these symptoms ?

This is why we’ve got the national Covid-19 hotline. I think it’s a very important message to send out to the public, that you don’t have to go to see your doctor. Discovery has set up remote consults where you consult with your clinician. They can discuss the symptoms with you and then they will guide you through the process of testing, because there is obviously that initial assessment that establishes the symptoms and they can then tell you where to go. They want to make sure that when you do go there, you’re not gonna be turned back because you don’t meet the criteria. So that process of consultation with your doctor remotely, can actually get you assessed and then you can be guided through the process. 

That national hotline number is 0800 029 999 and anybody who feels these symptoms can get on the hotline and you’ll be told what to do.

Yes. That hotline is important, because people who may be anxious about their symptoms – because remember we get these queries all the time – where it could be just a common cold or other respiratory viruses that is giving symptoms. If you look at our numbers – even though we have just over 1000 confirmed cases – the number of tests that have been done in relation to the confirmed cases, we can see that these are people who are symptomatic but have tested negative. Meaning not everyone who’s symptomatic is going to test positive. So I think it’s also very important to highlight that. Now that this local transmission community is potentially spreading the virus, we are worried that a lot of people are actually going to be infected. They may not have traveled anywhere and still have these symptoms, so it’s important for them then to be aware of what to look out for.

* After the recording of the show, the 28 year old woman was diagnosed as not have died due to Covid-19.

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