In episode nine of Inside Covid-19 we take a look at some promising developments in the medicines used to fight the virus; hear from a specialist in the subject who has 22 years of personal experience on how to survive being forced to work from home; and discover how Foodflow, an innovative Western Cape charity set up to address food insecurity, is now looking to expand to other parts of the country. – Alec Hogg
In the Covid-19 headlines today:
- For the second successive day, the official number of South Africans infected with Covid-19 rose only modestly Tuesday. The Department of Health reported that the country now has 1,353 confirmed cases, an increase of just 2% from Monday which was itself up only 4% on Sunday. The deaths, however, rose from three to five by Tuesday. Thus far 39,500 South Africans have been tested. The latest growth rates are down sharply from the 30% daily increases reported ahead of the 21 day lockdown.
- Confirmed global infections, however, continue to rise by double digits with John Hopkins University reporting 823,479 confirmed cases Tuesday night, up 10.5% on the day before. Confirmed infections in the US continue to grow at 20% a day, having risen to almost 175,000. Projections released yesterday by the University of Washington show the illness is likely to cause 84,000 deaths of Americans by August with the figure peaking at over 2,200 per day in the next fortnight. The governor of New York, Andrew Cuomo admitted at a press conference yesterday that US authorities underestimated Covid-19 and “it’s more powerful, its more dangerous than we expected.”
- Second only to the US, Italian infections are now at 105,000, and deaths at almost 12,500. For the first time, however the growth in both infection and mortality rates in Italy have started to slow. In Spain, a split is being threatened in the coalition government with the far left political party trying to enact a complete freeze on all economic activity to address a pandemic where deaths now exceed 8,000. In China, the return to normality continues with infection rates static.
- South African investors went bargain hunting yesterday for Covid-19 casualties, with MTN’s share price jumping 19%; Sasol up 17%, banks Absa and Nedbank rising 18% and 13% respectively; and property blue chip Growthpoint gaining 11%. The JSE’s rally mirrored that of most other stock markets, although the late improvement is far from enough to offset heavy Covid-19 inspired losses earlier this month, which made the three months to end March the worst quarter since the Global Financial Crisis almost a dozen years ago.
Jonathan Broomberg joins us, the chief executive of Vitality Health International. Johnny, we spoke with your colleague, Alain Peddle from Shanghai last night. It was interesting to hear that there are a number of tests that are being done on promising drugs in China. From a global perspective, have you been following this side of the whole Covid-19 story?
I have to some extent. I’m not a clinician treating patients, I’m an interested observer. It’s not just in China, a number of drugs are being tried all over the world. There is a big multi-centre trial across many countries in which South Africa is going to be participating quite soon. There are a number of challenges with these trials, there’s no time to design them. Often drug trials are designed years in advance and very carefully structured. You’d have a group treated with the experimental drug, what they call a control group here. This is all in real time, doctors treating very sick patients are trying things almost on the fly. One of the interesting things is as the results come out, you get the pedantic scientists saying, ‘Yeah, but where’s the control group? How do we know that this wouldn’t have happened anyways.’ The data that’s emerging is not uncontroversial because it has to be done.
What about the chloroquine? We spoke in an earlier episode to a South African black-owned company that was donating a million chloroquine pills that they’d managed to import from India. Is it is promising as it has been made out in certain quarters?
There’s definitely small pockets of evidence emerging. Small trials are often on 20 patients or 100 patients. There’ve been trials in France, China and there’s consistent patterns emerging from those which seem to make a significant difference in very sick patients. They reduce the viral load of the virus in the patient’s bloodstream, they shorten the duration of severe symptoms and so on. They’re often being used in combination, chloroquine with either an antibiotic or an antiviral in different trials. The critical message is people must not take these at home, chloroquine and hydroxide chloroquine which is a related medicine, both have significant and serious side effects. They must be used in very sick patients and with doctor’s supervision, typically only in a hospital environment. It’s important that people don’t DIY on this kind of thing.
Are there other drugs that are promising?
There are some. They are trying a bunch of antivirals. There’s a whole family of antiretrovirals, which you’ll be familiar with from the HIV world, where those combinations have now led to HIV becoming controlled for the majority of patients. They are trying combinations of those as well as some of the newer antiviral medications that were developed in the wake of the SARS outbreak back in 2002. There are a few drugs available and they are all being tried as far as I know nothing has shown as much promise as chloroquine. I read a paper this week where scientists are starting from first principles, looking at the proteins on the virus and figuring out molecules that they think would attack the virus. Almost synthesising new potential drug molecules from scratch, that will obviously take longer. The good thing about chloroquine is it’s relatively safe on people if used properly. With a brand new drug you’re talking about many years of trials before that can be released onto the market.
We had an interesting interview with Adrian Hill who is leading the Oxford University search for a vaccine. They are talking about having something tested anytime soon, potentially producing it before the end of the year. He was very skeptical about it taking 18 months for his vaccine to come through. This is an Oxford professor, so we have to take him seriously. He said there were two other vaccines that are being tested at the moment. If that were true, if they were to be successful, it just seems like there’s a new normal even in that area?
I think that’s true. There was another big announcement today from from JNJ, the huge US pharmaceutical company, who announced that they had selected a leading vaccine candidates among a few they were trying. They were in a huge partnership with an agency of the US government. They’re planning to rapidly put this through trials and have a billion doses ready by January 21. That’s you six seven months away. If you add those two stories together it seems there should be decent volumes of an effective vaccine, with a bit of luck, by the beginning of next year. It will be an amazing feat of human cooperation and ingenuity, it will mean this won’t be a recurring problem, but we’ve all got to get through quite a lot between now and then.
It’s interesting, it shows it can be done.
Yes, it can. One of the things that virologists look at is how rapidly a virus mutates. In the case of HIV, it’s a rapidly mutating virus which is why they’ve never really perfected a vaccine because you create a vaccine two one strain of HIV and then you find that the population has a different strain. It seems with the virus that’s causing this Covid-19, is quite stable from a mutation point of view, which is one of the reasons I think it’s been easier to create a vaccine. There must be other scientific reasons that have made it relatively easy that I’m not aware of, but it is pretty fast and quite quite astonishing if they really do think they’ve got something that works. They must have good evidence otherwise they wouldn’t be making these claims.
The way that South Africa has handled it, the president has been getting plaudits from all over the world for acting early and acting fast. You’ve seen in the past couple of days that the growth in the confirmed cases has been very low, 2% today and only 4% yesterday which is a long way from the growth rates that we saw before. Can we take anything at all from that, or is it just far too early early?
No doubt that our government acted very decisively and at a relatively early stage. In that sense we are blessed with the governments we have but also that we had the luxury of watching the US and Europe and China a couple of months ahead of us. Personally, I think it’s too soon to tell. And the reason for that is that there are big backlogs in some of the laboratories. When you look at daily rates of change now from one day to the next we can honestly say that there’s been a dramatic slowdown. I would prefer to say let’s look at a week, where there’s a little more data and you can get more of a larger sample. There must be some positive impact of this lockdown. It must be reducing the spread, but at the same time we’re not covering a huge proportion of our population with testing. The testing has been quite restricted to people meeting very specific criteria so it is also possible that there are a large number of infections out there that we don’t know, but of course if people are infected and not very ill then that’s also OK. We do need to know who those people are so we can isolate them, but I’m not sure we have enough data yet to convincingly believe that the rate of increases is tapering off and dropping.
So it still is far too early to say we’re going to either go the China route or what we are seeing in the United States where the numbers are just growing 20% a day. The University of Washington was talking about 84,000 deaths in the US where we are around 2,000 at the moment. It’s just a long way from where we are.
I mean even President Trump said 200,000 at some point. We’ve got a very good chance of doing a lot better than the worst of Europe and the US because we have moved sooner. Another big element beyond locked down which the president did address last night and the Minister of Health has been addressing as well, which is we have to become better than we are right now at testing and then tracing all the known contacts of a positive person and getting them into isolation. If we don’t have the other half of the equation which is you know the testing and tracing and isolation the minute people come out of the lockdown, because we can’t do this forever, epidemic will surge again. Some people will come out of lockdown infected and it’ll start spreading again. Unless we can quickly test them and isolate. That’s what China’s done, that’s what South Korea has done. All the countries that have been successful have combined lockdowns with blanket testing and tracing isolation. I’m very hopeful. It’s critical that our government gets that right in the next 2 weeks. We have lost some time on that component of this battle.
The support from the private sector has been quite astonishing. Last night’s announcement by the president that Naspers is putting in R1.5bn. It makes even the government’s contribution of R150 million look pretty small, supported by the Chinese government and their associates, our connections are starting to help.
They are. We governments are fighting this everywhere, and going to be ending up spending multiples of the private sector in all of its efforts, but the private sector response has been remarkable. Not just in donations, and those are really coming in quickly to the Solidarity Fund which is fantastic, but also through just support in kind. There is a huge response through the business South Africa coalition against Covid-19, and enormous amount of work going on securing supplies of testing and protective equipment, ventilators, modelling the epidemic, arranging the hospital response, collaboration with the public and private hospitals. There is a vast amount of work and in all my time in health care in this country, I haven’t seen this level of cooperation between public and private sectors. It is very heartening and crucial if we’re going to succeed as a country on this issue.
I must add that R150m was just seed capital for the Solidarity Fund, and 10,000 field workers that the government is also going to be having to pay for. Is that enough to go and test people? Is that the kind of army that one needs?
I haven’t really tried to calculate, I think that’ll be pretty phenomenal because we’ve got a lot of infrastructure already. People who have symptoms once we come out of lockdown, there can be mobile testing done by the National Health Laboratory Service, the private labs, the hospitals, and pharmacies will be able to start testing. You don’t only need to do assessment and testing by field workers like that. Those will cover the more semi-urban and rural areas. In the cities where most of our population lives, there will be a lot of other access to testing. It’s a pretty big army to start off with.
Since we last spoke are you feeling a little more optimistic or pessimistic?
I’m vaguely more optimistic. The announcements by the president last night are very heartening. The commitment to tracking and tracing and expanding testing is critical. I’m feeling more confident as I see the private sector response geling and starting to work in a more efficient way. Part of me hopes that these lower case numbers are something real or the beginning of a real bend in the curve. I’m definitely a bit more optimistic than a few days ago. We’re definitely not out of the woods and we started to hear about the deaths, which is already up to five. It is going to escalate, it’s very traumatic and tragic. We are far from out of the woods.
