The world is changing fast and to keep up you need local knowledge with global context.
In episode 17 of Inside Covid-19, some practical advice on why it is a really good idea to eat properly during lockdown (and how smokers and drinkers can overcome cold turkey); Capitec’s CEO on how his bank is transforming for the new world of work; and highlights from Monday night’s lengthy Health Ministry update where evidence was provided to explain why South Africa is doing so well in its war against Covid-19. – Alec Hogg
First in the Covid-19 headlines today:
- Total deaths worldwide from Covid-19 pushed above 122,000 Tuesday with confirmed global infections at 2m. South Africa’s confirmed infections rose to 2,415, a daily increase of 6% and also reflective of the increase from 73,000 to 87,000 tests. The testing is about to be dramatically stepped up with Business for SA announcing today that around 25,000 tests a day will be conducted over the next two weeks, helping to inform the authorities on what the next lockdown step should be. The organisation also said that Personal Protection Equipment worth R1.6bn, mostly from China, would arrive in South Africa over the next fortnight. The masks, gloves and other equipment is being funded by the Solidarity Fund, the Motsepe Foundation, Naspers and RMB’s Spire Fund.
- It was a day of media briefings with updates on South Africa’s response to Covid-19. Business for SA provided a sobering scenario of an economy which could contract by 10% this year, with one million people added to the unemployment lines. We’ll have the highlights for you tomorrow. The organisation also called on all businesses to pay SME creditors in full by next Monday, the 20th. In its announcement today, the SA Reserve Bank provided a slightly better projection with its best guess at economic growth suggesting a 6.8% contraction – which helped inform the decision to cut interest rates by 100 basis points, a moved rapidly followed by the banks. The International Monetary Fund forecast that as a result of Covid-19, global economic activity will contract 3% this year, and South Africa’s by 5.8%, in line with an expected 7.5% fall in Euroland, 6.5% in the UK and 5.9% in the US. At the massively disrupted Treasury media conference, Finance Minister Tito Mboweni said the country is holding regular discussions on financial support from multilateral institutions, and would be looking for a $60m loan from the IMF’s Covid-19 relief programme.
We’ve had some really interesting interviews in our Covid-19 podcasts and here’s one that I think is going to appeal to many people. Dr Megan Schultz is from the Eastern Cape – from Graaff-Reinet and Uitenhage – I’m not sure, you went to school to school in Graaff-Reinet and grew up in Uitenhage?
Actually, I was just born in Graaff-Reinet. I moved over to Uitenhage when I was about three. So I grew up in Uitenhage – went to school there, studied in Cape Town and I live in PE now.
Okay, but you’re an Eastern Cape person (apart from the studying in Cape Town part) and what I found fascinating about your story is that you went into the townships to get some pretty unique insight and this is interesting. South African scientists or medics, if you like as well, get exposed to very different things because of our socio-economic breakdown in the country, but you made some very interesting observations while you were serving in the township. Just take us through that story and what it led you to.
Okay so it started at Uitenhage Provincial Hospital – I was doing my community service there (that’s after your internship) and I was seeing patients in the hospital as well as in some of the clinics in Uitenhage and we started testing vitamin B12 in patients where we suspected there was something slightly off – that we weren’t quite getting a grip on – and we started noticing B12 deficiencies in very unexpected patients. So, usually what we’re taught in medical school tends to be elderly patients, those with poor nutrition, vegetarian or vegan patients etc. And I was now seeing these in young, fit patients – seemingly not with the typical symptoms (that we would normally see) of vitamin B12 deficiency.
What is Vitamin B12 – for people who aren’t scientists?
Vitamin B12, also known as cobalamin, is one of the essential vitamins that we need. Medication helps to build various amino acids in the body specifically helps with myelin; myelin is something that coats your nerves – so it pulls a sheath around the nerves. So if you can imagine like an electrical wire – we put coating around it so that the electricity can conduct more easily. With our nervous system, the myelin actually coats our nerves so that the messages can conduct quickly. Do you think you can move your toe without really thinking about it? That’s because of myelin sheets that cover the nerves and send that impulse down – very quickly – from your brain to your toe.
As you’re now saying, it became quite an important part of your observations.
Yes. So, normally we are taught that if you have a deficiency – you often get dementia and there are studies linking it towards depression, but we were seeing it in patients that had psychosis, anxiety (so the full range of symptoms) and not just in typical patients – in much younger patients as well. B12, as we are taught, is found in animal products (meat, fish, eggs, milk etc.) and our bodies cannot produce it ourselves, so we need to take it in from our dietary sources. So, typically a person eating a full diet that doesn’t have any other illnesses shouldn’t have a low vitamin B12.
But you discovered that many of the patients who had mental illnesses had this deficiency?
Yes I did – and that’s where my study is going. So, my study is still very much the first step of what needs to be a multi-stage study; and we were going to collect some data and then just sit and compare and see if there is any clinical correlation with our patients. The problem is, we’re not sure; is the B12 deficiency causing the mental illness or is the mental illness causing the person not to eat well enough or is this just a global thing or in a region that most people are deficient and, it just so happens, that I’m only seeing the ones with mental illness. So in the future, we’d have to compare the data I get with data from other departments and other wards as well to see if it compares to the other patients.
Megan, but bringing it to Covid-19 and the need now for proper nutrition – from what you’ve said; you might not get mentally ill but you might well get depressed or something along those lines?
It’s difficult to comment just on B12 during Covid-19. So theoretically, your B12 stores in your body should last months to years (depending on your level). If we look at someone who has a normal level going into lockdown; you should presumably come out of lockdown still ok – even if you didn’t eat any B12 containing products during that time. But, if you’ve got someone who’s already on a borderline level and now doesn’t have the money to buy the meat, eggs, fresh produce (things like that) – this might well push them into a full blown B12 deficiency. And obviously, if they already have a deficiency it can aggravate it.
And from a broader perspective; nutrition itself – does it not suggest that there’s some relationship between poor nutrition and actually just not feeling so good?
Definitely. I don’t think it’s something we think about often, but if you just think about how integral nutrition is in our lives and lifestyles – food is part of our routine. I was listening to the podcast you had yesterday about exercise – and our meals and what we eat are so ingrained in our lifestyle that that alone is going to be disturbing us. Food has a lot to do with our self-image. We do have a lot of patients with eating disorders. Now, you’re going to be even more restricted in what food is actually available, the availability of your fresh food. A lot of people only go shopping once a week or once every two weeks, so they’re living on junk foods. The costs we’ve seen – despite the fact that shops are not allowed to skyrocket the costs – there are definitely increasing costs (especially of meat). And then also, when you have a drug or alcohol addiction – if you can find that through an illegal source – you’re rather going to use your money on those than on food.
So what about some ideas on how we can help ourselves through better nutrition during this time?
So generally (when I discuss with my patients), I try to use the national and international guidelines – which generally fall along the food pyramid or the food plates. I quite enjoy the Canadian food plate – and that’s essentially a visual representation of what your daily intake should be like (they divide up a plate showing you how much should be fish, green or real veggies, how much should be starches, how much healthy fats etc). I find that very useful when I am counselling my patients. Obviously, the patients I see are not from the same socio-economic class as what your listeners are – so they often don’t have the money for a lot of the things we talk about. But I think that’s always a very good first step – to go and look at what the healthy recommendations are and to compare that to what the South African plate really looks like. An average serving in many of our restaurants is double or triple what we really need to be eating. And then also to put some consistency in what we’re doing – sitting at home with a fully stocked fridge and cupboard is not going to be helpful at this time if food is maybe your comfort at this point. So same as with the exercise, same as getting up in the morning, getting dressed – to try and keep some form of routine, to remember what my body needs to sustain itself and then also to forgive yourself at times as well. This isn’t the time that you need to be worrying about your figure as much as surviving this – giving yourself a little bit of a break and being kind to yourself and reaching out when you realise that you cannot actually cope. So nutrition on its own isn’t going to prevent or cause anything specific, but it needs to be seen as part of the full picture and not be forgotten.
Megan, just to close off with – and again on the mental health issue. You get people who are addicted to tobacco – to nicotine – they’re not allowed to buy cigarettes anymore. You get people who are addicted to alcohol (they might not even know it) – but you are not allowed to buy alcohol anymore. Have you got any suggestions apart from just stop drinking and stop smoking?
It is something that’s very difficult. There’ve been a few statements that came out but nothing the Department of Health has responded to yet. As psychiatrists, we have been concerned because alcohol withdrawal can be deadly. And you’ve seen people now – looting shops to try and get the stuff, the sale of illegal cigarettes etc. I think it would be important to be aware – if you are having any signs of alcohol withdrawal (like shakiness, your blood pressure can rise, your pulse gets very high, you become sweaty, some people can even have seizures), that you not ignore these sorts of things – that you rather seek help and that we can now detox you medically. Nicotine withdrawal on its own – though not very comfortable – isn’t as deadly as alcohol withdrawal. And this might be a very good time to stop smoking and then use this as your motivation. There are nicotine replacements widely available, from over-the-counter preparations to prescribed preparations, that you can use but do not forget that psychotherapy is also very useful in both of these addictions. And although the rehab centres might not be open – a lot of psychologists are now offering psychotherapy via telephone or Zoom or WhatsApp video call etc. So now might be the time while you have extra time to actually consider psychotherapy.
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