In episode 26 of Inside Covid-19, how to address the public transport dilemma with Friday’s lockdown easing; an economist explains how Covid-19 will effectively mean the SA business activity stands still for three years; an update on vaccines and a warning from Prof Alan Whiteside; an update, too, on widely touted anti Covid-19 drugs whose trials have failed; and a Government press conference detailing help for tourism companies, small businesses and spaza shops. – Alec Hogg
First in the Covid-19 headlines today:
- South Africa recorded 247 new coronavirus infections and three more deaths on Monday. That raises the cases by just over 5% to 4,793 while deaths are now at 90. The former vice chancellor of UCT, Dr Max Price, has added his voice to those warning that the easing of restrictions on May 1 will usher in a significant increase in Covid-19 infections. Writing in The Daily Maverick, Prof Price, a medical doctor by training, says there is no reason to believe that after the lockdown is eased on May 1, SA’s rate of transmission will be any different to the currently exponentially higher rates in other countries.
- In the UK, a fully recovered prime minister Boris Johnson went back to work yesterday, promising that shops could re-open provided they keep customers at least two metres apart – but that schools would be closed at least until June. Johnson says the country now needs to prepare for a second phase of the battle against the coronavirus. The UK has been the fifth hardest hit country with just over 21,000 deaths, surpassed only by the USA at 57,000; Italy at 27,000; Spain at almost 24,000 and France at 23,000.
- Globally, the confirmed number of Covid-19 cases has passed 3m with the US far and away the most infections at just over 1m. Johns Hopkins University reports that the worst hit country per capita is Belgium with a mortality rate of 63 per 100,000 residents, with Spain at 50; Italy at 44, France at 34 and the UK at 32. All five of these countries are reporting a double figure mortality rate for each 100 confirmed cases. The US’s rate continues to grow and is now at 17 deaths per 100,000 population and the observed mortality at 5.7%.
Dr. Ryan Noach is the executive officer at Discovery Health. Dr. Noach, this is now quite an important message that we need to unpack for the rest of South Africa. You guys are an essential service. You’ve had people coming to work, something that people are scratching their heads about is how do they physically get people to come into the office after the 1st of May and 40% of South Africans presumably will be doing so without getting sick when they’re using public transport. How did Discovery handle this dilemma?
This was a major concern to us. We thought we could rely on public transport. As you know the regulations were that public transport could operate limited hours between 5 and 9 in the morning to get people to work. But within the first day or two, we recognised two things: The first that the public transport was unreliable at that point. Secondly and more worryingly that actually they weren’t buying at all times. The special social distancing regulations inside the public transport vehicles and we were putting employees at risk.
We stopped that immediately and we had to come up with alternate plans which were costly, but important. In this situation, we’ve prioritised employee safety over everything else, including costs. We hired a large number of vehicles. We did this through an existing partner of Discovery Insure Avis who actually gave us very competitive rates and a very good deal. We placed a lot of their vehicles for storage in our basements in our buildings.
We hired vehicles for our employees –Â gave them their own private vehicles –Â those that could drive to work. This means that they were completely safe and also had reliable transport. In some parts of the country particularly the Western Cape, we had to make arrangements to get preferential access for shuttles where we bought up all the seats to ensure special social distancing that employees were protected.
When you say shuttles, that’s not the normal many cab taxis?
These are transport shuttles between hubs and they are for public use. We prepaid them to ensure that they had a small number of people per vehicle. The minibus taxis now can have a maximum of four people plus the driver. We bought up the space to make sure they didn’t fill-up with anybody else.
Do any of your staff use taxis.
There are staff that are using public transport. We’ve run a significant education campaign trying to make sure that they don’t get into a public transport vehicle if it’s not safe. We’ve worked with them to understand what safe means. We’ve made alternate plans wherever they need to.
So they will presumably be wearing their masks when they leave home?
We’ve given every employee working in our offices masks and gloves. We re-issue on a daily basis and we’ve encouraged them certainly to use those wherever they’re exposed to any third party. As of this week, we’ve insisted that it’s mandatory to wear the mask at all times when they’re in our offices, linked to the president’s request that we do so late last week.
A fellow medical doctor like yourself, who’s gone a different route. Max Price who was the vice chancellor of UCT wrote quite a strong article that was in Daily Maverick where he says that our low infection rate at the moment is the calm before the storm. Essentially, he says there’s no reason why we will not avoid the high infection rates like other parts of the world. I had a look earlier on at some of the numbers on the worst affected countries, those five in Europe and the infection rates there are high, the mortality rates are exponentially greater than we have in South Africa. Is this a similar kind of prognosis that you have at Discovery?
The truth is we don’t know. I also read Prof Max Price’s article which I thought was a very eloquent piece. We don’t know, we have an outbreak model that we’ve been tracking and thankfully the country has fallen way below our outbreak projections. We think it has to be because of really excellent enforcement early decisive movement by our president and the government, the minister of health and their strong leadership for one of the most onerous and stringent lockdowns in the world.
We think that’s what’s flatten the curve. If that is what’s happened, then it’s outstanding that we’ve been able to give our private healthcare system and our public healthcare system jointly and they’re working closely together. The time to collaborate, to purchase PPE and ventilators to prepare their policies and processes and to get everything ready for the wave when it comes. On the more optimistic side – as prof Price said in his article – maybe there are some factors that are specific to South Africa or to the southern hemisphere for example that may be favourable. And there have been various theories around this that have been bandied about.
None of which are proven but all of which are worth hearing about and hoping for. The one that got a lot of coverage is the BCG theory. Countries that have routine mandatory BCG vaccination against TB at birth tend to have a lower prevalence of disease.
This was published in The New York Institute’s journal. It’s a correlation at this point, but the correlation is stark and revealing and where it’s particularly interesting is in Europe. In Portugal, BCG vaccination and the vaccination is mandatory at birth. In Spain, it is not genetically similar. Populations in the same region exposed to the same climatic conditions dramatically different outbreaks. Spain has had a terrible outbreak with high mortality. Portugal has had a well contained outbreak. So BCG, there are correlations, but there is no evidence yet. The next theory which Prof Price to talk about in his piece is climate. Perhaps the warmer climate that we’ve been having and that the whole southern hemisphere has been having protects the southern hemisphere more so than the colder northern hemisphere at this time of year. We’ve seen Australia, New Zealand and South Africa with favourable flat curves and it may well be climate related in this regard, time will tell.
Warmth and sunlight does have two things two effects on the virus. Ultraviolet light denatures the virus. The sun obviously in summer is much higher, use the index and more ultraviolet light. The second is saliva droplets tend to evaporate much quicker in the heat than in the cold. As those droplets evaporate the virus doesn’t survive as long on in emanating animate objects.
Some interesting theories are that if DNA is drawn the virus dies. When we talk about a protein breaking down naturally. The other theory that’s a new theory – I haven’t seen any evidence on it – I’m just sharing what we’ve been reading, I can’t vouch for its veracity is that southern hemisphere folk populations tend to have much higher vitamin D levels whereas northern hemisphere folk who are not exposed to the same hours of daylight and sunlight on average do tend to have lower vitamin D levels. That’s factual. Is there a theory where vitamin D is actually preventive against this virus either on an infectivity level or on the severity of disease level, there is the data that demonstrates that vitamin D plays an important part in our immune systems. Is it perhaps vitamin D. Again, I cannot say, but there’s some thought around this.
The other thought is that coronavirus itself is a relatively common virus. There are 7Â known coronaviruses SARS-CoV-2, which is this new novel coronavirus responsible for Covid-19 is the 7th identified coronavirus. The four common ones are responsible for the common cold and it could be that people living in close proximity particularly kids have developed a level of immunity to the common coronaviruses that has some level of relevance and protection in immunological protection against this coronavirus. Another unproven theory, but another one that’s being spoken about that the point is that sincere hope that not only has the lockdown been successful in flattening the curves and giving us time but maybe there’s some other factor that is yet to be identified which hopefully is resulting in us having a less severe epidemic.
The point you make about Portugal and Spain is a fascinating one and one that is more and more being studied. I have no doubt, but you spoke about kids. What about when our kids start going back to school. Would that be something that could spark a wave of infections?
There are two different schools of thought here. To answer your first question directly, yes, it will likely spot a spark in infections. Kids seem to contract the disease have asymptomatic or mild disease. It’s not to say that they aren’t some kids that have got sick. But relative to the older populations very low morbidity in children. But of relevance asymptomatic carriers of this novel Coronavirus seem to be the spread. Unlike the SARS epidemic of 2008. In that epidemic, you are only contagious once you started exhibiting symptoms and therefore containing symptomatic people limited spread of the disease even though it had a very high or not all reproductive factor in this disease Covid-19, the SARS 2 virus seems to be highly contagious in the pre symptomatic phase and so kids go to school who will be asymptomatic carriers of the disease will probably be spreaders and that may well result in a spark in infection rates.
The bottom line is, we’ve got to get back to normal society. There’s got to be a new normal. We’ve got to get back to normal life. There are two opposing schools of thought here and I’m not sufficiently knowledgeable or expert to know which is correct, but the UK government has been talking a lot about herd immunity.
You would have heard them talking a lot about that they delayed their lockdown because they claimed that exposing people to the virus for longer would push up to our north and get us to the herd immunity threshold faster. Once we reach a herd immunity threshold, infectivity becomes far less of a problem across the community. There is one school of thought that says released people earlier get herd immunity levels up, keep the elderly and those living with chronic illnesses who are more at risk of dying or of severe illness keep them at home but drive up these herd immunity levels.
There’s another view that says, very slow very cautious release from lockdown. Schools being one of the last to be released. In doing so, small reactive areas of infection outbreaks – treat those lockdowns orderly and locally overwhelm each of those lockdowns. Make sure the health care system can deal with each of those individual outbreaks, but continue with the phased release. One of the big factors about school children is that if you don’t send them to school you do keep carers at home. In our society, the carers are in many cases productive parts of our economy. If we are to resuscitate our economy and kick started we need to get some of those carers back. There are some real tense forces pulling in opposite directions around returning to school.
What a subject and one that we’ll continue to explore with Dr Ryan Noach, the chief executive of Discovery Health.
