In episode 27 of Inside Covid-19, SA’s infections and deaths increase by the most in any 24-hour period as the exponential growth in the virus starts taking hold. We feature a wide ranging interview with Dr Jonny Broomberg, CEO of Vitality Health International, who says the data from all over the world says we’re right to fear Covid-19 and SA’s detailed plans and precautions are no overkill but fully justified; also, more on the way the coronavirus is exposing unsustainable societal fractures; Nobel prize winner Bob Shiller explores the impact of Covid-19 inspired fear on the human psyche; and a look at what Wuhan shows our cities will be like in future. – Alec Hogg
First in the Covid-19 headlines today:
- South Africa’s coronavirus infections jumped by a record 354 cases Wednesday, a rise of 7% to 5,350. The jump was partly due to the 11,630 tests done in the day, the highest yet, with a further indication of the storm that’s coming reflected in 3% of the cases tested turning out to be positive, the highest yet. Another 10 deaths were recorded, also the most on a single day, taking the total to 103. Four of the deceased were in their eighties. Among those who died was a 33 year old woman who presented flu-like symptoms and low blood oxygen but had no previously diagnosed co-morbidities.
- Stanlib chief economist Kevin Lings has poured cold water onto assertions that Covid-19 mortalities are little worse than seasonal flu. Lings says accurate data comparing current with past mortality rates is hard to source, but that one country which does track such information is the UK and deaths there since mid March have been more than double the country’s weekly average of the past five years. Lings says this is because UK coronavirus mortality data is not reflecting the full extent of the virus’s impact because it only tracks deaths in hospitals: many people have died without being tested for the coronavirus and he says “stated differently, in the past two months Covid-19 has had a massive impact on the overall mortality rate of the UK.”
- Globally, the Covid-19 cases and deaths continue on an upwards trajectory with infections at almost 3.2m and deaths past 225,000. The UK has now surpassed Spain, with 4,419 deaths yesterday taking its total to just over 26,000, third in the world behind the USA at 60,640 and Italy’s 27,700. The UK also has one of the highest per capita mortality rates at 32.7 per 100,000 of population. Neighbour Ireland, which employed a lockdown two weeks earlier than the UK, is at 23 per 100,000, the same as Sweden, the Scandinavian nation which warned its citizens to practice social distancing but did not lockdown the economy. South Africa is at a fraction of these ratios with a mortality rate of 0.16 per 100,000 residents, in line with another relative laggard, India, at 0.07. Brazil is thus far the worst hit of southern hemisphere countries with a per capita mortality rate of 2.43, with Argentina at 0.47 and Australia at 0.36. Scientists warn these rates could change significantly as the hemisphere goes into winter.
Jonny Bromberg is with us, from Business for South Africa. Johnny you are looking after the healthcare stream there. Can you give us an update on the personal protection equipment that you are sourcing for healthcare workers.
So there’s been fantastic progress there Alec it’s a remarkable story over just a few weeks of literally an army of volunteers who’ve come together and built the procurement machine that is doing remarkable things. There are significant donors in the background who are bankrolling this. Principally, the Solidarity Fund, Naspers, which is doing a lot, the Motsepe Foundation and Spire which is the FirstRand effort. BSA has set up very sophisticated infrastructure. First it’s built a portal that allows suppliers to register and be validated and to upload what equipment they can sell and at what price. Then there’s a whole process and people who ensure that these businesses are legit and that the equipment they’re selling is of the appropriate prices and quality. Imperial health, which is one of the major health logistics companies, does the procurement and brings in the equipment and distributes it mainly to the public health care system. On orders from the Department of Health or the provinces and also some to private hospitals and doctors because they’re also struggling to get it. So it’s pretty remarkable. There are approvals in with the funders in excess of a R1 billion of money that’s been made available. I think that north of 500 million rands worth of orders have been placed and the rest of the billion and some change are in process. Roughly 20% of the items, around 40 million items, are already in the country and there’s a lot more on the way. So we do think that within a week or two most of the gaps for the next six weeks will be closed.
If you consider that just a couple weeks ago there was very little in the country. It’s quite a remarkable achievement.
When you say the gaps, have you done some kind of analysis to say these are masks we need, these are how many gloves we need, and so on?
Yes. So that actual demand estimation is actually done by the Department of Health backed up by some technical advisors and they are updating that all the time so they are the source of if you like the demand estimation. Then the BSA people have looked at what’s available in the country at any point in time. That gives you and the one minus the other, that is the gap. So the one product that’s been easiest to procure in quite large volumes are simple surgical masks for health care workers and that gap is completely closed for a few months now. But the more complex masks, those so-called N95, respirators, surgical gowns, visors, goggles and those kind of things still have to be closed but a lot of orders have been put out to bring those in.
We’ve had some really chilling interviews on inside Covid-19 with people on the frontline doctors in ICU use. They say that the stats that they’re getting from Italy and other parts of the world are that health workers who are working in ICU and repeatedly exposed to Covid-19, that up to 20% of them are not going to make it.
I’m no expert on any of that. What I could say is that Italy is the very worst of it because what you had there is a severe epidemic in an extremely unprepared health care system with limited equipment and protection at the beginning. So I would imagine because we’ve had much more time to prepare, health care workers, health professionals, nurses and others who are going to staff ICU’s, have learnt huge lessons from all over the world and they continue to do that. So they’ll hopefully have the equipment, but it’s not just the equipment, it’s all kinds of protocols that they would have learned and very few of them will get sick, never mind die. So I would hope that what happens here is a small fraction of 20%, close to zero, would be the ideal outcome but as I say I’m really not an expert on that specific issue.
Hence the focus on getting this equipment to health care workers because of the risk that exists?
Definitely. It’s a huge risk and not just for ICU everybody. The GP working in her rooms, laboratory workers who are taking swabs, nurses and doctors working in a regular hospital because you can’t detect every single Covid patient before they arrive in the hospital. Ideally you should do that but you often can’t. So you need protection for all people working in the health care system.
You would be hearing, because all of us are, the critics who say that this thing is being overblown, that we have these people who are going to die anyway. I saw some excellent research today that came from Kevin Lings which took the UK’s death rate, he said it’s very difficult to get stats from around the world. However he shows the UK’s death rate over five years, the average, and how it’s shot up to more than double the normal number of people who are dying every month in the UK. Is this starting to resonate now, are we starting to understand now, even the critics, that Covid-19 is a killer?
Yes, I mean I don’t place much faith in the arguments of those critics. There is just overwhelming evidence from scientists and from doctors at the frontline that this is a terrifying disease. People die. You know people get cancer and heart disease and they die but they don’t die in the numbers and at the speed that people are dying and with the suffering. I read today that the number of people who died in the US now exceeds the soldiers who died in the Vietnam War. You know over the several years of that war, so I don’t see any good data to support that people are going to die anyway. There is excess mortality, clear evidence I’ve seen in all of Europe and North America. There is excess mortality. Interestingly if you look at the figures right now in South Africa our mortality is below trend and that’s because we’re not yet seeing the big numbers of deaths from Covid, but we’re seeing dramatic reductions in motor vehicle accidents and deaths from other non-natural causes like crime and violence.
So we’re in this interesting little sweet spot but in Europe it’s clear excess mortality and in the states as well.
Something that the president said yesterday and was also reiterated by Archbishop Desmond Tutu about this virus illustrating fractures that you have in society and I guess in South Africa’s context the healthcare haves and healthcare have nots. This is something that is more philosophical but from where you’re sitting how are you seeing this
We’re not seeing it yet here, because we’re at a very early stage of the epidemic, but the evidence from the US and parts of Europe is very stark which is that it’s disproportionately impacting on lower income communities.
That’s partly because they have less access to health care. It’s also because for many reasons they are less healthy. They often have higher rates of being overweight, of having underlying chronic disease, just having had less health care and less opportunity to lead a healthy lifestyle for many years. So I think that that’s one issue you can clearly see in the US. South Africa is going to have a triple whammy, it’s going to have people who’ve been chronically deprived of access to decent health, there are many disproportionately impacted by HIV and TB and the third effect is the socioeconomic conditions. It is already and it’s going to stay harder for people to practice social distancing. It’s almost incontrovertible that when there are hotspots and community outbreaks they’re likely to be more severe in low income areas because of living conditions. I’d be very surprised if we don’t end up seeing a strong correlation between socio economic status and the impact of the epidemic when we look back on it in 6 or 12 months time and so in that sense it does amplify in magnitude. You know socioeconomic divisions and fractures all over the world and it’s tragic.
Presumably this is something that is occupying the minds of the leaders of the country because it’s not sustainable?
That’s right, and to make matters worse, the lockdown, which is the best way to protect everybody in the country – whether you’re rich or poor, disproportionately impacts again on low income communities because they have less cash. Many of them have informal sector jobs who are literally living day to day on the cash they earn. I think the government is very worried about all of that and trying to balance the need for social distancing and lockdown, versus the risk to those communities of economic hardship, versus the health risk to them.
Like a Gordian knot.
Yes it is. One does have to give credit to the Minister of Health and to the president and the people around them. You get the impression that they are listening hard to the scientists and grappling in the right way with incredibly tough decisions. People who are super confident that their way is the best way out of this, I don’t think we should trust anybody who is overconfident. It’s just really very difficult. I guess these forecasts have to be updated day by day week by week.
On a broader perspective GG Alcock who appears on our programs often and is very in touch with the informal communities was saying that the feedback is that fear is now starting to spread through parts of South Africa particularly in the lower income areas. And we’ve got a really interesting clip later in the program this evening from Bob Shiller the Nobel Prize winner who says that the impact of fear on the human psyche should not be underestimated in this pandemic. Are we starting to see that and what should we look out for and is anything we can do about it?
It’s a good question Alec and I don’t know any facts about where the fear is spreading. I think to the extent that we’ve had any subjective impressions in the last weeks. It’s been anecdotal, but in a sense of unreality, particularly in low income areas. I’ve seen many vox pops on television and people saying where’s this disease I can’t see it etcetera. So that’s been the impression in the past. It’s definitely starting to manifest in parts of our country and it wouldn’t surprise me, because it’s something we should all fear.
I’m not a psychologist or a mental health professional so I don’t really know what the impact of fear on the human psyche means. There’s a good side of it which is it may motivate people to obey the lockdown and social distancing requirements you know. So to all of my family and friends we really should be fearful of this virus. It’s very easy to be blasĂ©. You just can’t predict who it’s going to impact very badly on or who will breeze through it. Nobody can predict that. So I think there’s an element in which fear is not a bad thing. Of course too much fear can lead to panic and then who knows. Communities are going to need strong leadership then, and I do think the president’s been doing that but he can only do so much.
So thus far he seems to have played his hand, a very weak hand and difficult hand in certain circumstances quite well. What needs to be done from here?
I think more of the same. So you know we’ve got to gradually lift this lockdown in a very scientific way that’s very hard. As I said there is more work to do on readying the health care system a lot more although the delay and the flattening of the curve that’s been achieved I think is credit significant space for doing that.
The current models suggest that the epidemic will peak sometime between in late July and September. So we’ve bought ourselves months to prepare and there’s more of that preparation that has to be done, including bringing in equipment, constructing additional facilities, and training the teams of health professionals. There is a lot to do, like figuring out smart ways to get people back to work in ways that can sustain the their livelihoods and the economy. But at the same time doesn’t just lead to resurgence of the epidemic which could easily do. It’s so easy to burst out again and I think this is a problem that’s going to be with us until the population is vaccinated and I can’t imagine that’s much less than 18 months to 24 months away. So until then, there’s this vigilance required and careful lifting of lockdown and sustained social distancing habits. I think it’s going to change the way everything works for the next two years. I would imagine many businesses that can continue to function from home need to continue doing that.