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We all know we need to wear a mask, but are we doing so properly? BizNews Editor Jackie Cameron talks to Dr Geraldine Timothy, a medical specialist at Discovery, for her insights on a variety of topics, including the right – and wrong – ways to wear your mask, the proper protocol to follow if you find yourself living with a Covid positive patient and the interesting field of Covid-19 testing. With plenty of news and development surrounding the development of a vaccine, BizNews asks Dr Timothy about her thoughts surrounding the highly anticipated immunisation and whether it will mean masks and social distancing will be relegated to the past. – Jarryd Neves
I’m Jackie Cameron and with me is Dr Geraldine Timothy, a public health medicines specialist. Dr Timothy leads the quality stream at Discovery and she is a health medicine specialist. Can you tell us just briefly, what does your role entail at Discovery?
So I lead the quality stream, which is basically looking at health outcomes, all aspects of care and ensuring that our members get the best value in terms of what they are accessing from both out of hospital, in hospital and all aspects of health care.
So do you take a close look at all the science and inform Discovery’s policies about what your clients should be doing?
Yes, it’s part of it. I think a lot of what we do is looking at research, applying it into our system and ensuring that the practices that our members are accessing, the accurate practice in terms of what should be done, the right testing, and that the right policies are applied in the healthcare that they receive.
What are you advising your members when it comes to masks?
So we’ve been quite strong and bold in putting out as much messaging as possible to ensure that everyone understands the need to wear masks. We’ve had quite a big market drive in terms of ensuring that we’ve used all of our forums and it’s not just around the need to wear the mask, but just to ensure that people are wearing it accurately and understand all the myths, confusion and anxieties around wearing masks as well.
What are the common myths that you’re trying to beat?
There seems to be a lot of confusion around wearing a mask over a long period of time. There are people that are concerned that there’s going to be this build-up that they speak to around carbon dioxide poisoning, as they call it. I think that it’s important people realise that wearing masks will not cause carbon dioxide intoxication in any form. There will always be adequate oxygen levels despite the wearing of masks. That’s been something that’s been in the news quite a lot recently. We’ve tried to address that, especially around people who have children that go to school and have to wear the mask for a long period of time. Parents are quite anxious around it, wondering if it’s dangerous or causing any lack of oxygen to them? The answer is absolutely not.
What about wearing masks more than once?
So ideally, we shouldn’t wear one mask for more than one day. Ideally, if we had to just really be stringent, we would say everybody should at least own two masks, subject to the fact that you’re able to wash them every day so that you have a clean one. It’s important to understand that the mask is blocking particles from entering. So it serves as a filter. If you don’t wash that, it’s pointless to wear the same mask, touching it and putting it back on your face. You have to change them. You can’t wear the same one again.
When we look at doctors and hospitals, they wear these very special masks. Tygerberg Hospital has actually come up with a reconfigured snorkel just to protect themselves. Is there a different type of mask we need to wear when we go into hospitals or specific settings?
The masks are varying in terms of the protection. The everyday person is expected to wear a cloth mask and that should suffice for the interactions that we have. If you’re working in a hospital setting – especially if you’re working with Covid positive patients – those particular health care personnel need to have a higher level of protection. So the highest level of protection is the N95 masks, which keeps out most particles. It’s not practical to provide that to the general population. It just depends on the type of exposure that you are going into. If you are a health care worker, by all means, you need the best protection. But as an everyday person, a cloth mask will suffice to protect you.
Why is that? Is that because the more Covid around you, the more likely you are to get infected? Why is there a difference in the efficacy of masks?
If you’re treating patients that are Covid-19 positive, it’s more likely that the particles are able to spread onto you. So there’s that ability to have a higher level of protection so that those particles can’t. Your exposures are higher. Going off to the supermarket, it’s not necessarily likely that you’re going to have exposure. But sitting in a room with a lot of people that are positive, there is a much higher probability that those particles are in your space. So the protection there needs to be much more firm, as opposed to you going about your everyday activities, where there’s a possibility you could encounter someone who’s positive but it’s a less likely situation than when in a healthcare setting.
Some people find it difficult to wear a mask, particularly if you’re exercising or if you’re working, like a chef in a hot kitchen. It’s quite hard to work with your mouth the whole time. What are the rules for people when they work and when they exercise, when it comes to masks?
The advice given out is to a wear mask as far as possible. There are some extreme situations which are reviewed individually and those are people with claustrophobia or certain respiratory diseases where it actually is not conducive. But these are far and few. With the majority of the cases, you need to wear it come what may. That’s the only way to actually make a dent in terms of slowing down the spread of Covid. If we start making exceptions for someone in the kitchen, we’re going to start making exceptions across the board. Whilst it is uncomfortable, I think we need to find a mask that fits well enough just to ensure that we prevent the spread of Covid particles.
If you have somebody at home who has Covid-19, should everybody in the house be wearing a mask? How do you advise people to work with masks when you have one person who’s tested positive and the other people are in quarantine?
So if you’re in a household that allows, the person who is found to be Covid positive, should be isolating separately from others. So in their own room using their own bathroom if possible. If that person is interacting with the rest of the household, then by all means, everybody needs to wear a mask. However, if that person is able to stay in their room and the rest of the family is in the lounge together, I think that in that time away from the positive person, it’s sufficient to not wear a mask. But if there’s any interactions with the person within the household, then absolutely, a mask is important to ensure that it doesn’t spread to the rest of the household.
What about children, should they wear masks? We’re hearing quite a lot about children being lower risk when it comes to the spread of Covid-19.
That’s an interesting comment. Whilst the data is showing children are not necessarily getting a more severe disease and they’re not known to be heavy transmitters, there’s not enough evidence to say that children do not transmit it or don’t get the disease. We are well aware that children are getting the disease. I think that while the jury is out, it’s important for children to also practice social distancing and mask wearing. They also need to keep the recommended distances within the school environment as well, to ensure that spreading doesn’t occur. We just don’t know enough to safely say that children shouldn’t be wearing masks. I would advocate that all children still wear masks at school and visors as well, where possible.
So the SARS CoV-2 antibody test. Dr. Timothy, how do you test for SARS? What are the different options?
Currently, there are two options. You have the option of testing for whether you are positive. That’s been going on for quite a while since this virus has come out. That’s the PCR (polymerase chain reaction) testing that we do – which is your nasal swabs that are taken. But we’ve now got the antibody tests. They’ve been around for a while, but they’ve only recently been approved for use in South Africa. This antibody test is a blood test. This is a way of detecting whether you’ve had the virus previously.
Do you do this at a doctor’s surgery or can you do it yourself at home?
We’re not advocating for people to do this at home. I think there’s a lot of – I wouldn’t say fake testing – but a lot of test kits that are being propagated that are not necessarily approved by the right regulators. I think it’s important that anyone who wants to have a test – whether this is testing for the fact that you are positive or just as a blood test – should do so via a healthcare professional or via an approved laboratory. I definitely wouldn’t advise anyone to buy test kits off any websites or off the shelf per se. You should be having a discussion to see whether it’s appropriate for you with a healthcare professional and then sent off to an approved place for testing.
When you say medical professional, could you elaborate? I’ll tell you why. I have a colleague who, along with her family, did some of these tests at home and they tested negative. Her father turned out to be positive when he was tested by a doctor. So they were engaging with him, thinking he wasn’t infected with Covid. They said they got this test from a medical representative. So how do you know when you are in the hands of somebody who is reputable?
So I think in South Africa, for now, it should be via a health setting. So via your GP or – in the case of a public sector – a clinic or hospital that will direct you to a lab if they’re not doing it themselves. I don’t think that a medical rep in the South African setting is adequate. A medical rep could also be selling kits that are being brought into the country that may not be approved for use in South Africa. So I think it’s important to go via a healthcare setting of some sort. So a GP, clinic or hospital and then be directed to an approved laboratory in South Africa.
Dr Timothy, have you heard about this latest case in Hong Kong, where they seem to suggest that you can get Covid-19 more than once because there are slightly different strains going around?
There’s a lot of different cases that have come out speaking to whether you can have different strains or whether you can have a repeat of the virus. I just don’t think that there’s enough evidence yet to safely comment to say that a repeat episode can occur. I think there’s much more research and investigation that needs to be done. Case studies are just one example where we probably need to do much more detailed investigations around this to actually draw conclusions.
How long do you think we’re going to be living with Covid-19 and masks and testing?
How long is a piece of string? The release of vaccines will definitely guide us in terms of understanding how this pandemic will unfold. However, I think as a public health medicines specialist, there’s more than just the availability of vaccines that needs to be taken into consideration. The roll out of vaccines, dealing with anti-vaxxers, ensuring that people wrap their heads around how to take this forward is very important. So it’s very difficult to actually predict how long this is going to take. I think mask wearing will continue for quite a while, even when vaccines are introduced. We need to have adequate coverage before we can actually safely consider going back to what we know as the norm.
You obviously are very close to the information about the vaccine. Any idea when we might start seeing vaccines rolled out in South Africa to the general population?
No, again, I think it’s difficult to comment. There’s a lot of wishful thinking around if something is coming out later this year. It all depends on how the phases of each study are going. There isn’t any indication at this point that we can receive vaccines this year. So I think it’s safe from my perspective. Maybe I’m just being a little bit too cautious. But I think in my mind, it’s best to prepare for next year and see the rest of the year through knowing that we need to just rely on our current strategies, which is social distancing. Washing your hands, wearing your masks and just practicing caution around what we’ve learned so far this year.
When we do get a vaccine, will the government be able to make it compulsory for us to all have one?
No, I don’t think that vaccines can ever be compulsory. I think, you know, we use the same rules around. Vaccinations will apply. I think humans have a right to choose. It can never be in a situation where we force it as a regulation per se. I think we do need to rethink our public health strategies around encouraging people to vaccinate. Compared to measles and mumps and all sorts of childhood diseases, there’s more attention on Covid-19, so there might be a better uptake. But there’s a strong group of people out there from an anti-vaxxer perspective who I’m convinced will never change their minds in terms of vaccines. We can’t enforce it, in my understanding. So we need to rely on just the goodwill of man, I suppose, in understanding the importance of this.
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