Get the 99.5% that won’t die back to work – UCT medical students of ’93

The calls for government to lift the lockdown, even if it is just partial, have been growing louder. Recently, it came from an informal sector expert GG Alcock who told the stories of the street traders who were initially banned from buying from markets and later allowed to sell cold food like vegetables, but were still suffering. And Dr Theuns Eloff who said the lockdown can lead to deaths if GDP plunges; to name but a few. And now medical students from the University of Cape Town have added their voices to calls for the lockdown to be relieved. Speaking for the group to Alec Hogg, Dr Fred Tyler said "even before the pandemic, more people died from poverty than from normal flu." His fear is not that people will die of the coronavirus but from poverty. President Cyril Ramaphosa has announced an extraordinary budget of R500bn to deal with poverty and hunger during the lockdown and said he will review the restrictions and announce a decision tomorrow. What many people are asking of the President is not to give them food or handouts; they want to be allowed to work so that they can feed their families. – Linda van Tilburg.University of Cape Town medical students who graduated in 1993 are obviously a pretty close group. They have put together an open letter to the president of South Africa (published below) outlining what they believe should be done. Amongst the ideas or intentions is to remove the lockdown immediately. The spokesman for the group Dr. Fred Tyler..___STEADY_PAYWALL___.But to to make a point. We are not a first world society. Before this whole process, our economy and our health system were on its knees, and hats off to the president for being absolutely on cue with what he did in the initial aspects of the lockdown. And I think is absolutely perfect. However we really need to understand how we're going to move forward and what are the factors that are going to mostly impact on our country. The lockdown is purely a medical perspective. One needs to understand that this is trying to stop this massive influx of sick people onto the health system essentially so that people don't die unnecessarily..That's really what a lockdown in the world is about. We must not lose sight of that. In South Africa not everyone has access to all the facilities. We make judgments every single day about who gets access to dialysis who and doesn't, who gets access to this form of therapy or medication for cancer treatments, specifically in the state region and our system is used to making decisions that are governed by a process, a budget and management. I'm a private practice urologist and I also work in the state facilities and this is what we live. Even before this pandemic started, more people died from poverty that died from normal flu that died from Corona..Just to unpack a little bit more here, the point that you made earlier was that this bought us time. The lockdown has bought us time to get ready. It also told the public how grave the situation is. However internationally these kind of decisions on lockdowns were made in an environment where the mortality rate from Covid-19 was presumed to be quite a lot higher than it is today..Correct. The question is how do we interpret those figures and how close are they to the truth. I think the one thing that we do know is that we've delayed or kind of flattened the curve. Originally the whole idea was to try and flatten the curve and ideally reduce the mortality of this process until it goes away maybe or we get a treatment, and we certainly have done that. I mean our figures are not dramatic. Right now there are hospitals that have got wards closed waiting for this massive surge that's going to happen, and it's definitely going to happen. The flip side however is you've got an economy that's being beaten to a point where that could well be far worse than potential deaths from Covid-19..What is it that you would like the president to do?.We would like to relieve this lockdown situation. Society has learned that we have to keep our elderly and high risk people, the immuno-compromised and health compromised people in our country hidden from this disease. Fortunately the younger people should probably shrug this whole process off like a common cold and not get infected in anyway. We need to try and understand how we make this virus go away. It goes away when you have the herd immunity concept and I want to quote a figure of 60% but I could well be wrong about that. The majority of the population really needs to get this thing and survive it for it to go away. To try illustrate this, the virus lives in human beings and let's say I have it and I've got a strong immune system and I survive it, my immune system will overcome the virus as will most of the majority of the population, and we agree that the mortality rates right now is less than 1%. So we have to back that. There will be people who will get it and unfortunately die from it. The virus cannot live in someone that's dead so it will also go away and eventually when there's not enough human beings where the virus can infect, that's how this thing goes away..So in other words it's the only ways it's going to go away on its own it's is to work its way through the population before it disappears from society..Correct or if we get a cure or a vaccine. However they've never really developed a clever coronavirus vaccine. It doesn't exist. There's some very capable people worldwide who are developing this, probably with lots of potential financial implications, but they're about 18 months away. So at some point one needs to try and understand what we're trying to achieve from lockdown and let's call it preparation. I would imagine there are decent people in the world of medicine in South Africa that are very capable, hardworking and very bright people would have been prepared to the best of the ability that they can prepare. I think the lockdown up until this point has been critical because as it's shown how important it is that this is a risk to human society. It's shown that we've had to change our behaviour which is what it's about. And I mean as you well understand many people have changed their behaviour. And so therefore as a group we feel that you would hide your elderly and your health compromised away from the system. And I think that's critical and that's why a partial lockdown allows for the economy to move on. It allows for people to get exposed and to probably be less effected by this process sooner rather than later and then this thing has got a chance of going away because we can't wait 18 months..Dr. Tyler an interesting point about all of this is that the people most at risk outside from the very elderly are exactly those of you who wrote this letter. It's the health workers. Do all health workers believe the same thing? Because it sounds very much like you getting this Swedish route of Professor Johan Giesecke and his idea that you can't stop this thing so rather let it work through the society but give the society rules will reduce the or flatten the curve..Correct. I mean that is fundamentally the base. I think they might be unlocking a bit radically but let the people who're going to make the decisions decide that. We must all be in agreement that this thing is going to spike however there is a risk of poverty. Can you imagine when we've got a community that are hungry and people are dying around them like crazy..So the idea that you are calling for is to just get the economy working again try and get people who are not really at risk from this, the 99,5% of the population who won't die from it are back to work and that will be the best way to actually protect the nation against it?.Correct. We're gonna take you back to what are we trying to achieve here. We need the herd immunity because we can't wait 18 months, and the fastest way we can get there is to expose the people that will push this off as a small little cold, protect those at risk and allow them some economy and people to be able to earn some money..There are reports in Port Elizabeth of huge funds of money being accessible for vouchers etc. I don't think anyone knows even how to even get one of those vouchers. The poverty is going to have a more dramatic effect. Much more dramatic than the less than 1% mortality that we understand from this disease. And it is really quite interesting that our debate, who are from all walks of life, some people are in government practice, some in private practice and some people are not even practicing in this country, but we all understand how medicine works in South Africa. There are brave dynamic people that make decisions and not just on medical facts but also on budgetary constraints, all the time. We need to understand what we're trying to achieve so we can get this thing over with as quickly as possible. We feel that this might be something to think about..Dr. Fred Tyler from the class of the University of Cape Town, 1993..Letter to the President from UCT 1193 doctors.Dear President Ramaphosa,.We, the undersigned doctors, admire the leadership you have shown in managing the outbreak of Covid-19. You have successfully galvanised unanimous support for the tremendous challenge facing us as a country and specifically as the healthcare profession..It has given the medical community time to prepare for the predicted surge of seriously ill patients. The public has also been handed a clear indication of the gravity of the situation. It has not, however, eradicated the anticipated pandemic from our country, merely delayed it. While in Europe and North America, funding might be available to balance the number of severely ill with the number of hospital beds and ventilators, we do not see this as a viable option for South Africa..Our healthcare system and the economy were already on their knees at the outbreak of Covid-19. The negative effects of keeping the country on the present "hard" lockdown – or even a relatively "light" lockdown – are innumerable. We appeal to you to lift the hard lockdown as soon as possible..Many patients without Covid-19 are not getting the treatment they require due to the hospitals being emptied for Covid-19 patients. Many of these patients are avoiding hospitals and having their out-patient appointments cancelled. Disruptions in regular prevention programmes, such as immunisation schedules for infants or sexual and reproductive health promotion will undercut our few hard-won health gains since democracy. Together these are steadily building up a backlog of health care that is potentially a crisis in itself..Doctors in South Africa have sadly had to become accustomed to the harsh realities of limited funding and limited beds for very sick patients. This means giving less than optimal care and even letting patients die as comfortably as possible on a regular basis. As a country we have bought into an international rhetoric which is a poor fit for local circumstances. We are lucky that the present Covid-19 virus does not predominantly kill young people as the flu virus of 1918 did. It does sadly kill many elderly, but this is still a relatively small percentage of the population; at this stage, we do not know the effects on people living with HIV who are not on treatment and those with TB. If at all, a vaccine is unlikely to be developed and distributed within less than 18 months. Our economy and our healthcare system will be destroyed if we wait much longer and as always, our poorest citizens will suffer the most..Although current estimates of mortality are more than six times less than initially estimated, at 0.5%, we are approaching winter and there are myriad reasons why the pandemic will hit South Africans harder in winter months. We cannot afford to stay on "hard" lockdown any longer. Each week that we delay is likely to worsen the outcome of the pandemic..As the health-related, social and financial side effects start to mount, we would strongly urge a return to work for most people..Those who can work from home or in isolation should be encouraged to do so, but we feel it is critical that the fit and robust return to work, in a staggered fashion wherever possible. Close attention should be given to ensuring that public transport operators adhere to the revised regulations to minimise the transmission risk to their passengers. It might be prudent to keep certain forms of business closed, especially where people congregate, including bars, clubs and any meetings of groups of people, including faith-based gatherings. Restaurants may be allowed to prepare take-away food or arrange home deliveries..Some restriction on the sale of alcohol during this crisis probably continues to make sense, as it probably reduces the burden on hospitals from alcohol-related traffic accidents and violence resulting in trauma. Limited household budgets may then be spent on food rather than alcohol. People withdrawing from alcohol may consult doctors for help..Schools (and higher education institutions) that are able to teach via the internet, may continue to do so if they choose, but the vast majority of children cannot do this and their parents need to go back to work to earn money to feed them. Many of these children need to go to school to access food programmes..All South Africans should be encouraged to continue washing their hands, maintaining physical distancing and taking other steps to slow the spread. Those that are most at risk, the elderly and the health-compromised, need to continue to try to socially isolate as much as possible and be helped to do so by their communities. Clear guidelines describing how access to different levels of healthcare interventions will be prioritised should be established and widely publicised in a transparent way. This will allow South Africans who are at risk to be forewarned and allow them to take extra precautions to reduce their risk of acquiring the virus..We have a limited number of healthcare workers so prioritising their health is important. Personal protective equipment (PPE) for healthcare workers needs to be a national priority throughout the pandemic and we hope the government is actively encouraging local industries who can manufacture these to specification to do so immediately..Last and by no means least, it may be well served to reassure the public, as there is an ill-founded fear that contraction of Covid-19 is fatal, and the misconception that a lockdown would purge us of Sars-CoV-2. This present fear has caused many people to discount the future of our country, which is currently at risk..Sars-CoV-2 is here to stay. The truth is that people will die, but even more will recover. We will do our best as a country and medical fraternity to treat the infected patients, but we also need to start paying attention to the other illnesses which have continued to progress relatively untreated..As those who are most at risk once the pandemic takes off in South Africa, we do not request this lightly. We see far greater harm to our healthcare system and our economy by further delaying the inevitable spread of the virus. Ongoing "hard lockdown" will likely cause far greater suffering in the short and long term than the pandemic itself..Sars-CoV 2 and Covid-19 have given us a moment of pause to reflect on many things. We've examined our priorities. We've refocused on important issues like healthcare and support of the less privileged..While we hope that lessons learnt will contribute positively to our new normal, it's time to hit the play button again. If we start the wheels turning soon, we stand a chance of recovering. If we languish at the bottom of this pit, we will do irreparable damage to our future and those of our children..Life needs to go on if we are to survive in any respectable form. DM.Signed: Graduates from UCT MBChB 1993 class: this letter's argument was informed by extensive discussions and sharing of experiences and evidence from our WhatsApp class group with doctors working in South Africa and around the world..In alphabetical order:.Zunaid Barclay, Nephrologist, Cape Town; Ingrid de Beer, General Practitioner, Cape Town; Perrin Hansen, Paediatric Neurologist, Johannesburg; Chris Hofmeyr, ENT Surgeon, Cape Town; Riaz Ismael, General Practitioner, Cape Town; Hilary Johnstone, Clinical Research, George; Ebrahim Kader, Neuro and General Interventionalist, Cape Town; Tracy Kilborn, Paediatric Radiology, Cape Town; Feizal Majiet, General and Occupational Medical Practitioner, Cape Town; Thane Munting, Orthopaedic Surgeon, Cape Town; Simon Pickstone-Taylor, Psychiatrist, Western Cape; Jenny Potts, Specialist Physician and Rheumatologist, Port Elizabeth; Neil Richards, Family Physician, Cape Town; Nandi Siegfried, Public Health Physician, Cape Town; Chantal Simonis, Consultant in Reproductive Medicine, Southampton, UK; Kerstin Simons, Consultant Vascular Surgeon, Tutzing, Germany; Paul Sinclair, Paediatrician, Cape Town; Fred Tyler, Urologist, East London; and Kathleen Van der Westhuizen, General Practitioner, Cape Town

Get the 99.5% that won’t die back to work – UCT medical students of ’93

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