Prof Alan Whiteside: Why SA Covid-19 deaths baffle – and UK, US make projections look stupid

Prof Alan Whiteside, an HIV/Aids specialist who like many other medical academics has become obsessed with Covid-19, shares his thoughts on the latest developments. Now based in the UK, the ex-KZN University and now the Global Health prof at Waterloo University, keeps a close watch on developments in his old country and his new one. He also shares an in-depth weekly blog on Biznews.com..Professor Alan Whiteside is with us talking from his home in East Anglia. .Norwich, Norfolk, East Anglia. .We've been talking a little about some of the coverage that we've had on BizNews. What we tried to do on BizNews be a platform to all views, but sometimes we've got to be a little more careful, particularly when it comes to Covid-19. Unpack a little for us, what should we be looking for?.___STEADY_PAYWALL___.The first thing that we need to be aware of is that the way that the public health and the governments began this whole process was to scare the shit out of everyone. Telling us how many cases there we're going to be. This wasn't unique to South Africa, where Salim Karim put out some pretty daunting figures. We also saw it with Niall Ferguson and various members of SAGE in the UK and we saw it in the United States with Anthony Fauci. Unfortunately, those are the numbers that have stuck in people's heads. We're not going to see that number of people being infected, affected and dying, but that doesn't mean the science was wrong. It meant that at the time we did what we thought was best and there is always an element of wanting to make it serious enough that people will take it as seriously as possible, which we saw happen with the HIV/AIDS epidemic as well. .So the numbers for South Africa, for instance, were 60,000 to 80,000. They were since adjusted down to 40,000. Now we are getting actuaries saying it's unlikely to reach 10,000, we talk about mortalities here. However, at the moment, we're at 3,200 and seemingly rising quite strongly. How should we be viewing all of this? .With South Africa, I really haven't a clue. I know that people are doing their absolute best to come out with clear figures. In the UK, Boris Johnson stood up and said, we'll be very unlucky to reach 20,000 and here we are at 44,000 and counting. .The reality is that the worst projections of what this epidemic might do seem to have been overstated almost everywhere. The possible exception might be South Africa, where we might see more cases than we had anticipated. .Why? .I don't know what's going on in South Africa. I think it's a combination of poverty and HIV. Perhaps for those people who are not on treatment or that we know people who are on treatment weren't necessarily have a worse outcome with Covid or even be more likely to catch it but that may be part of it. I hate to say this, but I think the government shot its bolt. I think they did the lockdown too soon and didn't keep it on for long enough, but then they're walking that incredibly difficult balance between health, economics and livelihoods. The other thing which we have to be very mindful of is the vast majority of people are not going to be made ill by this disease. We're making a decision to place health as being more important than economics, and we're doing it around the world. That's a discussion which has not been properly engaged with by any country. .When you say South Africa did the lockdown too soon and then for not long enough, surely the economic implications of extending the lockdown would have been even more horrific than what we see. .There are lockdowns and lockdowns and we're actually beginning to see this around the world at the moment. In England, the city of Leicester has been locked down because there's a serious increase in cases there. In Australia, the city of Melbourne has now been locked down again. What we did initially was a blanket across the country, we're all in this together, folks lockdown. .Now I think we can start being more nuanced and applying it to specific areas. I don't have any problem with governments placing the entire nation under lockdown at the beginning. The science was too new, the epidemic was too new, we didn't know enough, but what I think we should have moved to and this is where we're I believe we failed, was two more nuanced lockdowns. In other words, by geographical area or by population group. .When I say population group in the South African context, that's not about race, that's about ages. I think that people who are over 70 should still be locked down in some way and given support by the government and the community, but people under 70 who are at much lower risk and people in their 20s and 30s ought not to be locked down in the same way. .What about the news media? There are all kinds of different coverage that one sees, some of it sensationalistic, some of it perhaps giving emphasis to the wrong areas. How should we in the news media be covering this in a responsible manner? .One of the areas which is really important to do is to give people hope in a responsible manner. So in other words, there is already one treatment which is shown to work. We have talked about this before. The trouble is, it works when people are in hospital in a pretty dire way and it doesn't work for everyone. We'll see more treatments coming along. The news media has to be very cautious and not say, oh, miracle cure, which some of the gutter press has a tendency to talk about. The second thing is we must talk about vaccines. We must talk about them realistically, and this is something which calls me when I look at it with the British media, they talk about vaccine development as though there are only 2 or 3 organisations or institutions, universities involved with it. They talk about the Oxford vaccine as the vaccine that's going to save the world. Well, it may do or it may not. .There are vaccine developments going on around the world, including in China, probably over 200. One of them will be the answer, but it may not be Oxford or Harvard or any of those. .The third thing, which I think that the media has to do is to give people a proper sense of what is and is not risky and how risky things are because people need to make up their own minds on some of the things that they're doing. Now, there's been a series of excellent newspaper articles which I cover in my blog I did last week and republished it, of course, where various mainstream media organisations have done very thoughtful pieces on what are the risks. One of them is from the Wall Street Journal. One of them is from Box, and the other third one is from an academic at an East Coast university in the US. Each of them sets out a proper assessment of risk and I think people need to read these things and take them into account. Sensationalism doesn't work. .How are you reading it, a nice, rational view of how much longer we are going to be living with Covid-19, and when it might be safe to go back to the old normal?.There is no old normal, we will have to adapt the way we live. The first thing is people talk about a second spike, which I think is absolute nonsense. This thing hit us and our epidemic curve went up and up and up and now it's gone down. In many countries of the world, the epidemic is under control, including in Australia except in Melbourne, and we need to remind ourselves that. Including in New Zealand, where they had no cases until 2 British tourists arrive with Covid. .We do need to recognise that there are places that have brought this epidemic under the control and will continue to do so, but the price of doing this is eternal vigilance. That's why we'll never be back in a new normal. .If you take, for example, China, they had about 80,000 cases at the end of March today, assuming they're telling the truth and I don't see why they wouldn't. They've got 84,000, 4,000 cases in a number of months. They have this epidemic under control. When you look at the epidemiology and numbers, there are 3 groups of countries in the world broadly. First of all, there are those that have the epidemic in January, February, March. Where the number of new cases has fallen and the disease appears to be under control. That would be countries like China, South Korea, Spain, France, Germany, New Zealand and the UK. Basically the incidence cases, the number of new cases has fallen in all these countries. Even within those countries, there are significant differences in how serious the epidemic was. .For example, in the UK, the numbers are bit than in Germany, but the number of people who died is hugely higher in the UK than it was in Germany. In the UK, 44,000 so far, in Germany about 3,000. That's the first group of countries. The epidemic has gone down and the number of new daily cases has gone down considerably.. The second group of countries are those where the epidemic is still increasing rapidly, the USA is a prime example of that. It's got the worst epidemic in the world. I think today they will hit 3 million cases, I would include South Africa in that group and India and Russia. .Then the third group of countries are those where we really don't know what's going on. This is most of Africa where numbers seem to be going up and if you look at the daily cases going up, they are increasing exponentially off a very low base, but we don't know quite how far they're going to go. There may be protections for these populations, in particular the youthfulness of the population, but who knows? Those are the three groups of countries which are going to determine the trends of Covid-19. Even in countries where the epidemic has gone down, the price of keeping it down is eternal vigilance, so New Zealand had no new cases until tourists rocked up with Covid-19. .What happens now, say, in Australia, if they manage to get everything under control, does that mean that they're going to not allow tourists to come in? .Short term, they may well not allow tourists to come in. I think tourists will be allowed back because our economies are so interconnected. If you were invested in the airline industry, you must be weeping every time you look at the stocks and shares. Tourists will be allowed back in, but I think we're going to have to do is to have increased testing and rapid responses if we find people coming in who are infected with Covid. The problem with Covid is the asymptomatic phase when you can infect other people, but you don't know you've got it. .A tourist could arrive in South Africa, once the doors opened again, show absolutely no symptoms. Have Covid-19 and spread it as though it were a whole new wave. That's in theory, the possibility. .That's a possibility, but on the other hand, that tourists who arrived in South Africa with Covid is probably staying in places where people are taking precautions. The most basic precautions, washing their hands, wearing face masks and social distancing. They're greatly reducing their risk already. .You said we're not going to go back to the old normal. How can you see a new normal, will it be like in Asia where people wear masks almost as a matter of course? .I think it'll be people wearing masks as a matter of course if the virus is there. A year from now, we weren't probably be wearing masks because the epidemic will be under control. We will have to be nimble and probably wear masks in certain settings. .What about old fashioned handshakes, hugs, kissing greetings, which is obviously very big in South Africa? .I've never really bought into the idea that hugs are a major source of transmission but kissing with tongues. I think that's out. .I have no doubt that's out, that's not the South Africa I know! Looking ahead, we've got some months where steep vigilance is required. .Absolutely and it's also going to vary province to province. .In South Africa, we've almost had the Western Cape, which seems like the worst might be behind it, but elsewhere in the country, the facility's coming under a lot of pressure. .Absolutely. There is that wave of sick people who require hospital treatment, which is the real threat to any country's well-being, economy, etc. and you will see countries going through that. The one thing which I do think is that things have never been as bad as we feared there would be. The susceptible population has never been as large as we thought it might be. If you took the UK and said 80% of people are going to be infected, as we said early on in the epidemic, we're talking about 30 to 35 million people. The answer is it's nowhere near that. I think that there may be people who have some immunity for all sorts of reasons that we don't know. Maybe the common cold. It's been hinted at in some of the papers I've been reading. There may be people who are not going to get infected because they're lucky. There are all sorts of things going on that we need to think about. .When will we have more visibility on this? .On the likelihood of what's going to happen, I would say within a month. Remember, we're only six months into a new epidemic and my God, we've gained so much information already.