Professor Salim Karim, the man leading the way on scientific coronavirus advice to Health Minister, Dr Zweli Mhkize, gives us unique insight into just how far his reach goes, what he can advise on, and what he has no control over. It’s easy to pick holes in a strategy which affects nearly 60 million lives – it’s entirely another thing to take full responsibility for your part in it and to own up when things don’t work. Like lockdown level 3 regulations enacted by other cabinet ministers who have their own scientific advisory teams – and for whose actions he often wrongly gets the flak. He gives us chapter and verse of one such change he has advised on – among 50 advisories from his task team that Dr Mkhize has accepted and acted on. It’s around coronavirs testing which was virtually imploding on itself as the national laboratory services got bogged down in an impossible volume of tests with turnaround times, negating the entire point of the exercise. Like turning around an oil supertanker at sea, it takes time. Prof Karim explains why. – Chris Bateman
Prof Salim Karim changes coronavirus strategy
By Chris Bateman
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Lengthy turn-around times for coronavirus tests are ‘disappointing,’ but the strategy of community health worker-led testing has been substituted with the promotion of self-compliance risk-reduction measures, thus lowering testing volumes and reducing the test results backlog.
This is according to Professor Salim Abdool Karim, the chair of the Health Minister’s scientific advisory task team, in an exclusive interview with BizNews. He added that bulk testing kit supplies had recently been secured with testing now prioritising hospital workers and patients, vulnerable people and infection ‘hot spots.’
This is in line with protracted calls by the scientific community to make this adjustment, instead of dispersing testing so widely that the national health laboratory services, (NHLS), are overwhelmed, taking up to seven days to turn tests around.
Infectious disease experts and epidemiologists such as Professor Shabir Madhi confirm that after seven days, a person is far less infectious and that test turnaround times longer than 12-24 hours put hospital workers and thus patients at unnecessary risk. Tests taking 5-7 days were “virtually useless,” Prof Madhi told a Discovery Health webinar a fortnight ago.
Says Prof Karim: “I have to say, it’s been disappointing that it’s taken the NHLS so long to prioritise. This has been an issue because we know that in a clinical setting, we need test results quickly. Our advisory committee told the minister we need to reduce testing demand, increase the number of test kits and use them more efficiently.
“As the President announced in his televised address this week, we’ll be accessing test kits through the African-level platform, where some 15 million are being made available on a monthly basis, so this will increase the supply to some extent.”
Hospital staff and patient tests would now be prioritised. In addition, changing strategy for the tens of thousands of community healthcare workers to advise people in their homes to wear masks, wash hands and practice social distancing would take some time. Giving an example of the challenges in turning a ministerial recommendation into action on the ground, Prof Karim said his committee’s initial advice shortly after lockdown was to initiate a health care worker program of going house to house, looking for cases.
“We were seeing far too few cases and we wanted to get ahead of the pandemic and find them before they came to the hospital,” he explained.
However, this was easier said than done. It involved a ‘huge amount of work; massive planning and resources.
“You have to spend time getting community buy-in. So now we make a recommendation that, given the shortage of testing, we should change that program so that it doesn’t involve testing. The approach is that when a person in a community is found to have symptoms, we initiate quarantine – without a test.
“To implement that means going back to all stakeholders and getting new buy in. It’s a process that takes time. Those of us in academia expect things to always get done quickly, but in government that’s not easy because it’s a massive program. Changing things without consulting loses you credibility in the community,” he added.
Testing backlogs hugely reduced
Asked what he saw as the optimal test result turn-around time, Prof Karim said he expected a PCR test result within 48 hours, “and 72 hours in some instances – we’re now quite close to that. The backlogs are pretty much done in most cases, though I’m not best placed to tell you. From what I’ve been told, there’s no backlog in the Western Cape and other provinces are now significantly lower, including KwaZulu-Natal (where he is based). We expected quicker action, but it turned out that this doesn’t translate so easily in NHLS work procedures.”
Challenged on coronavirus infection projections having changed from initial actuarial calculations to actual data over time and the controversies that erupted, Prof Karim said the wider context was working in an environment of ‘imperfect data and evidence.”
“We’ve only known about the existence of this virus since January and we’re just scratching the surface. It’s like caring for patient who’ll die if you don’t act. You have to act, even if you make the wrong diagnosis, you then change course. I have a reasonable understanding of the current state of the pandemic and what the likely scenarios are in the next few weeks. Again, converting a recommendation into action on the ground with government requires substantial work,” he added.
All previous epidemics South Africa faced gave scientists time to follow the traditional health paradigm of collecting evidence to understand how the disease spread, developing an intervention program, piloting it and then adjusting. This was followed by taking it to doctors, consulting and eventually diffusing it into the general population.
“That takes one or two years. We couldn’t do that here, so we locked down and explained to people that this is a deadly, highly infectious novel disease. Now it’s no longer about enforcement. Just the opposite. We’ve lifted the lockdown, telling people they must take radical responsibility to protect themselves, and supporting them to do so as much as possible,” he said.
Asked how he thought the public was responding, Prof Karim said he’s seen both sides of the coin while out walking or shopping.
“On my morning walks, nearly everybody is wearing masks and the supermarkets have adjusted very well with distancing protocols, floor queuing markers and sanitising measures. It’s quite impressive. We could never have got to this place in March. Then I go to other areas and I’m shocked at the lack of self-protection measures. We’re not a regimented society. Some will make decisions not in the overall or their own interests. We have to accept that that’s part of it. The extent to which we lose that battle will define how severe the epidemic will be. However, I see a silver lining informed by the HIV/Aids pandemic. As the C-19 pandemic progresses and people know someone who has the disease or who has died, they change their behaviour,” he said.
Asked what his central take-home message would be for people, he responded: “The risk of the coronavirus to you, your families and communities is all in your hands.”
