🔒 SA epidemiologist warns Covid-19 will leave many ‘alive but permanently impaired’

Epidemiologist Dr Jo Barnes warns about a scary side of the Covid-19 story: many of us will be left alive, but permanently impaired. In this interview with BizNews founder Alec Hogg, she picks up on a heated debate about flawed Covid-19 statistics, saying that the focus on death rates is distracting us from the real issues. Silly restrictions have left many South Africans not taking precautions seriously. She believes the official death rate does not reflect reality, particularly in rural areas where hospitals are “completely falling apart”. Dr Barnes also takes aim at professionals in fields outside epidemiology who criticise the Covid-19 models, quipping that at university her peers used to regard economists as making weather forecasters look good. – Editor

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One of the most popular of our podcasts of the past month was with Dr Jo Barnes from Stellenbosch University. An epidemiologist – the people who are not very popular that are part of going in there and shaking things up. But also, at the moment, we’ve got lots of economists who are saying the epidemiologists made huge mistakes by overestimating the impact of this coronavirus. I’m sure you must be thrown that many times. How do you respond to that kind of criticism? 

Well, when I started out at university, I did a degree in mathematics and we used to say that economists were designed to make the weather forecasters look good. So, I could retort! Let’s start off there. Number one, I don’t think anyone – economists, any kind of scientist or epidemiologist – would have been able to do any better given the data that was available to us at the beginning of the outbreak. 

In fact, before the outbreak even started in South Africa: we learn as we go along about many, many versions and varieties of scenarios that this virus can present us with as well as the geographical differences around the world. So, I don’t blame the epidemiologists. Unfortunately, disease data is not like market related information. It’s got a much, much larger error margin around anything, and – if anything – it’s usually an undercount of whatever you’re measuring. It’s a valid criticism, given that we had to act on that. But I don’t see how they could have done any differently.

So where are we in South Africa? I remember last time we spoke, you had two very notable quotes. The one was: ‘this is a not insignificant enemy’. And the other one: ‘that we are still managing this in the dark’. Is it a little brighter now? Do we know more about this enemy to mankind? 

The depressing thing is that knowing more didn’t seem to somehow convert into better action. Yes, we do know more, but the action that we need is to a great extent in the hands of politicians. And I won’t bore you with quotes on politicians. So, we had a very promising start and things fell apart from there onwards. 

We had a promising conceptualisation and terrifically poor strategies to cope with this scenario. And it has all come down – and I think it was captured politically – to policing and control, instead of explaining, teaching and educating the population so that they can voluntarily up their behaviour to a point that will make it much safer and bring the caseload down. Now we have a sullen, resentful population trying to beat these sometimes silly restrictions any way they can. And in the meantime, that means that it ups the risk tremendously, even for those who do comply. 

And if you make laws that part of the population quite blatantly cannot obey, what you are inviting is for people to say: ‘well, I can’t do that and I can’t do this, so I’m not going to do any’. If you give them excuses to opt out that are very valid and very easy, then you’re going to get that kind of behaviour. And it somehow seems to be very difficult to get that basic community health message into the politicians’ heads. 

Dr Barnes, when we spoke last time: you explained that in your other life, pre-Covid, you dealt in densely populated communities with waterborne diseases. So clearly, you have an insight into what’s going on in that sector of the population. Is it as dire as you’re telling us – the sullen, perhaps resentful and ‘not prepared to even listen to common sense now’ within those communities? 

Yes, I think the emotional temperature upped considerably when the government banished the sale of hot food, where many of the people living under those scenarios, even though the food is not necessarily all that nutritious or the correct diet, but at least it’s food. A little while ago, there was a research project that found that one in five South Africans go to bed hungry. You cannot make it extremely difficult for people to get food and then only raw food, prohibit them to go out to get the wood you need to cook it with and go to bed hungry and not somehow explain how that is going to make the virus worse. 

If you really want to – by hook or by crook – you can explain this way and that way around. Eventually it’s going to have some connection with the virus. Everything we do in life at the moment has got something to do with the virus. There is absolutely no scientific proof to say that if you go out to get firewood or you go out to go and buy cooked food – your risk is any different. And people realised that. So it makes their life very, very difficult. And that’s where part of the resentment came from. 

In fact, two days ago, some of these communities said to the government: please don’t make any more promises, because you’re not keeping them. If that’s the kind of message that’s coming back, then the government must be tone deaf if it’s not hearing it. 

I’ve heard it once from a businessman who deals in the bottom end of the pyramid that: because people are poor, don’t ever believe that they are stupid. And clearly there is a similar thing here. Has this played much of a part in what we are now seeing of a rapid expansion in infections and indeed mortalities? 

You can almost call it an explosive expansion, partly because it is now moved inland to our most populous province, Gauteng. Also, a province that is really poorly prepared for it. Remember I said last time, one of the things I would first want to know is: we dearly and expensively bought time for the government to prepare for this – did they properly prepare? 

Well, to be honest with you: I think nobody, no committee would be able to design a better test for a government’s readiness and the general state of their governance than a pandemic. We’ve got our answers. We’ve got our answers even without doing any kind of research on this. No, they weren’t properly prepared. 

Western Cape was for a long time totally the market leader, so to speak, and crucified for it. Gauteng is, at the moment, in the process of overtaking them. Because they’ve got a much higher population – we’re going to end up with a large number of people dead. And that’s a hard sort of test that costs the ordinary man in the street an enormous amount of income and even loss of life. 

On the other hand, it’s not just South Africa. We heard yesterday that the Brazilian President, Jair Bolsonaro – who’s been calling this a little flu – has now himself been infected with Covid-19. 

Karma. It will hit you! Since retired people can’t be fired, I suppose I can say this. It’s very interesting to see that in the places where this pandemic has run riot and keeps on threatening to go out of control and so on, are the countries where government and the political leadership (however you define it) is actually divided, providing poor leadership, scoring political points rather than fighting the virus. 

So we’re ending up with a country – be they rich or poor, first world or third world countries – where there are divisions and interfactional fights in how to handle this. That is where the virus slips through the cracks. And part of the reason is Brazil. Now, I’m very sorry to say that it looks to me as if our country is not doing very well either. 

So, I’m hoping that there are some lessons to be learned in that, because this is being captured. This whole pandemic is now also having another form of state capture, because we now have control councils in every jolly place that you turn to – down to the municipalities. And we know that the municipalities: you’ve seen some reports about what tremendously poor situations they find themselves in, or most of them. They can’t even manage their way out of a paper bag, let alone manage a pandemic. 

And large numbers of actions to be taken to alleviate this problem are at ground level, at grassroots level, and that’s where the municipality operates. So, we are having local governments falling apart. We are having poorly integrated and poorly strategised plans coming from above. It’s not a wonder that we’re struggling. 

It will be very interesting when we look back on this, as surely historians will do to see how badly or how well, perhaps, we have been doing it. Clearly, your report card at the moment is a big fat F for fail. But the one good thing in South Africa is that the mortality rate – or at least the published mortality rate – is very low relative to other parts of the world. Have you any thoughts on why this would be so? 

I have a feeling that part of that mortality rate is an undercount. I do have a feeling that in more rural areas, in areas where the hospitals are completely falling apart and struggling – not all of them are certified – I do know we have a desperate situation with the testing. So, why would you test a dead person to make sure that there wasn’t Covid on board, because they don’t even have enough tests for the living. 

The National Health Laboratory Service is just about doing half, if not less, than what the private sector load is carried at the moment. But the other factor in there, and I really take my hat off to them: wherever they possibly can, we still have a very sophisticated top end of the health services. And that’s not only private, there are some fantastic individuals serving, working their fingers to the bone, inhumane hours to try and save people. 

But we also have gotten better at saving lives. As we knew or learned more, we managed to pull many of them through. But Alec, I’m worried about that in a way, because we are totally unprepared for the large number of people who will come out of this alive, but impaired. 

What do you mean by that? 

This virus attacks people’s nervous systems. Some of them come out of there with a permanent (what they call) brain fog. They can’t remember, they’re poorly orientated, have very poor balance. Some recover – others simply don’t. Others have had really serious cardiovascular damage. Some have had kidney damage and damage to the gut. A number of people will come out of there, certainly not really able to function on their own again. And where will we care for them? Even before we went into this crisis, we had very poor care for the elderly and the impaired. It’s now going to get worse. And I don’t hear a word about that anywhere. Nobody has thought that far.

Nobody is talking about that. I certainly haven’t heard that being raised in conversation. And perhaps, it’s because we are so early into this pandemic that we haven’t really looked beyond what’s going to occur then. But is there evidence for this then? 

It comes from overseas – a lot of places, people have said. Also, many people are so extremely tired that it’s going to take them six months or more, because it has affected the blood circulation, and as I say, the neurological integrity of the brain and so on. It’s worse than like a yuppie flu, if I can put it like that. And they are not able to function. And now your listeners and readers would be very interested to know or think about the massive impact on the economy if all of these people are withdrawn from what they had done before. If it takes them six months – at least they recover, but what about the percentage who are permanently impaired? Some of that damage is irreversible. 

It’s so confusing, because on the one hand: you hear about a high percentage of people who show no symptoms whatsoever (or are asymptomatic). Now, you are raising a big flag about those who, when they do get the coronavirus, will take a long time to recover. And it makes sense! If you don’t get oxygen to your brain, there could be irreparable damage. So, we are learning. But, I guess, the comment you made last time about us still being very much in the dark in certain areas still holds true. 

Yes. And, you know, as you say, it’s not even half a year that we’ve been struggling with this. So we are looking for other viruses and other situations – we’ve had long practice to know that a certain percentage of this will need that. We don’t know in this case. But it’s interesting: I’ve just (half an hour ago) read a very large Spanish study which found that 33 percent of the people who showed antibodies, in other words, they had the virus onboard some time earlier – showed no symptoms at all.

And I’m coming back to that shape of the iceberg under the surface of the water. In other studies, they found that it is 44 percent or close on half of the people. But some of those with no symptoms had an immune system response that was different to the rest. They can get it again. And when they do get it again – they get it very seriously. So, when I’m talking about these fall out symptoms: we are also not even sure if it is only the seriously affected that will eventually struggle to recover. So, just to take a nod to the economists (who are probably now starting to get nervous again): we are still in the dark when it comes to how much damage it will do across a population, but we are doing our best. This is probably the biggest wakeup call I’ve ever seen across the globe for not pinching off money around every corner for health services. Because it’s going to bite you, and it has. It has bitten us. We’re keeping track of the numbers of this one far, far better than anything else we’ve ever done before. 

Is there any bright light somewhere? Any bit of positivity you can share? 

Yes. Yes, I do think that there are a lot of very arrogant, very opinionated people who are starting to learn things that they wouldn’t have admitted before. Now, there is a damnable thing called saving face. They wouldn’t admit it. I don’t care about them admitting it or not as long as they start learning the lessons. And I do think South Africa is in a better situation than, for instance, Brazil or for that matter, the US. So, yes, the scenario is grabbing us by the throat at the moment.

But I promise you, South Africa will survive and hopefully not in the shape that it is in now. As long as we keep our government from making controlled councils and having two sets of power in all sorts of places. We now have a town council and a control council and some of the people are sitting on both, and when it suits them – they chuck it over here and when it doesn’t suit them – they talk from that side of their mouth. But I have huge trust in South Africans. They are the most practical people. You don’t sell them a lemon for a long time. So, yes, I think we would be able to get through here. I’m just mourning the hard road that it is going to take to go there.