Pending a novel coronavirus vaccine, progress towards which is apparently faster than what happened with Ebola, we may have an adaptive, widely-used-in-Africa drug measure that could help contain the spread. That this well-known malaria prophylaxis can be adapted to weaken the coronavirus in the host person, is amazingly positive news. However, the pragmatics of production on a mass scale, distribution and implementation – and the speed of the coronavirus spread – combine to create a conundrum. If this really works, can we roll it out among a growing infected cohort in time? How big will that infected cohort be by the time we’re ready to administer this drug? All these answers will emerge within hours or days of you reading this, but just having a weapon to contain the spread in South Africa where the pandemic is still within the containment stage is huge. We cannot afford to take our foot off the mitigation gas however. Increasing hospital capacity is paramount if we want to avoid serious coronavirus cases paralysing our already overburdened public health system. Don’t think the private healthcare system isn’t affected. It’s already bracing itself to help out, cancelling elective surgeries to free up capacity and thinking laterally about ventilation and bed capacity. – Chris Bateman
Necessity is the Mother of Invention
By Chuck Stephens*
Timing has so much to do with the Covid-19 pandemic. It spreads exponentially, which is hard for people to grasp. If you ask someone would they rather have R1m or a R1 coin that will double in value every day for 30 days, they will take the R1 million every time. But the real loot is in the alternate offer.
That’s why containment, contact-search and social distancing are so important – early on. By delaying this exponential onset of the inevitable, you can try to keep the outbreak within the coping capacity of the health systems.
The AIDS pandemic came with three phases – Prevention (e.g. condoms), Treatment (i.e. ARVs) and Aftermath (e.g orphans and child-headed households). The Covid-19 pandemic is a lot easier to get, because of the way that it spreads. Like handshakes. The HIV virus does not spread that easily.
The problem with “social distancing” is when the whole family lives in a tiny dwelling. Often several people sleep in one bed together, if there is a bed at all. This conundrum is on everyone’s mind as South Africans start spreading the disease to one another. At first, they were just “importing” it from Europe or Iran. Now it is starting to spread, and there is good news.
First, when one person in a crowded home tests positive, it does not have to infect everyone. Chances of another household member catching it can be as low as ten percent. Assuming that everyone is careful with hygiene. Of course it is hard to wash your hands often if you don’t have easy access to clean water.
The easy solution would be to start vaccinating everyone, but this pathogen is new. So there is not yet any vaccine. When they find one, they have to test it. Then it has to be manufactures, then distributed. All that will take some time. Some are estimating that it could take more than a year.
Enter a medical research team from Barcelona, Spain. Messi-ville. They have turned necessity into invention – by recycling the application of a drug called Hydroxychloroquine. This is not a treatment or a cure. What it does is simply disruptive to the coronavirus. So anyone who tests positive or manifests the symptoms can take this familiar drug (commonly used as malaria profilaxis) to weaken the virus. This reduces the risk of the “host” transmitting it to others. They may have just come into contact with someone else who has tested positive? Or they may be verifiably positive themselves, and thus known to be contagious? Basically the coronavirus gets knocked for a loop by the drug, like “forechecking” in hockey.
This drug can be deployed rapidly in high-density areas – where population is high and homes are tiny, robbing the term “social distancing” of any meaningful significance. Therefore, if one household member is positive, even if the household is under “lock-down”, then the infected one can go onto Hydroxychloroquine – as a way of limiting the spread of the disease to others in close proximity.
As this drug is very common (for other purposes), it can be rapidly deployed to reduce the spread of the pathogen. Long before a vaccine is available. As this drug cannot be purchased without a script, the dosage and frequency can always be determined by a trained professional.
So if someone in your household comes down with it, ask your doctor about them going onto Hydroxychloroquine. That will be protection for the rest of you. Even if they slam you all into quarantine, it will still reduce your chances of catching it from your loved ones.
It is good news for Africa! The longer we can delay this disease from reaching advances stages, the better our health facilities will be able to cope. Every invention that achieves this is worth its salt.
This is about “doing unto others as you would have them do unto you”.
“Ask not what your country can do for you. Ask what you can do for your country”.
The spread of the HIV virus was due largely to the holdback of ARV roll-out and treatment. Drugs can be deployed as a prevention strategy – as was not the case under that “death-wish regime”. Most of the 4.2 million citizens on ARVs today are “virally suppressed”. CD4-count monitors your treatment. Viral load monitors prevention. Let us not repeat that fatal mistake again.
Research so often supports our first responders and in this case, necessity has proved to be the mother of invention once again.
- Chuck Stephens works at the Desmond Tutu Centre for Leadership. He has written this article in his own capacity.