The World Health Organization has declared COVID-19 a global emergency pandemic, as countries in all continents except Antarctica are affected by cases of COVID-19, caused by the SARS-CoV-2 virus. Melt Myburgh spoke to Dr Prudence Kayoka from Unisa’s Department of Agriculture and Animal Health about the impact of the pandemic.
In which phase of the pandemic do we find ourselves now? Why is it important that the world is in lockdown and citizens are isolating themselves?
In South Africa, on 15 March 2020, President Cyril Ramaphosa declared a national state of disaster, as positive cases of COVID-19 started rising. Initially, cases reported were from people who had travelled abroad, but now there is evidence of local transmissions, as a few recent positive cases were from individuals – including very young children – who do not have any history of international travel.
The number has been rising rapidly since President Ramaphosa’s first announcement. But we might be missing asymptomatic cases and other unreported cases.
It is important for the world to be in lockdown and for people to isolate themselves, because this is the only way to break the cycle of transmission and replication of the virus.
The virus is an obligate parasite: it needs a susceptible living being in order to replicate – the cell makes several copies of the same virus. But, if it cannot find a susceptible host, it will not be able to replicate and will become inactive. If people are not close to each other, the virus will not be able to be transmitted from one person to the next, and it will therefore become inactive.
I use the term become inactive instead of die, because a virus is not a living organism with its own metabolism and cells; it is an assembly of DNA or RNA, in other words, nucleic acids, genetic information coated by nucleocapsid protein, and sometimes covered with an envelope made of lipid (fat).
What must happen before things get back to normal, and how long will it take?
We are at the early stage of the epidemic. If people do adhere to instructions, such as handwashing, social distancing, testing, treating, tracing and isolation, we will be able to contain the spread of the disease.
Researchers have reported that this virus is sensitive to high temperatures, as from 26°C, the virus will be inactivated. So far, our temperatures have been high, and one would suggest that if the virus were in the environment, it would be deactivated due to the UV light from the sun.
But, lately, we have observed a drop in temperatures, as we are moving towards winter. If people do not abide by the instructions, perhaps the worst is still to come in winter. Thereafter, a decline will come towards spring – I would guess September or October – when temperatures will rise.
The directive to the masses to wash their hands for at least 20 seconds – is it really effective? How does it help prevent the virus? Should people wash their hands in running water? What happens to citizens who don’t have access to running water, and what must they do?
The virus is an assembly of particles linked by weak bonds and covered in an envelope that is made of lipid (in other words, fat). Soap breaks the bonds and disperses the fat particles, and then it pulls the fat particles into its water part, and the mixture is washed away with running water.
Rubbing your hands with soap for long periods is important, as the soap will reach the virus everywhere on your hands, breaking the virus particles apart and washing away inactivated particles. Washing your hands in running water without soap will not deactivate the virus, however, like when you wash an oily plate with water only.
If you do not have access to water, sanitisers containing at least 60% alcohol, properly rubbed into your hands, will also break the fat and deactivate the virus.
One can also prepare a 70% alcohol soapy solution, for example: mix 35 ml alcohol with 15 ml soapy solution. Another recipe could be to mix – in a spray bottle – 300 ml water, 30 ml vinegar, 30 ml lemon juice, 30 ml sunlight liquid and 20 ml Dettol or Savlon.
Which segments of society are most vulnerable in terms of the pandemic? We hear that people with chronic diseases should be very careful. Is this true, and why is this?
So far, published articles from the worst-affected countries have reported high morbidity and mortality in adults older than 60 years, especially people suffering from underlying conditions, such as hypertension, diabetes, cancer, heart disease and coronary disease, and people who have undergone major operations.
In this age group, the course of the disease appears to be severe and rapid. People falling in this group are vulnerable, as their immune system has been weakened due to side effects of chronic medication. The condition itself has suppressed their immune systems, meaning that their bodies do not have the ability to fight the infection.
Naturally, the body has different types of soldiers that will fight any invader of infectious or non-infectious origin. In this case, the virus is an infectious agent, and the body will mobilise its soldiers – white blood cells – to get rid of the virus; but, in some cases, the number of specific types of white cells (lymphocytes and monocytes, for example) might have decreased below the normal value, due to side effects of some chronic medication or cancer treatment.
So far, in other countries, there have not been reports of young children at Early Child Development (ECD) facilities or chrèches. But, in South Africa we have had some cases in young children that seem still to be the mild form. I think it is still too early to speculate; we will draw our conclusions once we have survived this pandemic.
What would your advice be to people who are on chronic medication? And what exactly is the situation with people who are on cancer treatment?
People on chronic medication should adhere to the latest regulations as announced, namely washing their hands and social distancing. The same precautions should be taken by those around them, so that they avoid exposing themselves to those around them who are vulnerable.
The most important thing is to organise the stock of their chronic medication, as the number of positive cases is increasing. It may lead to a partial lockdown within a community, or perhaps a total shutdown. People should have sufficient provisions of medication, and they should discuss this with their doctor and pharmacist.
With cancer, the cells have lost their ability to divide normally; there is abnormal division of cells, hence the proliferation of abnormal cells. While cancer treatment aims to destroy the abnormal cells, unfortunately normal cells are also destroyed, especially during chemotherapy.
Cancer treatment suppresses the immune system, and if such patients were to face infection of the coronavirus, doctors face a dilemma, as they cannot stop the anticancer treatment. All they can do is provide as much support treatment as they can for the patient. These are the patients who will be given priority, should there be a need for access to ICU for assisted ventilation.
A story is doing the rounds that antiretroviral medication is very effective against the virus. Is there any truth in this? Any advice for people on antiretrovirals?
Research on SARS-CoV-2, the virus that causes COVID-19, is still ongoing. It’s only three months since the virus was first identified in Wuhan, China, and it is too early to confirm and validate such outcomes.
So far, evidence of the benefit of using antiretroviral medicine to treat the coronavirus infection has been limited. Studies conducted were small in size, time and duration, dosage for treatment was varied and patients were receiving cotreatments, which may have contributed to the reported outcomes.
Should people on antiretrovirals test positive for the coronavirus and volunteer for their cases to be shared by doctors as case studies, that could advance the search for a cure of COVID-19.
Is the virus mutating? Are experts making progress in finding a vaccine?
So far, no mutation has been reported, meaning that the virus has not yet changed the structure of a gene, adapting and being transmitted to subsequent generations.
This virus is highly infectious and rapidly contagious. In general, it takes some time before mutation can be observed. At this stage, researchers are still investigating the behaviour of this virus.
So far, there are three countries that are on the forefront of finding a vaccine. China will soon start its first trial phase on humans – the vaccine has already yielded effective antibody responses in animals. The United Kingdom will start testing their vaccine in animals next week, and they are hoping to use it in humans within a month. The United States has also started their first vaccine trial.
There are rumours that a “second virus” is on its way from China. Is this fake news? What would happen if a second, stronger strain suddenly hit us?
There are, indeed, many rumours and myths and disinformation around this virus! So far, I have not come across any evidence related to a different virus. The only concern is about a second wave that could hit after all preventative measures have been lifted. At this stage, we can only speculate and observe what happens to China once they remove all preventative measures. One should also keep in mind the season when they lift the measures, namely whether temperatures are higher than 26°C.
A strain is a genetic variant or subtype of a microorganism, whether it be a virus or bacterium or fungus. New viral strains can emerge from a mutation or a swapping of genetic materials, for example, when two or more viruses infect the same cell naturally.
If a second different strain more virulent than SARS-CoV-2 were suddenly to hit us, the same would most likely happen as has happened with COVID-19. There would most likely be individuals who are asymptomatic, meaning that they do carry the virus and transmit it to others, but do not show any clinical symptoms. Others would get the mild form, and there would always be those with weak immune systems who would show the severe form. The disease would reach its peak phase, and, naturally, the virus would disappear or sustain itself in the environment to become part of the normal group of some of the common viruses causing flu seasonally.
Isolation and self-isolation are happening on a global scale. How effective is self-isolation – working from home – really? What is a safe distance to maintain from somebody else?
Isolation, or self-isolation, must be conducted in a specific manner for it to be effective. Currently, people seem not to be guided as to how the isolation should be conducted in one's own home to protect one's loved ones. Isolation, if not well implemented, may result in massive household infections.
The person in isolation (whether showing symptoms or not) must wear a mask and gloves to protect those around him/her. If there are sufficient rooms, the patient should be isolated in a separate room, with a separate bathroom, and using their own utensils.
If isolation in a separate room is not possible, the infected person could be the last one using common space, and appropriate disinfection must then take place. He/she should wear a mask and gloves at all times, and dispose of such in a tightly closed bag in a closed dustbin that should be properly disinfected all the time.
Clothing and bedding can be exposed to the sun for at least two hours, as the heat and UV rays will deactivate the virus.
The economic impact of the pandemic is playing out like a disaster. What is the psychological impact of isolation and self-isolation?
Publications have reported different psychological impacts from countries that have been locked down and where people have been forced into isolation. Mental conditions such as depression, fear, anxiety and anger may be experienced by people whose freedom of movement has been taken away. Human beings always fear the unknown or change, especially if they still do not have an understanding of what is happening.
I suppose a pandemic like this highlights the huge gap between privilege and poverty anew. How do you see it?
The virus does not choose. Whether you are poor or privileged, you can be affected equally. Perhaps, the difference will be one's access to the basic means for preventing and combating the virus spread, such as running water, soap and sanitisers, and basic healthcare in hospitals.
This is the time to unite. The privileged must reach out to the less fortunate and provide them with basic means. In our country, there are already good initiatives from some companies reaching out to remote areas to donate soap, sanitisers, etc.
Is it true that people should refrain from kissing their pets?
Yes, avoid close contact with animals. Refrain from kissing an animal, as a virus is an obligate parasite, which means it needs a living cell to replicate, multiply and be maintained.
A virus has the marked ability to mutate – to change the structure of a gene, adapt and be transmitted to subsequent generations. There is evidence that animals are intermediate hosts for other types of coronavirus previously isolated, for example, civet cats for the severe acute respiratory syndrome outbreak in 2002, and camels for the Middle East respiratory syndrome.
There is a recent study of a dog in Hong Kong that tested positive for SARS-CoV-2, after picking up the virus from its owner, who was tested positive for COVID-19. This may suggest that the owner did transmit the virus to the pet, but there is no evidence that the dog is capable of transmitting the virus to another host or to people.
People should practise social distancing from their pets as well. At this stage, researchers are still investigating the behaviour of this virus.
What is your immediate advice to the people of South Africa in terms of the pandemic?
Every South African needs to be aware of COVID-19, and must cooperate to avert the spread of the disease. The government cannot deal with this issue alone.
Everyone, without exception, must abide by the new regulations. As citizens, we are firstly responsible for our own movements and health. We should unite and care about one another, as the virus does not choose who will be infected.
However, all sectors of society – including schools and other educational institutions, the media and the health sector – should be involved in the dissemination of true information about COVID-19.
All South Africans must adhere to the basic principles of hygiene, and follow the rules below:
- Wash your hands regularly.
- Cough into tissues.
- Do not pick your nose.
- Do not touch your face.
- Keep away from others when you have flu-like symptoms (even if you have only the common cold).
- Avoid kissing and hugging.
- Use different approaches for greetings (footshake, bowing, hand-waving).
How do you see the role of academic institutions in the effort to combat the pandemic? Please tell us what you guys at Unisa are doing.
Academic institutions with operational laboratory facilities that can contain highly pathogenic microorganisms, such as the Biosafety Laboratory Level 3 (BSL3), are involved in different types of research, for example, producing test kits for diagnostic purposes, and detecting people who carry the virus, so that control measures can be implemented.
Others are testing different compounds/drugs to find a treatment against the disease, producing vaccines, conducting trials to test the vaccines and publishing reliable information to the world on the behaviour of this virus, so that we can control the spread of this virus.
At Unisa, as part of our community engagement initiative, we have been involved in the dissemination of the relevant information, reaching out to communities in remote areas on local radio, with the information being translated into local languages. Without the participation and understanding of all, we will not be able to combat this pandemic successfully.