COVID-19: We are at war

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We are now in a state of emergency, and the streets have run empty.

Shelves are empty. Hand sanitiser and protective masks are sold out. In the medical community, we have adopted swift preparations and are assuming the brace position. We all know what is about to come; we all hope we are wrong.

Not everyone feels the same.

In the face of this epidemic, many people throw their hands in the air and adopt a fatalistic view: “COVID is here, and we will all get it; what is the point in stopping it?” Even worse, “data experts” tend to create doubt about the severity of the epidemic, and imply that our declared state of emergency and social distancing measures are an overreaction. They charge us with not knowing the full picture. Some go as far as to question such harsh control measures, and throw around numbers, saying how the estimated death rate of 2–3% is vastly overrated.

I respectfully disagree with this attitude.

When it comes to epidemics, there is no such thing as doing too much or overreacting. I lived it in the ’90s, as patient after patient died of AIDS in the local hospital where I trained. It would be years before the national antiretroviral programme would reach us, too late for many.

It is true that the statistics, as they stand, do not reflect an accurate picture of population prevalence and death incidence. The outbreaks in the various countries in Europe and Asia vary wildly in their records of the spread rate of the epidemic and the incidence of critical illness and death. Reading the reports from other countries, we can see that the percentage of critical patients who die in ICU can be as low as 1% (Germany), or much higher (Italy and Iran). Does this mean we should step back and wait for more data? I think not. I say this not because of the 80% or so of people who will recover. I am talking about the old and the weak who might succumb to COVID in an ICU bed. I say this because we have learned from previous epidemics.

We all know, by now, that patients who are older and who live with chronic conditions have borne the largest number of the COVID-SARS deaths reported so far. The virus has now affected many countries, and, due to its infectiousness, it has the ability to make thousands of people ill in a very short time. My heart sank when I learned that asymptomatic individuals may infect between two and three people before they become ill. It is clear that this virus will not “go away” like SARS or H1N1 did a few years back. In the face of such circumstances, our only hope is to get treatment, develop a vaccine or achieve herd immunity. The UK seems to be aiming for herd immunity. This involves carefully controlling the spread of the virus through the population, while isolating the high-risk population. When 50% or more of the general population have had COVID, their acquired immunity will protect the rest of the country and those at risk.

In South Africa, we dare not adopt this approach, simply because we have one of the highest immunocompromised populations in the world. According to Statistics South Africa, the HIV prevalence for adults aged 15–49 in 2018 was 19%. This translates into 7,7 million people. Tuberculosis affected 322 000 people in 2017, according to WHO statistics. Six percent of our population suffer from diabetes – roughly 3,5 million people, without even counting the people older than 70 and those with heart disease, cancer and asthma. Allowing this virus to spread in our country may be catastrophic.

If ventilators aren’t available, or if staff are overworked or are sick themselves, the death rate will simply spiral out of control. Italy is a chilling example of this. Doctors were instructed to give the ventilator to the person who had the highest chance of survival. In some instances, this meant every second person.

It’s not all doom and gloom, though. Countries like South Korea and Singapore have managed to keep their infection rates low, and we could, too. I count our government’s response one of the quickest, even quicker than some first-world countries.

It took China seven weeks to respond to the events in Wuhan. In the medical community, we are all geared up to do our part. We have some excellent doctors, epidemiologists and virologists who are actively involved in the planning and management of the outbreak. Worldwide, the rush for research, treatment and vaccine development is making strides. Quoting some recent research from a Chinese study on monkeys, Christian Drosten, the director of the Institute for Virology at Berlin’s Charité hospital, recently said that once a person has had COVID, they are likely immune to it. Even though these are early days and more research is needed, this is encouraging to hear, as it predicts reinfection to be less likely.

Angela Merkel, the German chancellor, recently said that she views the COVID crisis as the biggest since the Second World War. The impacts of it will be felt for a long time to come.

I concur. We are at war. As South Africans, we need to stand together now. All indications are that it won’t be over in a few weeks. In all likelihood, COVID will be with us for the foreseeable future. Be prepared.

“Act quickly and proactively. You must be the first mover. Have no regrets. The virus will get you if you don’t move quickly. And you need to be prepared. If you need to be right before you move, you will never win. Aiming for the perfect timing is the enemy of recovery when it comes to emergency management. Speed trumps perfection. And the problem in society we have at the moment is that everyone is afraid of making a mistake. Everyone is afraid of the consequence of error. But the greatest error is not to move; the greatest error is to be paralysed by fear of failure.” – WHO executive director, Dr Michael Ryan

If we stand together now, if we act responsibly and if we seriously consider the risks, we may yet survive this war.

  • Erika Drewes is an integrative GP working in Cape Town. She writes in her personal capacity.
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