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BUSINESS DAY The wildfire spread of the coronavirus from China’s Hubei province to 28 other countries suggests it is just a matter of time before it arrives in SA. Scientists are racing to model the likely effect of the new pathogen, with a leading epidemiologist at the University of Hong Kong warning last week that Covid-19 could infect up to 60 percent of the world’s population. Even if most cases are mild and the mortality rate is less than 2 percent, as now appears to be the case, such extensive spread would be devastating. The big question confronting SA whether health authorities will be able to detect and isolate patients fast enough to contain the virus, or whether the worst-case scenario will unfold, with extensive transmission within communities. Official communication has focused on the measures being put in place to screen for the coronavirus, with little acknowledgment of the effect that a sudden surge of critically ill patients would have on SA’s overburdened public health system. The wildfire spread of the coronavirus from China’s Hubei province to 28 other countries suggests it is just a matter of time before it arrives in SA. In the barely two months since it first emerged, Covid-19 has sickened more than 68 500 people and killed at least 1 669 in mainland China, with a spike in cases late last week after authorities changed the way they are reporting the numbers. The demands Covid-19 is placing on China’s hospital services are staggering, according to figures provided last week by the World Health Organisation’s (WHO) head of emergencies, Michael Ryan. About 15 percent of the people in China who were infected with the virus required hospitalisation. Virtually all the hospital patients’ required supplemental oxygen, 20 percent-25 percent of those patients required intensive care, and up to 10 percent needed mechanical ventilation. Until Friday, Africa appeared to have been spared, despite the continent’s extensive trade, aid and travel links with China, but that may have been more due to weak surveillance capacity in some nations rather than a delay in the arrival of the virus. Egypt announced its first confirmed case on Friday. In SA, the Health Department has been scaling up its capacity to detect and manage Covid-19, including increasing personnel at ports of entry, screening incoming travellers and designating public hospitals in each province for potential cases. Officials are talking to the private hospital sector about how they will co-operate should the need arise, as private hospitals have lower bed occupancy rates than those in the state sector. The National Health Laboratory Service is conducting all testing for suspected Covid-19 cases, but provincial laboratories were asked last week to submit their requirements to take on some of the load, and private laboratories are stocking up on test kits. By Saturday the National Institute of Communicable Diseases said 82 people had been tested in SA, and all the results were negative. Those are all reassuring moves, but they do not address fundamental weaknesses in SA’s health system highlighted by the global health security index, which scores countries out of 100 based on their capacity to cope with a health emergency such as Covid-19. The index, compiled by the Nuclear Threat Initiative and the Johns Hopkins Centre for Health, found no country was fully prepared to deal with such an event and gave SA a score of 55, placing it 34th out of the 195 countries assessed. China scored 48, the US ranked first at 84, and the average score was 40. While SA is ranked top in Africa, with high marks for its ability to detect disease outbreaks, its Achilles heel lay in its health system, with particularly low scores for infection control practices and equipment. That should come as no surprise: while the country’s leading public hospitals, such as Tygerberg and Steve Biko Academic, have the capacity to isolate and manage patients with serious illness, many parts of the state system are dysfunctional. Smaller public health facilities regularly hit the headlines over crises ranging from in-hospital transmission of deadly diseases to a lack of running water. Facilities such as these simply will not cope with a sudden influx of contagious and critically ill patients. SA’s experience with the novel H1N1 influenza in 2009 offers a hint of the kinds of problems that could accompany a coronavirus outbreak. The surge in patients admitted to Tygerberg Hospital with H1N1 created such demand for intensive care and respiratory support that all elective surgery was temporarily suspended. While it reflects well on the provincial health system’s capacity to manage H1N1 at the time, it illustrates the knock-on effect for other patients.
Created at 2020/02/24 09:10 AM by Mediclinic
Last modified at 2020/02/24 09:10 AM by Mediclinic