Coronavirus in South Africa: why the low death rate can be misleading

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As coronavirus infections increase, at a ferocious rate, across South Africa, I have spent the past two weeks traversing this huge country trying to figure out where and why things are going right and wrong.

Here are, in seven points, some initial conclusions and, perhaps, other lessons for the rest of the continent.

1) The fog of war

Beware of statistics, even here in South Africa which has one of the best data collections on the continent.

And be even more wary of assumptions based on anecdotes.

Some observers have rushed to celebrate figures appearing to show an incredibly low death rate for Covid-19 patients in the country – 1.4% compared to 15% in the UK. Could it be because of a relatively young population? Or maybe Africans have special immunity, genetic or otherwise?

The short answer is no. Or rather, it is still too early to tell.

If you compare, for example, the death rates of confirmed viral patients at major hospitals in South Africa, they are almost exactly the same as those in Italy or the United Kingdom.

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But when you expand the statistical pool beyond hospital admissions, each country and province uses fundamentally different criteria and methods.

“It doesn’t make sense anymore,” Professor Shabir Madhi, a vaccine expert at the University of the Witwatersrand, told me.

He points out that so little testing takes place in the rest of the continent, it is impossible to draw any useful conclusions or comparisons. His hunch is that – as with the 2009 swine flu pandemic – we won’t know the true impact of the virus in Africa for several years.

2) Fear of hospitals

Remaining on the question of statistics, South African researchers have released alarming data on an additional 17,000 deaths which appear to show significant underreporting of deaths from Covid-19 here.

As the researchers point out, the growing fear of going near hospitals or clinics – which is not unfounded in some places – may well be a significant factor.

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This means that many people with the virus die at home, while others succumb to different illnesses rather than seeking treatment.

Tuberculosis screening, for example, has declined by around 50% in recent weeks, and there has been a 25% reduction in vaccinations in South Africa.

The solution? There is no quick fix to this, but local health services need to work better with their communities, to build trust both with patients and with staff who have often reacted to new infections and disease. potential exposure, for example, by closing everything. clinics for weeks.

3) beware of white elephants

In Port Elizabeth, a new giant coronavirus ‘field hospital’ has been built by the private sector. But last week only about 30 of its 1,200 beds were in use due to a shortage of essential personnel and oxygen.

“Brainless,” Prof Madhi said dismissively when speaking of the hospital.

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The Gauteng provincial government built something, but again, hardly any of the beds are staffed or supplied with oxygen, leaving the facility nearly empty and prompting volunteers and private donors to step in to try to save the day.

“Oxygen is the new currency,” a doctor told me, complaining that more than half of the facility remained “a white elephant” and that the plan to add 700 more beds would be a total waste of time. and money if the local government didn’t. ensure an additional supply of oxygen and hire the necessary medical personnel.

4) here to stay

“The storm is upon us,” President Cyril Ramaphosa said last week, and his choice of weather metaphor was appropriate. After all, wars – the analogy of the virus favored by many world leaders – tend to end, while time will always be with us and perhaps this coronavirus.

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In the absence of a vaccine, herd immunity, or a significant change in behavior, several experts have told me they believe South Africa may need to treat Covid-19 the same way it has treated the tuberculosis (which still kills some 200 people here every day) and HIV, and learn to live with the virus for the long term.

5) On the ground

Much has been written about the forceful, generous and sometimes effective role played by the South African private sector in helping to fight the virus. But, as usual, it is local communities and small organizations that make the most difference in such crises, and which are too often overlooked.

Doctors in Cape Town told me that these are the clinics that have the closest long-term relationships with local communities and know how to communicate with them.

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Cape Town Together’s Facebook page is a good portal to explore the basic types of work that thrive during the lockdown – community action networks, for example – and which can still help reconfigure one of the world’s most unequal. , and siled societies, once the immediate storm has passed.

6) expose rot

It was a revealing moment. Amid this health crisis, powerful figures from the ruling ANC in South Africa were caught lobbying to reinstate two prominent figures who had been implicated in one of the most egregious corruption scandals in the world. democratic era of the country – the looting and collapse of the rural bank VBS. .

It was a sobering reminder of the institutional decay within the ANC, where competence and honesty are sometimes less valued than party loyalty, and where a culture of “deployment of cadres” has left some behind. key public institutions – hospitals and health services, for example – run by unqualified party hacks.

“If you don’t have robust management systems, you can’t change the situation overnight during a pandemic,” a chief medical officer in Johannesburg complained to me, saying the provincial health department from Gauteng was almost as incompetent as the one from the Eastern Cape.

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In the aftermath of this crisis – and I remember something similar being revealed village by village in the aftermath of the Asian tsunami – the quality of local leadership seems to be a determining factor in distinguishing success from failure.

7) Masks, masks, masks

While the UK worries about the specifics of when, where and how to wear masks in public, it is heartening to note how quickly and relatively obediently South Africans have embarked on the profession of cover the face.

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Yes, there are huge and growing frustrations here, especially in the hospitality and alcohol industries, struggling with the implications of the government’s sometimes erratic and conflicting foreclosure rules.

For example, why can passengers squeeze in a minibus when people are not eating in restaurants?

But many doctors here seem confident that masks will prove to be the most important step in tackling the virus, especially in crowded cities, where social distancing is nearly impossible.

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