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WRAP: Mkhize says scientific models helped SA avoid a Covid-19 ‘explosion’
South Africa has thus far averted a “rapid explosion” of Covid-19, Health Minister Zweli Mkhize says, with the lockdown playing a huge part in stymying a possibly uncontrollable spread.
The minister presented slides on the latest developments regarding Covid-19 in the country.
Mkhize said the number of cases have increased every day, and experts told the department that this was because of a high number of people being referred from community screenings.
The second factor is that the communal spread of Covid-19 means the spread will continue despite the lockdown, Mkhize said, reiterating the importance of physical distancing and good hygiene.
This second factor is what is “driving” the infection rates, he said, but he noted that there hasn’t been a “rapid explosion” of cases.
The minister said, in other countries, the virus spreads quickly and reaches a peak and at that point health services are overwhelmed.
Conversely, South Africa decided to institute a lockdown to delay the spread. This was on the advice of mathematical models which showed the possible scenarios.
One of the models mirrored the worldwide trend of the virus spreading fast. The advice showed “optimistic” and “pessimistic” outcomes – that being the country being able to cope with cases, and the country being overwhelmed respectively.
Mkhize said the lockdown stymied what could have been an “exponential rise” in cases. “When we addressed the media two weeks ago… we indicated that the lockdown was able to contain the spread, not stop the spread.
“We are quite pleased with what has happened,” he said.
Mkhize noted that the government’s decisions during the lockdown have been made on scientific advice, including the looming relaxation of regulations starting on 1 May.
The additional two weeks of lockdown, Mkhize said, allowed the country to screen a lot more people.
Mkhize rebuffed claims in the media that the mathematical models the government used were “flawed”, saying they are done by a number of groups.
Protective gear
Mkhize said about 135 medical staff members have been infected with the virus. He said the government was investigating the sources of the infection of each case.
He said only one health worker had died, which was an elderly Limpopo doctor who was working part time.
Regarding concerns surrounding protective gear for medical staff, Mkhize said the country will face some challenges with stock, but was confident there is enough to go around at the moment.
He said the government was looking to negotiate with other countries in getting more protective gear.
Unemployed doctors, and Cuban doctors
Mkhize said the government is looking at clearing the backlog of unemployed doctors, and he has informed provinces to “go ahead” with employing doctors who are looking for placement.
He said the government is still looking for more doctors.
Mkhize said there is a group of doctors who qualified overseas who are without work. They have not yet been registered with the Health Professionals Council of South Africa (HPCSA). He said those “are not possible to employ” until they’ve passed relevant examinations and gone through the process.
Mkhize supported the incoming of 217 Cuban doctors, adding that they will “not be taking anybody’s post”. He said Cuban doctors will be spread across all provinces.
Comorbidities
Mkhize added that studies have shown that there is a “strong” correlation of death and serious Covid-19 illness when a person has already-existing “comorbidities” – existing ailments – especially hypertension, diabetes and obesity. Lung diseases are also associated ailments that deteriorates a person’s condition when they contract the virus.
More than one-third of South Africans, for example, have hypertension, Mkhize said, adding that all these so-called comorbidities were common in South Africa.
It is not clear yet, however, how those living with HIV/Aids cope with Covid-19.
Mkhize said South Africa’s mortality rate is around 1,9%, probably because the majority of people who contracted the virus are on the younger side.
Meanwhile, there have been three more deaths, taking the death toll to 93. All deaths were elderly people from the Western Cape with “underlying challenges”, Mkhize said.
New cases
The minister announced that the country was just on the cusp of 5 000 positive cases, sitting at 4 996 as of Tuesday night.
Mkhize said the number of tests being done is “rapidly increasing” thanks to the government’s community testings and screenings.
To put this into perspective, in the first week of March, when the first cases were announced, about 430 tests were done. The following week it was doubled. In the first week of April, however, it was as high as 8 200 across the private and public sector.
There are three groups of people who are being tested: those in the private sector, public sector, and those who are being referred from community screenings.
With South Africa in lockdown during the coronavirus pandemic, Springbok captain Siya Kolisi and his wife, Rachel, are doing their bit to help those in need.
Kolisi, who grew up poor in the Zwedi township just outside Port Elizabeth, said in an interview with CNN Sport that he knows the feeling of going to bed on an empty stomach.
His foundation is providing food parcels and protective equipment to townships during this period.
“For me, it’s personal because I know there’s nothing worse than hunger. There’s nothing worse than listening to your stomach before you go to bed. And you just hear grumbling, you have nothing to eat, you’ve got no other choice,” Kolisi said.
“That’s what gets me going and keeps me motivated to work as hard as I can to try and help the frontline workers… I’m not disadvantaged anymore, you know, and I don’t see myself like that. But I know what it feels like. What I’m trying to say is you don’t have to come from there to be able to give back. There’s no better feeling than helping somebody else,” he said.
Kolisi, 28, is the first black African to captain the Springboks and last year led the team to Rugby World Cup glory in Japan where they beat England 32-12 in the final in Yokohama.
WATCH in the video clip below where Siya and Rachel discuss the work of their foundation and the special permit allowing them to conduct crucial work in townships:
“There’s nothing worse than hunger. There’s nothing worse than listening to your stomach before you go to bed and you hear grumbling”
Dozens of drugs are being investigated for their value in treating Covid-19, as desperation drives doctors and researchers to look for something that could battle the virus and save lives.
“There are really no FDA-approved medications for the treatment of Covid-19, unfortunately,” said Ashley Barlow, a pharmacy resident with the University of Maryland Medical Center in Baltimore. “We’re doing the best we can to try and ramp up studies, but since we’re doing it in such a quick period of time there are a lot of flaws we have to take into consideration.”
The Covid-19 drugs being tried and tested fall into two general categories, explained Dr Rajesh Gandhi, director of HIV clinical services and education at Massachusetts General Hospital in Boston:
Antivirals aimed at limiting the spread of the coronavirus inside the bodies of infected people
Immune system medications that limit the damage the body does to itself while fighting off the coronavirus
“There are drugs we believe can help pull people through the natural evolution of this infection and can really make a difference,” Gandhi said. “Right now, the jury is still out on some of these things that have been proposed. That’s why we need to have clinical trials that will provide an answer.”
Remdesivir
Many of the drugs proposed to treat Covid-19 are already approved for other conditions, and can be put into immediate off-label use. That’s not the case with one of the most promising potential therapies, an IV drug called remdesivir, originally developed to treat Ebola and MERS (Middle East respiratory syndrome).
“Remdesivir is not an approved drug, so the only way you can get it is if you are in a clinical trial or through a compassionate use programme,” Gandhi noted.
The drug attacks the genetic code of the Covid-19 coronavirus, hampering its ability to replicate, explained Barlow, lead author of a review of potential coronavirus therapies published recently in the journal Pharmacotherapy.
Early studies in small groups have shown benefit in patients, but doctors are still waiting on results from larger clinical trials to verify those findings, Barlow and Gandhi said.
“I would say in the next month we will probably get an answer on remdesivir,” Gandhi said, adding that even partial benefit would be a good result.
“Even if it doesn’t work 100% of the time, then you have something to build upon,” Gandhi explained. For example, remdesivir could be added to a cocktail of drugs, much in the way that researchers developed an effective therapy for HIV, the virus that causes Aids.
Chloroquine and hydroxychloroquine
These anti-malarial drugs have been touted by President Donald Trump and others as one of the great hopes for Covid-19 treatment.
But these drugs have already laid an egg in several major studies, Barlow said. Clinical trials are ongoing for the two drugs, but researchers aren’t holding out much hope.
“We were looking for a promising drug, and unfortunately hydroxychloroquine ends up being not so promising as we originally thought,” Barlow said.
One nationwide study focusing on its use in US veterans’ hospitals found that 28% of patients treated with hydroxychloroquine died versus 11% of those who didn’t get the drug, according to media reports on Tuesday.
Even before these results, doctors had already started turning away from the drugs, Gandhi said.
“A few weeks ago, when it really started getting intense here in Boston, we were using hydroxychloroquine more than we are now,” Gandhi said. “The waters have remained very muddy. It’s very unclear whether it’s been beneficial, and there are more reports of toxicity.”
Tocilizumab/baricitinib
These immune system-modulating drugs originally were developed to treat rheumatoid arthritis and other inflammatory diseases, Barlow said.
Researchers think they could help Covid-19 patients because the coronavirus appears to trigger an overactive immune response in some people, doing a lot of damage to organs and increasing the risk of death, Barlow and Gandhi said.
“They block one of the alarm bells of the immune system, and try to keep the immune response under control,” Gandhi said, comparing the response to the virus as “when there’s a fire and the fire’s been put out, but the firemen keep trying to put it out.”
This “cytokine storm” can fill lungs with fluid, promote a high fever, or drop blood pressure to dangerously low levels, Barlow said.
Clinical trials for tocilizumab and baricitinib are either underway or in preparation, experts said.
Ribavirin
This broad-spectrum antiviral drug, formerly used to treat hepatitis, is being tried as a Covid-19 therapy and really shouldn’t, Barlow said.
The drug inhibits viral replication by interfering with genetic synthesis, but comes with a host of dangerous side effects.
“It is considered a hazardous drug,” Barlow said. “For us as pharmacists, it’s kind of scary to see people use it because of the significant adverse effects that come with it.”
Ribavirin’s inhaled formulation, for example, can be toxic to foetuses and is not indicated either for pregnant women or their male partners, Barlow and her colleagues said. The drug also can cause anaemia and low blood levels of calcium and magnesium, and has the potential to interact dangerously with immune suppression therapies.
Gandhi said, “I haven’t seen a ton of really exciting data” supporting ribavirin’s use.
Lopinavir/ritonavir/nelfinavir
These drugs were all developed as ways to interfere with the viral replication of HIV, and “in MERS and SARS [severe acute respiratory syndrome] – the other human coronaviruses before Covid-19 – there was some interest in lopinavir/ritonavir,” Gandhi said.
Early randomised trials out of China have not shown any particular benefit, but the World Health Organization and others are still including one or more of the drugs in ongoing Covid-19 clinical trials, Gandhi said.
But, Barlow added, “I think a lot of institutions have stopped using this agent because of the lack of benefit seen.”
Interferon alpha
This drug is one of the older antiviral agents, examined as a means of treating hepatitis and some cancers. It’s based on a protein your own body makes to direct immune response, Gandhi said.
“It’s a natural antiviral that our bodies use, but it’s given as a medication to go beyond what our bodies make,” Gandhi said.
However, there’s little laboratory evidence that interferon alpha is effective in treating either SARS or MERS, Barlow and her colleagues noted.
Nonetheless, ongoing studies are assessing whether interferon alpha used in combination with ribavirin could help treat Covid-19 patients, the experts said.
Interferon alpha generally isn’t used to treat chronic infections like hepatitis because it can cause depression and flu-like symptoms, Gandhi said. However, it could be applied to short-lived infections like Covid-19 if the evidence warrants its use.
“It’s one thing to have flu-like symptoms and depression for a year, it’s another to have it for a week,” Gandhi said.
Nitazoxanide
This drug is approved by the US Food and Drug Administration to treat diarrhoea caused by Giardia parasites, and it has been found to also act against cryptosporidium parasites and some bacteria, Barlow and her colleagues said.
The medication could potentially inhibit the expression of proteins found on the surface of the Covid-19 coronavirus that allow the virus to invade human cells, Barlow said.
Nitazoxanide studies in the lab and with animals have shown that the drug can reduce infections of MERS and other coronaviruses. However, a study published late last year in the journal Clinical Infectious Diseases found the drug did not improve coronavirus patients’ outcomes.
“The history of medicine is just littered with things that looked good in test tubes or in animals, but don’t work well in humans,” Gandhi said of nitazoxanide.
Arbidol/favipiravir/baloxavir
These drugs, approved to treat flu in other nations, are being studied as emerging potential therapies for Covid-19, Barlow and her colleagues said.
Favipiravir is being tested in a clinical trial in the United States, Gandhi said, while other countries are testing the other drugs for their potential in fighting the new coronavirus.
The drugs all work by blocking either the virus’ ability to replicate or to enter human cells.
“That is an interesting drug,” Gandhi said of favipiravir. “I think it’s well worth studying.”
Health Minister Zweli Mkhize struck a defensive tone during a marathon press briefing on Tuesday night, dismissing criticism over early projection models, surveys showing support for the Covid-19 lockdown had waned and the arrival of more than 200 Cuban doctors this week.
“The issue is when we started with the lockdown we wanted to slow down the viral infection. To suddenly open without putting in place the necessary mechanisms for limiting the spread… if you just go back to normal, we are actually going to go to an early explosion, which means you can have a rebound of infections quite quickly,” he said.
Mkhize said modelling had shown that extending the lockdown further would not have a substantial benefit on pushing the peak infection curve further back.
“The nature of the spread of the infection has not stopped completely because of the lockdown,” he added.
“The fact that we are not seeing as many deaths as in the rest of the world, does not mean it cannot happen in South Africa… I think we need to take it a little more seriously,” he said.
He defended the decision to bring in more than 200 Cuban doctors, saying their expertise in community-wide health would be key in the coming weeks.
Mkhize also dismissed criticism of early modelling around the coronavirus spread that informed discussions over lockdown measures in the first days of the outbreak in South Africa.
News24 reported that these early projections were cast aside in mid-March, and a team was assembled to prepare new, updated models.
His words come as the country’s hard lockdown comes to an end this week, with a mild easing of some restrictions related to the economy to come into effect on Friday.
Scientists around the world and in SA are also now grappling with the question of how to accurately measure the impact of the disease, with widespread concurrence that reported and confirmed Covid-19 cases was likely far off the mark in terms of the reality on the ground.
In SA, as of Tuesday night, 4 996 cases were confirmed and a total of 185 497 tests conducted. Six million people had been screened by nationwide screening and testing programmes.
Three new deaths were recorded in the Western Cape, the new epicentre of the outbreak in the country, bringing the total death toll to 93.
But this reflects deaths from known, hospitalised Covid-19 cases.
Scientists globally are moving to a new method of tracking potential coronavirus deaths and are increasingly finding a much higher number of fatalities than what is being attributed to Covid-19 officially.
While these numbers reported by various publications in recent days show higher than expected death rates in countries such as the US and the UK, for South Africa, it’s too early to tell, according to at least one top scientist.
Local data shows that deaths in South Africa have dipped below expected numbers as a result of the lockdown – there are less road traffic accidents and murders. Natural deaths are also showing a downturn, but are generally tracking within expected bounds.
Early tracking of mortality rates related to natural causes in South Africa during the coronavirus outbreak. (Source – SAMRC/UCT Burden of Disease Research Unit Weekly Report of 20 April 2020) (Click to enlarge)
But it would be premature to draw any conclusions, according to Professor Tom Moultrie, an actuarial scientist based at the University of Cape Town.
“Watch this space,” he posted on Twitter on Tuesday.
Moultrie has consulted with the New York Times on its reporting of higher than expected death rates, and is part of the Burden of Disease Research Unit at the University of Cape Town and the South African Medical Research Council (SAMRC) to produce similar analysis of mortality in South Africa.
Deaths
While scientists try to calculate accurate infection rates around the world, there have been warnings that the reported mortality rates could be too low.
Professor Cheryl Cohen, the co-head of the Centre for Respiratory Diseases and Meningitis at the National Institute for Communicable Diseases previously told News24 that it was widely accepted that the confirmed number of cases was underreported.
This means there were many more cases existing than what was known at any given moment in time, including a high percentage of possible asymptomatic cases.
What the comparative percentages are, Cohen could not say, as too much remains unknown.
Some scientists are trying to get a better picture by taking the total number of reported deaths overall reported by citizen registry bodies such as the Department of Home Affairs, and comparing those with expected numbers based on years of mortality data.
Early tracking of mortality rates in South Africa during the coronavirus outbreak for natural deaths in persons over the age of 60, a particularly vulnerable group of the population. (Source – SAMRC/UCT Burden of Disease Research Unit Weekly Report of 20 April 2020) (Click to enlarge)
The Economist reported that mortality data collected by a group of epidemiologists under the name of EuroMOMO shows that there were 70 000 excess deaths more than expected between mid-March and mid-April.
The publication reported that in Italy and the Netherlands excess deaths tally double the official Covid-19 body count.
The Financial Times meanwhile reported that the global death toll could be as much as 60% higher than reported.
New tools
The SAMRC unit has built an analysis tool to provide insights into mortality data the SAMRC receives from the Department of Home Affairs on a monthly basis.
More recently, the data is being provided weekly – making more up to date analysis possible.
Mortality data can reveal this undercurrent of coronavirus impact. While it is not a scientific measure for coronavirus cases, it is a much clearer indicator of deaths during a local epidemic.
This is because a person who died does not necessarily need to have had Covid-19 for their death to be attributable to the virus.
An actuarial scientist who asked to remain anonymous as he is not authorised to speak with the media, explained to News24 that concern existed over the methods currently in use to measure cases of Covid-19.
Data published on an ongoing basis could be misleading, as many did not understand that it reflected infections from days prior to positive results and did not reflect absolute numbers of deaths.
In essence, he explained, there were four types of mortality that could be linked to Covid-19 – those who died directly as a result of the virus, as well as people who were not tested for Covid-19 prior to their deaths.
New York revised its death toll earlier this month to include a little more than 3 000 cases that had not been identified as Covid-19 cases prior to their deaths.
A third category were people who died as a result of other injuries but could not access healthcare because of hospitals being too full of Covid-19 patients, a scenario that did not yet apply to South Africa.
The fourth category were people who were already terminally ill and died during the outbreak, but whose deaths have no link to the coronavirus other than when they died.
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Production Supervisor – Bed Manufacturing Industry in Cape Town | Other General Employment | Job Mail | 4639604
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Are you currently a successful Supervisor in a production environment looking for a change of scenery?
My client, a well-established manufacturer of different categories of mattresses and bed bases, urgently needs an experienced and reliable Production Supervisor for their factory in Elsiesrivier. Specific duties include:
Supervise about 20 staff members to ensure optimum productivity
Check stock levels of raw materials daily and order when required
Maintain Occupational Health and Safety measures at all times
Ensure production targets are met according to orders received
Calculate prices, including VAT, and write out Invoices
Properly close the factory and set the alarm at the end of the day
You may be the successful candidate to lead the Production team to exceptional industry leading delivery times and consistent quality with every delivery if you have:
A proven track record (at least 5 years) in the Supervisory environment of a manufacturing concern. Experience with mattresses and bed bases will definitely count in your favour
Experience and knowledge of labour law procedures and disciplinary actions
At least Grade 12 with mathematics as subject. A relevant tertiary qualification from a recognised academic institution will count in your favour.
Basic skills to work with ease with MS Outlook, Word and Excel
Some technical know-how to understand the workings of manufacturing machines and equipment
The personality attributes, supervisory and technical skills typically associated with successful Factory / Production Supervisors.
BUTCHERY MANAGER – SOUTHERNWOOD EAST LONDON in East London | Other General Employment | Job Mail | 4677094
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in SOMERSET PARK, UMHLANGA, KWAZULU-NATAL, SOUTH AFRICA
3.5 BEDROOM SIMPLEX TO LET IN SOMERSET PARK
Listing Features
Listing Description
Bedrooms: 3.5
Bathrooms: 2.0
Building Size: 202
Erf Size 0
Garages: 2.0
Carports/Parking Bays: 1.0
Pool: Yes
Exterior Wall:
Domestic Accommodation: 0.0
Flatlet:
This beautiful unfurnished simplex is situated close to Gateway and all amenities. It has 2 spacious lounges and an open plan kitchen with a lovely outside patio with your own private sparkling splash pool. Small pets allowed with permission, 2 lock up garages plus 1 visitors parking in secure complex. Please take note that viewings can only be done after lockdown.
This 4 bedroom thatched roof property is well situated within River Lodge Estate. Large open plan dining and lounge area with a Family room. Nice size kitchen with stove. Own Pool and Lapa. 1 Garage. The Estate offers a communal pool, tennis courts, jetty, clubhouse and quad bike track.
