Government and the health department have been given time to prepare for the “wildfire” of Covid-19, but it is going to have to do so with a notoriously underperforming public health system, creaking under the demand for services and battling with a lack of r…

On Sunday the government and the Department of Health were given time to prepare for the “wildfire” of Covid-19, but it is going to have to do so with a notoriously underperforming public health system, creaking under the demand for services and battling with a lack of resources, writes Pieter du Toit.
The New York Times led with a deeply reported story about the Unites States’ delayed and ultimately fatal response to the Covid-19 pandemic, setting out in detail how President Donald Trump fobbed off warnings and delayed any action to prevent its spread.
According to the report scientists and epidemiologists issued stern warnings about the spread of the virus since January, with senior government officials sounding the alarm directly with Trump at the end of that month – to no avail. Six weeks passed before Trump started to take the matter seriously and announced physical distancing measures.
By then, on 15 March, President Cyril Ramaphosa, with only 51 confirmed cased countrywide, had already announced a state of national disaster, convened an inter-ministerial and inter-disciplinary body, consisting of government and the scientific community, to plot a response to the growing crisis.
And during a media briefing on Monday night, it became clear exactly how comprehensive South Africa’s response has been.
Professor Salim Abdool Karim led the briefing. He is the chairperson of Health Minister Zweli Mkhize’s advisory group, which consists of four ministerial advisory committees, including committees on public health and epidemiology. It has 45 members, including 20 professors specialising in immunology and virology. The advisory group feeds into the Covid-19 National Command Council, chaired by Ramaphosa, which serves as the main advisory body to government.
Abdool Karim seems to know what he’s talking about. He occupies academic chairs at the universities of KwaZulu-Natal (where he obtained his degree in medicine alongside Mkhize), as well as Harvard, Columbia and Cornell. He is an expert in public health systems, immunology and infectious diseases.
SA’s infection curve is unique
During his presentation, which he conducted at a snappy pace, with good humour and great clarity, he explained how the advisory group went about unpacking the problem the novel coronavirus presented, how planning was done and how the different stages (stage one to eight) of the country’s response and the spread of the disease was mapped.
He also explained that South Africa’s infection curve is not following that of other countries, like the United States or Britain, and why it differs from countries like South Korea and Japan.
It is baffling, he explained, that our infection curve initially followed the same gradient, but then started to even out. And, the academic that he is, he offered three possible explanations: either we aren’t testing enough, or we aren’t testing widely enough, or it might really be that the infection rate is decreasing.
“We’re scaling up testing and we’re testing in every community, so it must be the third possibility… but we cannot definitively say that,” he offered.
Abdool Karim – who advised Mkhize during the height of KwaZulu-Natal’s fight against HIV/Aids when Mkhize was MEC – went through a series of graphs and statistics, explaining at which point infections starts to increase exponentially, and what that means.
He elaborated on the efforts to clamp down on infections, why currently most infections represent “a dead-end” for the virus, and the statistical analysis behind the daily average infection rate – and why it’s important.
And he sounded a warning about the coming winter and the extra burden the normal flu season will put on the health system.
“So, I have to tell you, as much has we have succeeded in stemming the flow of the virus in our communities, in keeping community transmission at a reasonably low level, I have to tell you a difficult truth,” he said as he flicked to slide number 17.
‘We cannot escape this epidemic’
“Can South Africa escape the worst of the epidemic? Is the exponential spread avoidable? The answer, sadly, is that it is very, very unlikely. Put simply: no, we cannot escape this epidemic.”
This is because “it is a completely new virus, there is no vaccine, we have no immunity and it affects white and black, old and young… everyone”.
And his and his colleagues’ major concern? “This will fundamentally be about access to healthcare,” he said, saying once community transmissions pick up it spreads like “wildfire”.
It was sobering, scary and necessary to hear the scientific reasoning behind government’s response to Covid-19. Although Ramaphosa and Mkhize have received praise for their management of the crisis, South Africans have not heard from its leading scientists since the virus became a full-blown crisis.
The country has, in the space of five weeks, gone from an open society to absolute lockdown, with the police and army on the street, its borders closed, airspace cleared and its economy shuttered.
Abdool Karim, alongside his colleagues professors Glenda Gray, Koleka Mlisana and Brian Williams, explained where we are, why we are here and where me might be headed. They did it based on hard science, numbers and statistics. It is the science that gives the political decisions credibility.
With the scientists providing the road map, it will be up to the politicians to make sure the country follows it. And our ruling political class have managed to make a mess of most things over the last decade.
Government and the Department of Dealth have been given time to prepare for the “wildfire” of Covid-19, but it is going to have to do so with a notoriously underperforming public health system, creaking under the demand for services and battling with a lack of resources. In the last budget, funding for the health department was slashed by R4 billion, with SAA getting R16.4 billion extra.
If anything, Covid-19 is going to expose government’s priorities and reveal the grim extent to which the Department of Health has suffered under corruption and poor governance over the past decade.
In the United States, the weakness of that country’s leadership might yet be saved by its infrastructure and ability to harness its resources.
In this country, our leadership’s early response might yet be scuppered by a decade’s lack of investment in the health system and decline in infrastructure.