Day 78 – Numbers

Just a quick one here from me today, because there’s really not much that can be said or done about the situation we find ourselves in now, but I probably want to record it here so that when I look back on these crazy times, I can nod sagely and note that I recorded the situation here.

To call them a network of spies would be a bit over the top, but I have a number of people with whom I am in regular (electronic) contact, and who work in labs, clinics, hospitals and the like around Cape Town.

And none of them are saying that things are going well at the moment.

In fact, it seems that things are completely out of control.

While we are watching all of the Covid-19 numbers going through the metaphorical roof here, it would appear that it is far from the whole story.

People who have Covid-19 are not being tested: I’m hearing this from everyone, everywhere.

One individual working at a City clinic has told me that she estimates that only 1 in every 20 patients presenting there with Covid-19 symptoms is being tested for the disease at the moment. Only patients with proven co-morbidities and those over the age of 55 are eligible for testing. I’ve mentioned these “new” rules before in this post, but I didn’t know about the numbers that are being affected by these guidelines (put in place because there aren’t enough test kits to go around).

Let’s break for a few quick points here.

Firstly, this is only one person’s estimation at one clinic. But it’s a story I have heard often, and she’s experienced, she knows what she’s about and she is really not prone to exaggeration.
But sure, it is just her view at one clinic.

Secondly, there’s nothing wrong with assessing people clinically.

Doctors diagnosing TB have been doing clinical diagnoses at City clinics for ages, but with one notable difference – they test at the same time. The test result takes n days to come back, but the doctors, having seen what TB looks like in thousands of patients each year, know exactly what TB looks like, and can get the patient on treatment n days earlier than if they’d waited for the result. These days, n is much lower than it used to be, so it makes less of a difference, but I’m sure it’s saved a lot of infections and a lot of lives over the years.
But importantly, the reported number of TB patients remains accurate, because the TB test is done and recorded. (Ironically, Covid-19 will have a huge detrimental effect on the accuracy of the reported TB numbers for 2020, because patients aren’t turning up to clinics for testing and treatment, but that’s another story.)

Patients who present with clinical Covid-19 but don’t make the grade for testing are sent home and told to isolate for 14 days. That’s the same advice they would have been given if they had tested positive. So no change there.
But they won’t be counted as a positive, even though they almost certainly are, because we get our numbers from tests conducted, not patients seen and they were seen, but they weren’t tested.

Do they isolate? Hopefully, but maybe not.
Do they infect (or have they infected) other people who also can’t get tested? Likely, yes.
Do those people get counted as positives? No.
Do any of them die? Maybe. Probably.
If they do, are they counted as a Covid-19 death? Almost certainly not.

So when Covid-19 tests aren’t being done, we can’t rely on the numbers we’re seeing to make any informed decisions. But as I’ve said, the only important inference we can draw from this is that we’re completely overwhelmed, so there’s literally nothing more that can be done anyway, and we are all very well aware of that.

Thirdly, when you know that you’re not going to be tested, you don’t even present at the clinic. You’re feeling crap and you don’t want to hang around for hours in the cold for nothing. So essentially, that 5% that is being tested and which is the tip of the iceberg, is actually 5% of another tip of another iceberg.

Look, however you choose to view this, the upshot here is that we are far, far worse off than the official figures are – or ever will be – able to tell us. 

The system is so overwhelmed that it can’t tell us just how overwhelmed it is.

And we’ll probably never be able to prove this or say exactly how much worse off we actually are, which is irritating because in the future some people will suggest that this whole thing was a lot less severe than it actually was, and more seriously, we’ll not be able to learn important lessons which we would have used to set us up better to deal with the next viral pandemic.

South Africa is at a Covid-19 crossroads, and none of the roads are looking like good options right now.

Ironically, metaphorically and literally just staying right where we are might be our best option. Limiting the spread of the virus – especially at the time we are seeing the highest rate of infections ever – is hugely important.

If you can: Stay home, stay safe, make a difference. Please.

Images snipped from here.