Tag: covid-19

Day 78 – Numbers

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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.

Day 75 – Epidemiologist expectations

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Here’s an interesting article in the New York Times (behind a “free” “paywall”, but summarised here for your ease of reading):

These are the personal opinions of a group of 511 epidemiologists and infectious disease specialists who were asked by The New York Times when they expect to resume 20 activities of daily life, assuming that the pandemic and the public health response to it unfold as they expect.

These are American epidemiologists, so their timelines will (and should!) be different to what our local experts might think – maybe we need to add two or three months to each of the timelines presented here. Additionally, it should be noted that their 3-12 month period includes a winter – that’s our “now”.

Important disclaimer:

Their answers are not guidelines for the public, and incorporate respondents’ individual life circumstances, risk tolerance and expectations about when there will be widespread testing, contact tracing, treatment and vaccination for Covid-19.

So yes, there are a lot of variables, assumptions and personal opinions in there, but even given that, there are still some interesting trends to look at.

The NYT has helpfully highlighted the most popular option in each case and assigned them to a “now”, “soon” or “much later” section.

Those first three are pretty clear cut, but the haircut has divided them, hasn’t it? And – as I think we are experiencing already in our everyday lives – it’s very much a case of wanting/needing to do something and then performing a mini mental risk/benefit assessment as to whether it’s worth doing.
Mail – something we want and need, limited risk – let’s go.
Doctor – something we need, possible risk, but yes, beneficial – ok.
Weekend break – definitely a want more than a need, potentially risky, but you can make a call on where you’re going and what precautions or safeguards are in place there and then choose based on that knowledge – could be safe.
Haircut – would be nice, but certainly won’t die without it, prolonged close personal contact – hmm, maybe not just yet.

Although:

For Robert A. Smith of the American Cancer Society, a haircut might be worth the risk: “It really is a trade-off between risky behavior and seeing yourself in the mirror with a mullet.”

Fair point.

And then there are the ones which are a bit further out:

‘Hiking with friends’ and ‘sending kids to school’ are interesting, given that some people are already doing the former in Cape Town and we’re all being told to do the latter. And yet (with that time difference mentioned above), the majority of the experts questioned here would be looking at ±6 months before they would consider either of them.

A lot of epidemiologists have a lot more faith in the safety of tubular aluminium petri dishes than I do. It’ll take a lot to get me flying again before there’s a vaccine and I’ve had it.

Another figure that sticks out here for me is the 4% who will never go back to exercising in a gym. Earlier in lockdown, someone (locally) said on twitter that they had realised just how easily they could manage without gym. At that point, I was really missing my time at gym, but the longer that time goes by, the less I feel I need it. Will I go back when I am allowed to? Performing that little risk assessment in my head, no, probably not. Obviously, I appreciate the benefits of it, but it is a properly high risk environment:

Surprise, surprise, the more energetic your breathing, the more virus you expel. So runners are the ones who are more likely to be spewing clouds of virus out.

Stick a lot of heavily-breathing, exercising individuals in an enclosed space and… well… you do the maths. It’s not pretty.

No thanks.

And then there are the things which used to be perfectly normal, but are now – and will remain for the next year, at least! – out of bounds for most of the respondents.

And yes, it seems that social contact is the major casualty of the pandemic. But then, were our learned friends doing it anyway? T. Christopher Bond from Bristol Myers Squibb states:

“Real epidemiologists don’t shake hands.”

Yeah. Us microbiologists aren’t big fans of the practice, either.

Masks work. Epidemiologists recognise this fact and most will be wearing them for the foreseeable future – probably until they have been vaccinated. Mere mortals should take notice of this. Look at that 7% in the first column (and add the 3 months) and understand how much a part of our daily lives masks are going to be for the rest of 2020 and probably most of 2021 as well.

And then the sporting event, concert or play. Sadly, these things are now a high risk luxury and I can’t see them coming back (safely) any time soon. Maybe not ever again in the way that we used to enjoy them before.

So what was your last concert or sporting event BTV, and will it be your last one ever?
I bet you weren’t thinking that way when you were there.

As mentioned above: this isn’t a scientific study, but it is a study of scientists and I think it provides a valuable insight into how the behaviour and the lives of the people in the know is going to change.

And if they are thinking that way, why should we feel that we know any better?

Day 74 – A tweet about Italy

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It’s weird.

We’re in the midst of a viral pandemic: one which has hit South Africa probably a couple of months after the country in which you might be reading this. (So I mean “now”). And yet, if it weren’t for the ongoing grumbling about not being able to buy cigarettes or inability to go to pubs and restaurants, you wouldn’t really know.

In Cape Town, people are meeting up with friends and family as if there’s nothing unusual going on. There are braais, walks, runs together – sometimes even with individuals in the well-publicised “vulnerable” demographics*. (Dafuq?!?) It looks like an entirely normal life, albeit one set against the backdrop of exponential infections, a struggling health service and a ever-steepening death rate.

And yet, the very first instruction in the Level 3 restrictions is:

You must remain at home at all times… 

It’s really not rocket surgery.

Social media is full of photos of people out and about with friends: sometimes masks on, sometimes masks off. But “it’s so uncomfortable to wear them all the time” and “you have to speak so loudly” and “it’s not like we’ve got the virus anyway” so I think that we can all guess what the situation is when the camera isn’t on.

What will it take for attitudes to change? Previously, I’ve guessed that it would be people being personally affected, but given the completely blasé approach from even well-educated, apparently intelligent people, I’m wondering if even that will have any effect.

So will attitudes change at all? Experience from other countries suggest that it would probably be a very good idea:

 

 

Sure, you can point to the numbers and the apparently extremely low chance you have of getting the virus, but remember that we’re so overwhelmed in Cape Town right now that we’re not even testing most people anymore (already a red flag, no?), and so you need to be aware that most local cases aren’t included in those figures anymore. And then there’s the “teeny tiny” death rate and the knowledge that most cases are mild, self-limiting, don’t kill you etc. I agree. It could give one an unfounded sense of security.

But in white SA, we’re (sadly) well used to other horrific health epidemics like TB and HIV, and those are problems which affect other cultures, not us**. We’re not used to having these problems in our houses and our immediate environs. So maybe this general indifference is because people think that this won’t affect them either.

Additionally, many of us are used to having decent private healthcare available whenever we need it via pricey health insurance packages. So maybe we need to have more than just numbers for “new positives” and “new deaths” each day. And since “didn’t die, but health was left so damaged that they’ll never be able to lead a normal life again” is a bit vague, maybe “available local hospital beds if you or one of your family gets sick” would be a good idea.

[Spoiler: Not very many right now. Likely even fewer tomorrow.]

Yes, yes, yes… I do recognise that I am banging my head against a wall. Shouting into the void. And I genuinely hope that you are not personally affected – whatever your behaviour over the lockdown period. But I don’t think that people understand how serious this is right now in our city, our province or our country. And I really don’t know how we change that.

 

* If you think this is about you, you’re probably right.

** I’m well aware that this is a gross oversimplification of a number of complex issues, but this post isn’t about them.

Day 68 – A return to…

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… lots of things.

But first:

Day 67 (as some beagle-eyed readers noted) was a bit of a non-event.

Sorry about that.

Thanks to some sterling and much-appreciated detective work by The Guru, it has been determined that the Jetpack plugin (the very one that informed me that the blog was down) was actually the one which was breaking it.

Sneaky little bastard.

Having re-installed it, it’s still behaving somewhat errantly, but now I know where to look if/when things go wrong, I think I can sort it out much more quickly than previously.

And there ends the technical stuff.

And thus, today marks a return to several things: the usual dross on the blog, school for some students (after the confusion over the weekend), the traditional South African sport of drinking and driving now that we’re (legally) allowed to buy alcohol again, and – for some morons – the idea that socialising is fine without taking any precautions.

The number of social media posts I saw yesterday with friends meeting up again for the first time in n weeks and then sitting right next to each other with no face masks in sight was… let’s say:”concerning”. But in reality the actual virus has almost completely slipped from the news headlines with the riots in the US and the new-found joy of buying beer taking its place.

And yet we find ourselves continuing on a very steep upward trajectory right now.

But it’s only going to get worse in the very near future. And I’m including all 4 provinces displayed here in that prediction. Just look at those telltale little upticks on the red lines, especially in the EC and Gauteng.

To be honest, since our progression to Level 3 was announced on the 13th and since Cyril decided that churches were fine to recongregate , the lockdown had become something of a sham for a lot of people anyway. Sadly, those events coincided neatly with the Western Cape case numbers moving into overdrive and they really haven’t helped at all in limiting the spread of the virus. (And let’s be honest, the situation is much worse than the numbers here indicate: there are plenty of people who have the virus who simply aren’t being tested because there simply aren’t enough tests available.)

We have to get over the hurdle of thinking that wearing masks when near family or friends implies that either we or they are ‘dirty’. The fact is that the virus isn’t discriminatory: it will infect anyone, and anyone can then transmit it to anyone else. We need to recognise that and we need to wear masks to protect everyone – not just ourselves, but also our friends and families and our communities.

To go and meet up with your mates in a park, at their house or wherever and to not socially-distance or cover your face right now is maybe mildly foolhardy in the UK, is tempting fate in SA and is downright dangerous and selfish in the Western Cape.

There’s plenty of it still happening though.

Sadly, I feel that it’s going to take people being personally affected by Covid-19 before that message starts to get through.
And – equally sadly – that’s very likely to happen, given the current local behaviour and attitudes.

Day 66, Part 2 – Pigs

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We (humans) are not the only ones in South Africa struggling with a virus problem.

There are now outbreaks of African Swine Fever in three provinces: Eastern Cape, the Free State and Mpumalanga. And so the Department of Agriculture, Land Reform and Rural Development (broad portfolio, bru) are advising that pigs are subjected to some of the same restrictions as humans to avoid the further spread of the virus:

There you have it.

Socially distance and self-isolate your pigs. Disinfect their surroundings regularly.

Keep them off beaches and out of National Parks. Ensure they wash their trotters for at least 30 seconds at a time. Don’t (or do) (or don’t) allow them to go back to school. Cook their food thoroughly.

Ensure they wear a mask and only exercise between 6-9am. Quarantine them where necessary. Only allow them to buy alcohol on Level 3. Keep them away from warthogs.

NEVER LET THEM SMOKE CIGARETTES.

Do not get them wet or feed them after midnight.

 

Right. I think that covers everything. Bring on the next viral pandemic.