South Africa leads the continent in many ways and right now it is poised to lead Africa into the next, most dangerous phase of the pandemic, as the country braces itself for a dramatic rise in infections that will almost certainly overwhelm its relatively well-resourced healthcare system, writes Andrew Harding of BBC News.
He says there are eight things it can teach the rest of Africa:
1) Keep the tea rooms clean – Instead of wasting time and money – as many experts now see it – on acquiring expensive but relatively ineffective ventilators, the evidence from South African hospitals already grappling with the virus points to the need for vastly improved hygiene protocols.
2) Fast tests – or no tests – the article says after a promising start, South Africa is now struggling, woefully, with its testing. "Currently the turnaround time for COVID tests is around 14 days in most places, so that basically means it's a complete waste of time," said Dr Tom Boyles, an infectious disease specialist in Johannesburg. The same concerns apply to South Africa's much-hailed community screening and testing programme which, experts say, has outlived its usefulness, since the virus has now spread far beyond the capacity of the country's large team of community health workers to track with any effectiveness.
3) It is not old age, it is obesity – the report says much has been made of the fact that Africa has an unusually young population, and, indeed, that may yet help to mitigate the impact of the virus here. But the evidence from several South African hospitals already suggests that alarmingly high levels of obesity – along with hypertension and diabetes – in younger COVID-19 patients are linked to many fatalities. Two-thirds of coronavirus deaths in South Africa so far are among people aged under 65, according to Professor Shabir Madhi, a prominent vaccine expert. "Obesity is a big issue, along with hypertension and diabetes," he said.
4) Exposure isn't always exposure – "there needs to be clear guidance on what sort exposure is significant. We have not adequately demystified this virus," said Madhi, who stressed that a person needed to spend 15 minutes or more in close proximity to a confirmed case to be considered at serious risk of infection. Unions have been understandably robust in seeking to protect their members and to raise concerns where personal protection equipment (PPE) has been lacking. But, the report quotes several medical workers as saying that tougher discipline was needed to enforce hygiene protocols among staff – along with better education and training about managing risk.
5) The devil is in the detail – South Africa has announced that religious groups could resume worship in gatherings of no more than 50 people – the move, the report says a clearly political concession by a government under pressure to ease lockdown restrictions and that understands that to retain public trust over the longer-term it must show signs of give and take. But the decision carries significant risks.
6) Winning the peace – the report says the blame game will be a brutal one across the continent. Will the power of incumbency – such an important factor in African politics and beyond – prove to be a strength or a weakness with COVID-19?
7) Bring the public with you – When South Africa banned the sale of alcohol during the lockdown, many people accepted it as a harsh, but perhaps necessary step to limit domestic abuse, prevent violence, and thus keep hospital beds free for coronavirus patients. But in tandem with the alcohol ban, South Africa put a stop to all cigarettes sales too. The report says the ban is playing into the hands of powerful criminal syndicates controlling contraband cigarettes, and is costing the government a fortune in lost tax revenues. But perhaps more importantly, it is undermining the credibility of the lockdown regulations themselves – making compliance, as the country moves to ease some restrictions on movement, less likely.
8) Keeping it simple – Countries need to plan according to their limited resources. "The investment in ventilators was a huge waste," said Madhi, who, like colleagues in Cape Town, stressed the importance of high-flow nasal oxygen machines that work more efficiently than more traditional oxygen masks.
The report says the principal of looking for simpler solutions applies to staffing too, with many doctors urging the health authorities to focus on bringing final-year medical students, and perhaps retired staff, into an overstretched system, rather than importing expensive foreign doctors from places like Cuba.
[link url="https://www.bbc.com/news/world-africa-52835160"]Full BBC News report[/link]