Johannesburg couple Anne von Gottberg and Cheryl Cohen are married, both mothers, as well as being medical doctors and scientists, and not only do they work together in the National Institute for Communicable Diseases (NICD), they work in the same unit; the Centre for Respiratory Diseases and Meningitis.
“We’re the pathogen specific experts,” says Cohen, who heads the centre, while Von Gottberg is in charge of the national reference laboratory for Covid-19 and other diseases, within the centre.
South Africa has the two scientists and their teams to thank for the country’s world-class surveillance of SARS-COV-2, which was predicated on the surveillance and research infrastructure that both spent years helping to develop for influenza, writes Sean Christie for Bhekisisa Centre for Health Journalism.
With other partners, their centre corroborated that in South Africa, non-communicable diseases like diabetes place individuals at higher risk from Covid-19, and that people living with HIV, particularly those who are not on treatment, are also more likely to fall very ill with Covid-19 or die of the disease.
Finding time for conversations with these public health powerhouse professors was not easy. Von Gottberg was in Paris to attend a World Health Organisation meningitis meeting at Institut Pasteur. And Cohen was preparing to travel to Belfast, to attend a conference on influenza and Covid-19.
“It’s getting busy again,” says Cohen, who explains that although the pandemic was “immense and emotional”, it had in many ways been good for their family, and for her.
She says: “I haven’t had to travel out of the country for two-and-a-half-years. In all of that time, I’ve put my children to sleep every night.” The couple has three children.
“Anne and I work closely together but with a different focus. I’ve always worked more on epidemiology – the data – and Anne is on the laboratory side,” she says.
Working with a partner has its disadvantages, Cohen adds, “but it also has advantages, and a big one is that we trust and can backstop each other. It’s what enables us to have busy professional lives as well as a rich family life.”
In 2021, in her inaugural lecture at Wits University, where she is an epidemiology professor at the school of public health, Cohen compared the 1918 Spanish influenza pandemic and the 2020 Covid-19 pandemic, pointing out that the interventions were almost identical. She presented century-old pictures of courts being held outdoors and people wearing masks in public transport.
“The study of virology was still in its infancy and yet they had the concept of social distancing. What nobody explored was the impact of those interventions on the economy, which were perhaps masked by World War 1. We need a proper accounting now of Covid-19, so that, come the next pandemic, even if the virus is new, we will know more about the interventions.”
Von Gottberg describes the concerning impact of South Africa’s load shedding at the NICD: “We run tests on machines that require electricity, which break down if they switch on and off too often. It has been a nightmare.”
Weighing more heavily on her mind, however, is the impact of Covid-19 on childhood vaccination services.
“Routine vaccine services bore the brunt of what happened in the past two-and-a-half-years… a consequence is the rise in vaccine-preventable diseases like pertussis and measles.
Polio is another vaccine-preventable disease that has appeared in southern Africa and will possibly soon appear in South Africa,” says Von Gottberg, who is the chair of the national advisory group on immunisation that advises the Minister of Health on vaccines.
The NICD has been urging people to return to vaccination centres, and although routine immunisations were well accepted before the pandemic, especially infant vaccinations, she’s concerned that the hesitancy related to SARS-COV-2 vaccinations will “crossover to routine vaccination services”.
She says: “I am not frightened of the community questioning us and arguing with us – an engaged community is a good thing – but we need to anticipate this and be better at hearing concerns and responding to them.”
A melding of cultures
On the history shading their relationship and sewn into their identities – a non-Jewish German and a Jew, and both white South Africans who lived through apartheid – Von Gottberg says: “It’s heavy, but good for us and our children. We have a duty of great carefulness and responsibility for actions now and in the future.”
She introduces the twin boys – nine-year-olds Daniel and Joshua, and Sarah, 12. Cohen, incidentally, carried all three children, and “loved being pregnant”.
Cohen’s mother was her inspiration for going into medicine. She grew up in Johannesburg and recalls that her mother, a generalist with an interest in infectious diseases, attended interesting ward rounds at Sizwe Tropical Diseases Hospital, then called Rietfontein. Von Gottberg, by contrast, grew up in mining towns like Carletonville and Welkom — where her father had worked as a geologist – and arrived in Johannesburg for the first time as a medical student.
Both went on to specialise in microbiology, and for similar reasons.
“It was the height of the HIV epidemic, and due to a lack of access to antiretrovirals there was little that clinicians could actually do for their patients. The public health system had its difficulties, too, making clinical medicine gruelling and emotionally difficult, and so I chose to enter the laboratory,” says Von Gottberg, who stayed very close to her specialisation.
Cohen also loved microbiology, and credits it with leading her into the deeply human enterprise of public health.
“Despite being lab-based, microbiology taught me the importance of the broader social context in determining, for example, how a disease spreads – contact patterns – and also how it can be successfully prevented,” says Cohen, who earned a master’s degree and a PhD in epidemiology, before moving into public health.
“Being a clinician, you are the product, and therefore constrained by how many patients you can see in a day, whereas in public health, you get to take a broad view and design and implement strategies with a hopefully beneficial impact for a large number of people, although on the flip side public health strategies can have unforeseen negative consequences, too,” she says, citing the 2021 National Income Dynamics Study — Coronavirus Rapid Mobile Survey (NIDS-CRAM), which found that the closure of schools during the COVID-19 led to more than half a million learners dropping out.
“Kids were disproportionately affected. Daniel and Josh learned to read during the pandemic period. If you happened to be six and lost two years of schooling … well, it’s not irretrievable but it requires a lot of energy and effort to make it up.”
“Oh boy, remember our caravan holiday?” asks Joshua, portentously. “Jungs wollt ihr euer Puzzle drinnen fertigmachen (You guys want to finish your puzzle indoors)?”, says Von Gottberg, who speaks German to the children, but the boys aren’t interested.
"What went wrong on the caravan holiday?” I goad.
“It started with Hogsback,” says Daniel, and between them the boys gave a breathless account of a recent family road trip, which traversed multiple provinces and entangled the Von Gottberg-Cohens and their hired caravan in many interesting situations, including a violent service delivery protest in the Eastern Cape, and a vehicular snafu on a perilous bridge in the Drakensberg.
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NICD analysis finds Omicron subvariant increases risk of reinfection
Increased risk of SARS-CoV-2 reinfection associated with Omicron — South African study
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