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Be your own president, and lock yourself down to level 5




If you struggled to imagine what was going on in Wuhan in March 2020 as I did at the time, June Gauteng 2021 is your opportunity to vicariously relive that situation. An unexplored virus. Disproportionate loss and grief. Draconian – and now not so draconian – measures of hospital isolation of the seriously ill and those home bound with infection.

The 16 months that have passed since the Wuhan fiasco, the initial knee-jerk lockdown, and the economic devastation have disempowered our authorities from implementing harsh enough measures at this sensitive time in Gauteng.

Let me share a few insights as to how rampant COVID-19 is in Gauteng at the moment. My own family medicine practice has diagnosed an excess of 20 cases a day this past week. Each patient requires a careful explanation about appropriate medication, warning signs of deterioration and, most importantly, contact tracing in a desperate attempt to curtail further spread.

Every day, our doctors admit at least one or two patients who simply aren’t coping at home. However, admission is no longer a golden bullet. Patients are often admitted via casualty, where they wait five or six hours for the availability of a normal bed. The fortunate patients who receive direct admission from home to a ward are the select few who manage to access limited hospital resources. However, being one in a hundred patients admitted with COVID-19 at a hospital like Netcare Linksfield Hospital is far from ideal. Provincial statistics are showing that 20% to 25% of admitted patients require critical-care beds. These beds are full.

Surely these problems affect only “other” people? I will let you decide. Last week, I admitted a 37-year-old man who isn’t overweight and has no comorbidities. He has now spent a week in a top facility, his oxygenation progressing from nasal oxygen, to a high-flow system, to non-invasive CPAP (constant positive airway pressure), to a full ventilator. His prognosis is guarded. Like yours, my Facebook feed is flooded with people sharing their pain about loved ones succumbing to this virus at an untimely stage in their lives.

I’m not a pessimist, and I do see various solutions. However, in the eye of a storm, we don’t go sunbathing. We have to be our own president and lock down our social lives to level 5.

I’m not concerned about risk and exposure in parks, zoos, or beaches. I’m not significantly concerned about the risk from disciplined visits to controlled institutions, with formal interactions, such as bank appointments, doctor appointments, cautious visits to quiet shops, and the like. At these monitored times, masks are worn, hands are cleaned, and distances are kept.

I’m deeply concerned about all of us who exercise the nth degree of caution in the examples above and then have our siblings over for a Sunday afternoon lunch because “they’re definitely also being as safe as we are”. This is how the vast majority of COVID-19 patients in my practice have become infected.

I’m the first proponent of relaxing restrictions wherever possible. We are all discouraged by this lockdown existence that has owned us for longer than we can clearly remember. My commitment is to encourage people to live normally as much as possible, but at the appropriate times. However, now isn’t that time. We need to be smarter than our government, and pull in the reins over this surge, which is projected to peak in two to three weeks. We certainly understand that in the longer term, children need human interaction and businesses need to operate. But, more importantly, patients requiring oxygen need supplies now.

President Cyril Ramaphosa, please notch up our province similarly, just for a short time, and urgently open our vaccine rollout to younger, healthier individuals who are also at risk. Empty vaccine halls don’t save lives. Big business in South Africa is ready to be given the license to procure vaccines in parallel.

Finally, let me remind you that waves end, vaccines work, and COVID-19 will certainly pass. Keep your head up. Be your own president.

  • Dr Daniel Israel is a family practitioner in Johannesburg.

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  1. Deanna Isaacs

    Jun 24, 2021 at 11:03 am

    Thank you for your wise words I have friends who just don’t understand what lockdown means and “only just went for a small party with family”


    Jun 24, 2021 at 12:24 pm

    This is a brilliant article, succinctly and eloquently written.
    Thankyou for sharing your insights and wisdom
    And mostly for your massive input during these challenging times.

  3. John H Abeles MD

    Jun 24, 2021 at 1:00 pm

    Prophylaxis and early treatment using the Zelenko or Borodny protocols wound greatly reduce illness and hospitalization

  4. Toni Rowland

    Jun 24, 2021 at 5:11 pm

    What is your view of Ivermectin?

  5. Soula

    Jun 25, 2021 at 6:44 am

    Thank you Daniel! Truer words never spoken.

  6. Judith Shopley

    Jun 25, 2021 at 1:31 pm

    A sane and informative expose of the facts. I “enjoy” reading Daniels articles. I wondered about the other and I thought it might be ‘an other’ who still go for crowd events.

  7. Margaret

    Jun 25, 2021 at 2:41 pm

    I live in Canada (the province of Alberta) but read about the situation in Gauteng because I have close family there. In April and May we experienced a terrifying third wave, and at one point our per-capita numbers were higher than India which was in a hellish situation. As vaccinations increased the situation improved so much so, that next week ALL restrictions are being lifted including mask-wearing which we have been doing for over a year. We have hit 70%+ of first vaccinations, but still have a way to go and people to convince. Good luck Gauteng!

  8. Eva Gush

    Jun 26, 2021 at 6:38 am

    What a helpful article to highlight what is actually happening on the ground right now… people of all ages are getting infected and the health system in Gauteng is overburdened….
    The reference to family and friend visits over weekends is also very helpful, as we mostly tend to think these are okay…
    And then as a final point, your note around this too shall pass….
    But for the next few weeks, the call to be our own president and personally lock down as much as possible…
    Thank you Dr Israel for this article and for supporting so many people and families…
    Wishing you, your practice and all your medical colleagues strength in this difficult time….

  9. Phillip Shifren

    Jun 27, 2021 at 1:54 pm

    Well spoken. Many people are taking note and acting accordingly. However, these are the few sensible ones. If only more people will follow the rules and impose a self induced level 5 lockdown, we can contribute to alleviate suffering and heartbreak. Forego freedom of movement now and we will be rewarded with enjoyment and fulfilment later.

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Safe socialising saves lives



The overarching emotion that signified the outbreak of the COVID-19 pandemic was fear. I remember a palpable fear that permeated the community before the first case on our shores, and months before it had to grapple with the overwhelming grief from COVID-19 that would follow.

The fear extended far beyond our encapsulated, almost self-governed community that holds the value of life supreme. Throughout the world, social media warned of the risks of doing almost anything in light of the unknown entity of COVID-19 that had hit the world.

In contrast, 20 months later, we are scampering about – albeit still with some trepidation – trying to recover from the immeasurable social losses we have all experienced. In fact, there are many who are so cognitive of these losses that they have nullified all fear of COVID-19 whatsoever, and have swung to diametrical behavioural extremes just to “get life back to normal now”.

This is a controversial article – probably one of my more controversial articles – because it makes a case for socialising, celebrating, and physically meeting up with loved ones at this stage of the pandemic in South Africa.

The controversy is that as a medical professional who has previously insisted that people “lock themselves down at level 5 and become their own president” is now seemingly advocating the opposite. The controversy is really a fallacy, and by understanding that the COVID-19 pandemic is fluid and requires a constant weigh-up of risks, we can understand why.

Let’s examine the option of remaining completely socially isolated until this pandemic is over.

A study conducted by the Human Sciences Research Council reported in October 2020 that 33% of South Africans were depressed, while 45% were fearful, and 29% were experiencing loneliness during the first lockdown period.

These statistics are significant, and since then, we have endured two far larger peaks of infection. Not a day goes by that my practice doesn’t diagnose a new case of depression caused by the social and economic effects of lockdown or social distancing.

Grandparents are missing out on the opportunity of shaping their grandchildren’s development. The elderly are spending the last years of their lives isolated. Young adults are struggling to find suitable life companions. Children are growing up fearful of the world, and previously successful business people have had their self-esteem crushed as they continue to tread water in survival mode.

The real challenge over this pandemic is to re-evaluate the balance of risk and decide on the safer route, repeatedly. With the reproductive number of COVID-19 well below 1 currently, and with the successful vaccination of a high percentage of individuals in community “bubbles”, we need to understand that the personal risk of not getting out there and socialising is greater than the risk of serious disease imposed on vaccinated communites by COVID-19 at the moment.

I recently encountered a personal dilemma in this space. My elder daughter turned 12, and in an observant Jewish family, her Batmitzvah was a big deal to us. This was our opportunity to mark and celebrate the momentous occasion of her becoming a responsible Jewish woman.

After balancing the gains of a celebration against its risks, I decided to allow her to have a full function, but I ensured that we remained focused on the important details that ensure that such celebrations don’t become super-spreader events. This focus is vital to keep the decision to celebrate sound.

There’s no reason to host an indoor function if wonderful outdoor alternatives exist. Ventilation is probably the single most important factor to prevent COVID-19 spread. Masks are still vital: particularly in close person-to-person contact. Temperature screening alone has shown to be ineffective, but imploring individuals who are feeling under the weather not to attend is important.

Consuming food and alcohol – which necessitate mask removal – only in good open spaces and with distance between people is a must.

If this reduced-risk approach to hosting a function is so simple, why haven’t we been holding such celebrations for months? The answer certainly lies in one word: vaccination.

Vaccination is the only intervention that has changed our risk balance. It’s now known that vaccination doesn’t stop infection or spread, but it certainly drastically reduces both COVID-19 incidence and its spread – by at least 50%.

More importantly, vaccination undeniably prevents people from becoming significantly ill. This point is the game-changer.

Last week, a study of 50 000 COVID-19 deaths in the United Kingdom demonstrated that only 640 of the deceased had been vaccinated. That’s only 1.28%. This week, Momentum, a South African financial services provider, released statistics that over the past two months only 2% of its COVID-19 death claims were in vaccinated individuals. There are many such congruent data sets from all across the world.

It’s time to realise that we’re in a different phase of this pandemic. Get out there, or risk the long-term damage of not doing so. But ensure that you are vaccinated and still well-focused on the measures that reduce the spread of COVID-19.

There may be a time in the near future when the balance of factors will necessitate staying home strictly again. But now is the time to smell the spring air with your safe friends. It smells good.

  • Dr Daniel Israel is a family practitioner in Johannesburg.

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In the race against COVID-19, vaccination just the first lap



About 200 years ago, the Torah giant, the Tiferet Yisrael (Rabbi Israel Lifshitz – 1782 to 1860) exhorted his followers to be vaccinated against smallpox. The sage was meticulous in fulfilling the mitzvah aseh (positive commandment) of the obligation to avoid the much greater threat to life posed by the disease even if the vaccine itself was far from harmless. In those years, smallpox vaccination was a rather hazardous procedure coming with a mortality of close to 1:1000.

It has been ascribed to the Tiferet Yisrael that he drew up a list of non-Jews who ought to be credited with olam habah (a future in the world to come). Top of his list he put the chosid, Yenner, (Edward Jenner) who developed the first human vaccine against smallpox at the close of the 18th century which saved millions of lives down the years. About 200 years later, that virus was eradicated from the planet by global vaccination.

So, where are we now with our present pandemic – the COVID-19 pandemic? What could the future light at the end of the tunnel look like?

Our current travails with the COVID-19 pandemic are due to a new virus, SARS-Cov-2, introduced into the human population just less than a couple of years back. This is a new pandemic, against which new vaccines were developed at an unprecedented breakneck speed to prevent the resulting new disease. It was a triumph of advanced modern science to develop new vaccines within a year of discovering the causative virus in order to address this formidable new pandemic with urgency. Technologies were employed which had never previously been used for human vaccines. To add to this bewildering mix came the internet and pervasive social media – valuable tools for disseminating important public-health messages, but an equally sinister vehicle for spewing misinformation, conspiracies, and mistrust and, in no small measure, contributing to confusion, anxiety, and, unfortunately, vaccine hesitancy.

So, where do we stand on the eve of Rosh Hashanah 5782 (2021) in controlling the COVID-19 pandemic? As of 24 August (by the time you read this these figures will be quite a bit higher) more than eleven million doses of vaccine have been administered in South Africa with more than 21% of the adult population being vaccinated. Even now, the effectiveness of the vaccination programme is starting to be felt with a small, yet significant, reduction in serious COVID-19 disease and hospitalisation in the country.

What is our expectation for controlling the pandemic with vaccination? It’s interesting that when we look back at the earlier days of the pandemic last year, the scientific community thought that the SARS-Cov-2 virus was as menacing as any new pandemic was feared to be, but that it would turn out to be no more complicated than measles or polio to combat and conquer. We hoped, as with measles and polio, that it wouldn’t take long to develop an effective vaccine to conquer this newcomer.

But that was before the virus uncannily demonstrated its ability to mutate and generate new variants which could escape the protection afforded by vaccination. In turn, the Beta variant arrived, which was relatively resistant to vaccines, and after that, the highly contagious Delta variant, which is now also flexing its muscles for vaccine escape.

Common wisdom dictates that infectious diseases can be combatted in four phases. Phase one is the phase of containment. In this phase, the main damage caused by the offending infectious agent is brought under control. In the case of COVID-19, this is the phase reached by Western developed countries. High vaccine coverage has drastically reduced severe disease which, in the pre-vaccination era, resulted in wealthy countries being brought to their knees and unable to cope with the overwhelming number of critically ill patients, and mortuaries unable to keep pace with burying the dead. But, in spite of extensive vaccination campaigns, infection and illness still persist to a worrying degree. Fortunately, in the majority of cases, illness is mild. Where preventive measures are relaxed, as prematurely occurred in many countries such as Israel, the United States, and several European countries, there have been significant flare-ups. Most public-health authorities would accept this to be an interim phase, as restrictive measures still need to be in place to prevent epidemic waves of illness flaring up.

Only in a future phase two, the phase of control, may we contemplate returning to a pre-COVID-19 life. To enter into this phase, a second generation of advanced vaccines would have to be developed. They would need to provide more effective and durable immunity, be able to be effective against any new variants, and also be able to reduce transmission markedly from infected vaccinated persons. For the latter, the new vaccines will need to effect good immunity in the upper respiratory tract – mucosal immunity. There is, indeed, intensive research into developing this next generation of vaccines. In this phase, restrictions may be relaxed to the point of returning to our pre-2020 lifestyle. Infection and illness won’t totally disappear, but it will be at a tolerable level – perhaps much like the common cold or flu we all accept every winter season.

Phase three, the elimination phase, has been reached with a number of vaccine-preventable diseases. In this phase, infection and illness no longer occur in many parts of the world because of successful vaccination campaigns, although it remains present in other regions of the globe. Examples are polio, measles, and a number of other childhood infections. This phase cannot yet be contemplated for COVID-19. Our best expectation would be to enter into phase two, the control phase.

The ultimate phase four, the eradication phase, has been achieved only with one infectious disease – smallpox. About two centuries after the chosid, Jenner, invented the smallpox vaccine, and following unprecedented vaccination campaigns in every corner of the world, the disease and the virus were finally eradicated in 1980, and the virus formally declared to have been purged from the planet.

Meanwhile, let’s try make the present phase, phase one of COVID-19, as successful as possible. Get vaccinated, and continue to maintain all infection-prevention measures religiously so that we can safely look forward to phase two – maybe some time next year?

  • Barry Schoub is the chairperson of the Ministerial Advisory Committee on COVID-19 Vaccines. He is professor emeritus of virology at the University of the Witwatersrand, and was the founding director of the National Institute for Communicable Diseases. He writes in his personal capacity.

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US withdrawal from Afghanistan – winners and losers



The Taliban had a famous saying, “You have the fancy watches, but we have the time.” With this cryptic line perhaps summarising the reason for the failure of the United States (US) in Afghanistan, it’s important to analyse the winners and losers from the US’s chaotic withdrawal.

It must be said, to begin with, that the Middle East as a whole is the loser. One of the main reasons that the US decided to pull out of Afghanistan is to be able to better focus its resources on those who it perceives to be a far bigger threat, namely Russia and China.

This pull out is all part of the US’s strategic pivot to Asia. Add to this the fact that the US no longer needs the Middle East’s oil, and it’s clear that the US is fast losing interest in the whole region. While some might rejoice, there is no doubt that the region will be worse off for the US’s absence.

Having the US involved in the Middle East, for all its failures and errors, still helps to maintain a semblance of stability in that chaotic region. With the US gone, other actors will step into the breach, and it’s likely that they will favour power and might over any rules-based system. Long term, this won’t be to the region’s benefit.

Russia, China, Iran, and Turkey – the region’s big powers – are no doubt enjoying seeing the US get a bloody nose, and know that seeing the US depart the region allows them automatically to increase their power and influence by default. However, behind the scenes, they are all also well aware that they don’t benefit from more instability in the region.

Iran and China border Afghanistan, and Russia and Turkey are close enough to feel any rise in fundamentalism in the country. All four countries are keeping relations with the Taliban open to try to ensure that their interests are protected.

They will be watching developments unfold in the country with a fair amount of anxiety. China, in particular, has relied on the US defence umbrella in the Middle East to secure the flow of energy and much of its trade, and unless it’s prepared to take a more active role militarily, will actually miss the US’s presence.

Israel and the Gulf states will be very concerned. The US withdrawal shows them again how unpredictable the US is as an ally, as its international policies and commitments are liable to change as the political winds change back home.

With the US showing an increasing lack of interest in being involved in the Middle East, the shadow of the Iranian threat looms large, and they know that they will in all likelihood be left to their own devices to counter this. They also know that the US doesn’t have the stomach any more for long, drawn out campaigns, which is preciously what the Middle East requires. Israel, in particular, will be watching for three key developments:

1.    Will the US stay in Iraq? If the US leaves Iraq, then it will be well and truly showing its lack of any interest in the Middle East. At least if it keeps its small force in Iraq it will have some active interest in the region. (Apart from passive bases in the Gulf states and a very small force in Syria.)

2.    Will this foreign policy debacle make President Joe Biden more reluctant to do a deal with Iran? This might well be the one unintended positive result for Israel from the Afghanistan debacle. Biden cannot afford another foreign policy failure, and this will mean he will most likely push harder for the “longer and stronger” nuclear deal we have been hearing so much about from the US side. The nuclear deal isn’t likely to be agreed to in a hurry, and the US is likely to toughen its position.

3.    How will the Gulf states react? The Gulf states must now surely realise – if they didn’t know this already – that the US wants to disengage as much as possible from the Middle East, which leaves them to deal with Iran without their “big brother” in the forefront. While the US would probably assist them if they were invaded, it’s unlikely to get involved for anything less than that. The Gulf states can, as a response, react to this in two different ways. Either they can enter into a detente with Iran and de-escalate tensions, or they can draw closer to Israel, the only power in the region they can rely on. This second option would probably mean the Saudis would at last open diplomatic relations with Israel. It remains to be seen which option they will choose, but either way, they won’t want to make a decision too hastily but rather carefully weigh up their options. Israel will be watching their next move with great apprehension, but again, this could end up in a significant gain for Israel, although it’s by no means as certain as point two.

Although the US has had an embarrassing failure in Afghanistan, international geopolitics is seldom binary. In other words, just because the US has lost doesn’t mean everyone else has necessarily gained. Only when it becomes clear where the nuclear deal is going and on which side the Gulf states will fall, will it become clearer which countries have shown a net gain or loss.

Events in the Middle East are complex and often turn out in totally counter intuitive and unpredictable ways. Many experts and commentators might find they have passed judgement on this one a bit prematurely.

  • Harry Joffe is a Johannesburg tax and trust attorney.

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