Be prepared to ‘pump the brakes’ on social distancing

  • DanielIsrael
I remember receiving two WhatsApp videos eight weeks ago. The first was a video of an horrific animal market in a city I had never encountered in Wuhan, China. The amateur footage of snakes and bats being eaten alive was bantered about, which “justified” the second video of random Chinese citizens dropping dead from a new disease called coronavirus.
by DR DANIEL ISRAEL | Apr 02, 2020

“If you eat live creatures, that’s what will happen to you,” one of my patients remarked. There was little concern though. These events were all only in “Wuhan”, an exotic place governed by a strange government and a different reality, unrelated to real life in Johannesburg.

Today, eight weeks later, I carefully use my elbows to open my office door in a quick dash from my practice to my car. It’s home time, the end of another day of frantic calls about chesty symptoms. My goal has been to differentiate the common anxiety-stricken from the occasional real patient.

Over this short period of time, 775 748 people in more than 150 countries have contracted the SARS-COV-2 virus. A total of 37 109 people have died from the disease, COVID-19, that it causes. Beyond the statistics, worldwide economies have plummeted, unemployment rates have soared, and healthcare systems have crashed. At home in South Africa, the rand has hit its lowest value, air travel has been stopped altogether, and all South African borders are closed.

So how will this unprecedented crisis end?

Pandemics only have three possible endings. The first is that all countries are able to isolate and trace their cases, and bring the disease to heel, as in the case of SARS 2003. However, given the spread of the corona pandemic, this endpoint is unlikely.

The second possibility is “herd immunity”. This is the resistance developed to a contagious disease when enough people have become immune to it. Considering the contagiousness of coronavirus, two thirds of the world’s population would need to be infected to act as a firebreak and stop this virus. The United Kingdom initially advocated a herd immunity approach, and then backtracked in view of its dire consequences and the expected loss of human life.

The third is vaccination. Vaccination is 12-18 months away. Let’s explore why. Two weeks ago, the United States National Institute of Health already started its first clinical testing phase of a coronavirus vaccine. That’s a world record of only 63 days from typing the viral genome to injecting vaccine material into someone’s arm. But this is only the first step. The next challenge will be to determine effectiveness, measure whether the vaccine causes disease, determine the effective dose, and then to orchestrate mass production and distribution. This takes 18 months minimum.

So what in the meantime?

By implementing social distancing, we are preventing the population from being exposed to this potentially serious disease. We are “buying” time to develop a vaccine. Fewer new cases over time (a “flattened curve”) mean fewer critical cases in general, and fewer deaths.

Realistically, this is a far longer process than 21 days. We need to protect the capacity of our healthcare system. However, a full year of social isolation would break our society, both economically and spiritually. “The only way not to overwhelm the critical-care capacity of hospitals is to ‘pump the brakes’,” says Brenda Goodman, writing for medical website Medscape. She is correct, and she is referring to intermittently tightening and relaxing social isolation in the future, similar to pumping the brakes to get a skidding vehicle to stop. These ebbs and flows in social distancing may be the picture on our horizon for some time.

What to expect in the short run? South Africa is behind in testing. As of 30 March 2020, there are 1 326 positive coronavirus cases in South Africa, and there are many more positive untested cases. Testing is pivotal to track the disease. As testing becomes more widely available, the numbers will spike drastically. Testing will raise numbers far quicker than social distancing will drop them. We can expect the news to look much worse before it looks much better.

But in spite of the reports you will hear of thousands of increased cases, and in spite of the deaths that will inevitably occur in our limited healthcare system, the preventative interventions will prevail. Thousands of lives will be saved. I believe regular daily life will ensue, and COVID-19 will become a manageable seasonal “flu”.

When SARS-COV-3 hits one day, the world will be far better prepared.

  • Dr Daniel Israel is a family medical practitioner, who has been practicing for several years in Johannesburg.


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