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Second wave like a tsunami

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OP-EDS

We have emerged from the eye of the storm to confront a second wave that is significantly worse than we anticipated. It feels like a tsunami.

Once again, SARS CoV2 has proven to be unpredictable, and has mutated to a new strain which is more contagious, involves a higher number of people, and is less discriminating. We have easily slid back into our roles in a well-remembered dance.

Once again, we are working long hours and spending a lot of time on our feet. Stress levels are very high again, and there is a constant feeling of anxiety as one waits for the next crisis.

Last time, the patients were older, and it was easier to be more philosophical in accepting their deaths. In a complete deviation from pattern, this wave of COVID-19 has affected younger people to a much greater extent. They are often younger than us, and we all know a lot of people who have COVID-19.

As with the first wave, there are more men in hospital than women, with 60% of the patients being male and 40% female. This time, however, all population groups seem to be represented.

When looking at intensive-care units (ICUs), which are a critical resource under huge pressure, it’s startlingly obvious that not only have we had to accommodate more patients in ICU, but that they are significantly younger and much sicker this time. Fifty percent of the ICU cohort are under the age of 60, and 80% are on more than usual oxygen therapy.

Our ICU is full, and we are using all our ventilators for one form of ventilatory support or another. It is a surreal experience to look around and see the vast majority of our patients with masks of various shapes and sizes strapped tightly to their faces in an attempt to keep their blood oxygen levels adequate. It’s difficult to communicate, and all one sees are the eyes looking at you with fear, anxiety, distress, and sometimes calm acceptance.

The mood is sombre, and there’s little humour this time around. Patients with comorbidities still raise a red flag in that they are more likely to have severe COVID-19 with a higher mortality rate, but this time around, there are significant numbers of young, fit, healthy individuals with no comorbidities who are desperately ill. The staff are more fearful because of this. After all, you can’t allay your anxiety by listing the patient’s comorbidities which have resulted in severe COVID-19 if there are none.

Another unique feature is the number of young individuals presenting with severe cardiac disease that has proven to be rapidly fatal. There are also a few confirmed cases of reinfection now, some far more severe than the initial episode of COVID-19.

In addition, we are called for far more acute deteriorations in clinical condition, and seem to be running to many more resuscitations than we ever dreamt we would be. Often, patients have young families, and a desperate desire to live for their children.

There is definitely a higher number of patients who require mechanical ventilation and as such, there is enormous pressure on ICU beds. We are contacted on a daily basis by hospitals looking for ICU beds for young patients with severe COVID-19 pneumonia.

It’s not only the beds that are under pressure, but the units are often understaffed as the healthcare workers contract COVID-19 themselves or simply burn out.

This past weekend, I was told of a physician who contracted COVID-19 and landed up on a ventilator in his own unit and was cared for by his friend and colleague. This is all very hard to deal with.

The fact that many of the patients in hospital are well into the pulmonary phase with significant inflammatory changes in their lungs means that it’s a juggling act, with ICU beds being filled as soon as they are emptied and patients yo-yoing between ICU and the wards, and back to ICU.

There are times when ambulances wait patiently to offload their patients while space is made in emergency, or they are diverted to another hospital.

We are aware of private hospitals which have actually run out of oxygen for a time period. We are aware of hospitals in which they have started using anaesthetic machines to ventilate patients in their theatres.

We have seen photos from a hospital in Gauteng which has set up tents in its parking lot to treat patients with COVID-19.

Resources are limited, and a strict criteria for ICU admission will have to be implemented, a task we are dreading.

In the meantime, as we deal with this unprecedented surge in numbers, elective surgery has been cancelled and, other than COVID-19 cases, we are admitting emergencies only. People are scared to come to hospital and as such, are waiting until they can’t wait anymore, being admitted in extreme conditions.

Our physical discomfort is worse with long hours in personal protective equipment in the summer heat with no air conditioning in the wards. Our fingers are cracking open again, and the emotional toll is huge.

This past weekend, we witnessed the compassion with which our staff cared for a patient with Down’s Syndrome and how happy they were when it seemed that she would survive. We have taken wives to say goodbye to their husbands who are dying of COVID-19. We had to tell five patients that their parent/spouse had died of COVID-19 while they were lying in a hospital bed. I also had to call a lady who was isolating at home with COVID-19 to inform her that her husband had passed away on their 56th wedding anniversary. We also celebrated two birthdays here.

We are familiar with the vagaries of this disease, and write the treatment charts by rote, monitoring individuals intensively. We make therapeutic adjustments according to various clinical and blood parameters, desperate to prevent severe pneumonia or the cytokine storm.

We feel enormous relief if it looks as if the inflammatory process is reversing. And yet, in spite of all the knowledge gained over the past few months, there are patients who you know cannot pull through. At those times, kindness and compassion are all we can offer.

The stories are familiar. A minority of our patients (often the elderly) contracted COVID-19 through no fault of their own. But the vast majority know exactly where they picked it up – a dinner party, a function, on holiday, at a picnic, in a friend’s home, etc. The equation is simple to me: socialising without respecting the COVID-19 rules of social engagement = COVID-19 (for yourself or some unlucky individual that you come into contact with).

If you’re lucky, you get away lightly, and if you’re unlucky, you become critically ill (with the attendant risk of dying) or you develop long COVID-19 or one of the unusual late complications.

It’s going to get a lot worse, and we are going to run out of hospital beds, medication, and potentially oxygen. There’s no magic cure, and the vaccine is on the horizon. It behoves everyone to be respectful of COVID-19 and behave responsibly, respecting the sanctity of life.

  • Dr Carron Zinman is a pulmonologist at the Linksfield Clinic.

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Every doctor’s COVID-19 jab is one step closer to your vaccination

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The myalgia I awoke to this morning isn’t unfamiliar to me. It’s the common achy feeling we all experience at the onset of a touch of flu. The mild malaise I’m also feeling, after a shorter night’s sleep, is a physiological effect I try to avoid, but it’s the result of a habit that seems to creep into most of our busy lives.

Perhaps more particular, last night was the close constant attention I paid to my glucose levels as a Type 1 diabetic. Thankfully, all remained normal. Barring my mild symptoms, I’m feeling fantastic this morning, 24 hours after receiving the Johnson & Johnson COVID-19 vaccine.

My mind drifts back to almost a year ago, when I contracted a simple rhinovirus (the common cold). In spite of experiencing similar symptoms, I would certainly not have described myself as feeling “fantastic” at the time. These same symptoms used to conjure up uneasiness that my family had to bear as part of the role in life I have chosen. That’s what happens when you live with some comorbidities and work in a busy practice that had started to screen its patients vigilantly for the new “Wuhan flu”.

I welcome the vaccine’s side effects as do my colleagues as we enrol this week as the guinea pigs of the Johnson & Johnson trial. This is the only vaccine to date that has shown significant efficacy in preventing severe COVID-19 or death as a result of the 501.V2 variant, the most common strain of COVID-19 in South Africa today.

It’s a single-dose vaccine, with 500 000 doses secured to inoculate healthcare workers over the next four weeks. This is a trial still at stage 3b, which means that it’s not yet registered anywhere in the world for commercial use, in spite of its rolling application in the United States, the United Kingdom, and South Africa.

The vaccine is being rolled out as an emergency measure while it awaits FDA (Food and Drug Administration) approval potentially at the end of this month. Should the vaccine prove to be effective amongst South Africa’s healthcare workers, it will give SAHPRA (the South African Health Products Regulatory Authority) the green light for commercial rollout to our citizens.

My social media feed has been preoccupied with posts by colleagues receiving their vaccines. I, too, have added my own story to this noise. In reality, it’s far from noise. The supportive response we have all received from the public has been overwhelming.

A dear pulmonology colleague and I engaged in conversation yesterday as to whether doctors should be “flaunting their receipt of a vaccine” on social media or rather just quietly receiving the jab under the radar.

After some meaningful thought, we both agreed on the former. The palpable excitement by the public to doctors’ Facebook posts is fuelled by some valuable perspectives which I would like to share with you. These are the reasons that our community members should feel joy that our healthcare workers are finally being vaccinated this week.

The healthcare worker’s safety perspective: during surges of COVID-19 infection, patients have described the thought of not being able to see their doctors, nurses, and paramedics with ease as a terrifying dynamic. Statistics have shown that healthcare workers are three to four times more likely to develop COVID-19 than the general public. As many as 54 685 healthcare workers in the public sector alone have been infected with COVID-19 over the past year, with 779 losing their lives.

Unfortunately, every community doctor knows another doctor who has either contracted a serious COVID-19 infection or even lost their life to this plague. The vaccine offers you the promise that your doctors will be protected and able to help you when you may need them whether for COVID-19 or another reason.

The experimental perspective: the AstraZeneca vaccine taught us that in the dynamic, evolving space of COVID-19, variants affect efficacy tremendously. This phenomenon is so significant, that an already procured vaccine at one million units had to be returned. It’s still unknown whether the Johnson & Johnson vaccine will indeed be effective in large numbers on the ground, beyond the limited sample size of the original study in South Africa.

It’s best to run a live trial on largely healthy healthcare workers. I have my predictions that even with the Johnson & Johnson vaccine, modifications will need to be made to the product in the near future. Dr Glenda Gray advised me that a two-dose regimen is also being explored. Other expert vaccinologists have reported that it’s relatively simple to modify vaccines. As a member of the public, you will hopefully have access to the next round of vaccines – the improved version two.

The snowball perspective: this is the mindset that has excited me most since the rollout of vaccines a week ago. Every country with a functional vaccine campaign started off by vaccinating its healthcare workers. They constitute less than 5% of the population. Once healthcare workers start being vaccinated, the rollout soon spreads to essential workers and the elderly and vulnerable. Thereafter, vaccines are offered to younger healthy adults.

There is nothing more my wife and I would like to see than our own parents being vaccinated. I can say the same for my elderly patients. Understanding the procurement plan in South Africa, I’m confident that once the initial snowball of vaccinated healthcare workers has been formed, it’s inevitable that it will grow quickly and our deserving, beloved, vulnerable citizens will be vaccinated soon. Every doctor you see vaccinated means you are one step closer to being vaccinated yourself.

COVID-19 has changed our lives. It continues to place tremendous strain on our community socially, emotionally, financially, and physically. It has been proven that our second-nature, non-pharmacological measures of mask wearing, sanitising, and social distancing are powerful weapons in our armament. These measures dropped COVID-19 cases from a peak of 21 980 a day on 8 January 2021 to 998 today. However, we are finally exploring options of real pharmacological immunity. I’m utterly grateful to be contributing towards the body of knowledge of this development, and I have confidence that as the lightning development of vaccines continues to play out in South Africa, we will slowly get back to normal life.

Dr Daniel Israel is a family practitioner in Johannesburg.

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Tel Aviv rolls out COVID-19 vaccines for illegal foreign nationals

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Although South Africa is only starting to vaccinate its healthcare workers, Israel has already vaccinated nearly half the population.

It’s not only Israel’s citizens who have been vaccinated, but also migrant workers living there from the Philippines, Moldova, and Nigeria, as well as Sudanese and Eritrean asylum seekers. They are receiving the Pfizer-BioNTech coronavirus vaccine at the Tel Aviv COVID-19 Vaccination Centre in the southern part of the city, home to a large migrant community.

As part of an initiative to inoculate the city’s foreign nationals, Tel Aviv City Hall and the Sourasky Medical Center started administering vaccines free of charge to the city’s foreign nationals, many of whom are undocumented asylum seekers.

This was evident on Tuesday, 9 February, the first day of the operation, as dozens of asylum seekers and foreign workers in Tel Aviv lined up outside the building to receive their first dose of the COVID-19 vaccine. Posters provided information in English, Tigrinya, Russian, and Arabic.

“I’m very happy,” Indian national Garipelly Srinivas Goud told Associated Press. Lamenting that foreign workers in Israel don’t have money or insurance to afford to pay for the vaccine, Goud, who has been working in Israel for eight years, welcomed the vaccine drive as a “very good decision”.

Although it’s the government’s responsibility to vaccinate everybody within the nation’s borders, Eytan Schwartz, spokesperson for Tel Aviv municipality, said the city would take the next step and start “to vaccinate illegal or undocumented asylum seekers as well”.

And although far from completing the vaccinating of its own population, having thus far delivered more than 4.4 million first doses of the Pfizer vaccine and at least three million second doses, Israel has started providing the Palestinian Authority (PA) with thousands of vaccines for its healthcare workers. This is in spite of the fact that the ultimate responsibility for health services and vaccine acquisition falls upon the PA, elected by Palestinians to govern the West Bank.

After receiving thousands of doses from Israel, the Palestinian Health Ministry administered its first known coronavirus vaccinations at the beginning of February. It announced the start of the campaign by saying that Health Minister Mai al-Kaila had received a first dose along with several frontline medical workers. While acknowledging receipt of 2 000 doses on Monday, 8 February, the first batch of vaccines sent by Israel, the PA didn’t say where they came from.

Back in May 2020, COVID-19 relief aid from the United Arab Emirates was rejected by the Palestinian leadership because it arrived by freight plane to Israel’s international airport without prior co-ordination with the PA. This resulted in 14 tons of urgently needed COVID-19-relief medical supplies languishing at Ben Gurion Airport. The reason for the PA refusing to accept delivery was because it didn’t want to be seen as condoning the normalising of ties between Israel and the Arab world.

Disregarding the health of his people, Osama al-Najjar, the medical services director of the PA health ministry, explained that Ramallah couldn’t “accept shipments that are a gateway to normalisation between Arab countries and Israel”.

Asked what he thought would happen to the medical supplies, al-Najjar responded, “I don’t know where they will go, but we won’t accept them. They’re free to do with them what they please, but we will neither accept them nor welcome them.”

However, Al-Najjar did acknowledge that the PA was “in need of ventilators”.

What we are “all in need of” is better understanding and co-operation as there are no borders when it comes to the health of the planet and its vulnerable citizens. Israeli epidemiologists agree that it’s in Israel’s interest to ensure Palestinians are vaccinated as quickly as possible, as the populations are too intertwined to have one gain herd immunity without the other.

As recently departed Health Ministry Director-General Moshe Bar Siman-Tov told The Times of Israel in January, “The message is very simple: we are one epidemiological unit. As much as we can, we have to help them address this matter.”

  • David E Kaplan is the editor of ‘Lay of the Land’, and executive director of the Global Investigative Journalism Network. This piece was used courtesy of ‘Lay of the Land’.

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Call to wake up and listen

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The great Rabbi Yehuda says, “The human soul should turn g-dly … Perceive the world, enjoy the sublime, that sublime light and the hearing of the divine speech.” (Zohar)

How far has humanity travelled away from this truth here in South Africa? The dreaded load shedding, darkness upon the face of the earth … hmmm!

It’s time to take a good look at yourself – no television, no devices – could Hashem be asking you to now look inwards?

Then the virus, resulting in the wearing of masks. How many different masks do we wear for our spouse, children, friends, and co-workers, so full of masks covering up our true self, not hearing the divine voice of Hashem. We are now wearing our mask outside of ourselves. Why? No more space inside, full up, the pretence is overflowing.

Then comes a cry of compassion for humanity – a new rule, masks, social distancing, sanitising, or could we say this, could we look at it like this, expose the truth, give each other space, cleanse soul and mind?

Yet, humanity couldn’t obey this simple law of protection, then came lockdown.

Imprisonment not only of your mind – your body, your whole being, locked up.

And now death, what’s more final on this earth than death? Death, giving up or giving in, surrendering. How to die, why, where do we go, what do we do … well this is for another discussion.

If each of us does our best by being still, listening to the voice of Hashem, doing it through prayer is one way to hear his voice.

We have, as some people call it, collective karma, the law of cause and effect, we also have our own individual karma (attaining good merit or drawing negative energy through our deeds and actions). In collective karma, we are all in the same energy, this is where we see how the innocent and guilty suffer together as a result of a situation.

We can open the door to a new energy, a new way of living, we all have the key in our hand, all you need to do is turn the lock and enter.

Let your fancy dress and mask for your Purim celebration be the last mask you wear.

Pesach is nearly upon us. Think of the slaughtered lamb in place of the first born, allow the angel of death to pass you by, the angel will know death has been, she will see the sign written on the door although it’s the blood of the lamb.

What an auspicious time to play your part to turn your life around! A time in which there are no more masks, the truth can be revealed, the doors open wide, children can laugh and play in the park once more, the light of Shekinah shines brightly in your soul once more.

Let’s pray that through the blessing power of Hashem, the truth will set us free and heal us. It’s time to turn to prayer.

Wishing you a spiritual and enlightening Purim and Pesach!

  • Melanie Moritz is a spiritual teacher and healer.

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