Prof Salim Abdool Karim this evening engaged in an insightful question-and-answer session on the Coronavirus
Although many Covid-19 studies have been disappointing, South Africa has gained valuable insight from the experiences of other countries in dealing with the pandemic.
This is according to Epidemiologist, Professor Salim Abdool Karim, who answered South Africa’s coronavirus FAQ’s from Twitter on eNCA tonight.
The health of children returning to school, and that of their families, was placed in the spotlight.
Other issues discussed included whether one is able to contract Covid-19 twice, and whether those infected with TB and HIV are more susceptible to contracting the disease.
“For as long as we do not have immunity and a vaccine, we are going to have to live with this virus, which will continually pose a threat. There is no question that we have to ease the lockdown in a systematic way. Returning to school is part and parcel of that,” he said.
This, after the Department of Basic Education proposed the phased returning of teachers and learners from 4 May, which is yet to be finalised by Basic Education Minister, Angie Motshekga.
Karim, who is the Chairperson of the Covid-19 Ministerial Advisory Committee, explained that children only seem to contract a mild form of the virus, which includes a runny tummy and a runny nose. “A large percentage of children will be asymptomatic, or present very mild symptoms. The death rate is low, much lower than for the elderly. It’s the category of least concern.”
Karim added that if South Africans follow guidance, the risks will be minimised, as all citizens are at risk.
On the issue of immunity and whether those infected with TV and HIV are at a higher risk of contracting Covid-19, Karim noted it being a big conundrum. “As the disease has only been around for a few months, there is insufficient clinical data, and South Africa will have to collect and assess the data regarding TB and HIV. As far as I am aware, of the deaths South Africa has had, only one was that of an HIV positive patient. There have been no TB-related deaths.”
Karim added that what is becoming apparent is that most deaths have been that of older people with co-morbidity (heart disease, lung disease of immunosuppression such as cancer, diabetes, etc).
“The data we have seen from China and the US suggests that those above 70 years of age carry a higher risk of contracting a severe form of Covid-19. We have taken the approach that if you above the age of 60, you need to think about how you are going to reduce your risk of getting the disease. Age is a big factor, the younger you are the less severe the disease.”
Karim explained how Covid-19 is contracted and how it manifests. The virus enters the human body mainly through the nose, throat and eyes. The nose has receptors onto which the virus that causes Covid-19 latches. The virus then enters cells and takes control of the cell’s genetic reproductive tools and replicates until it bursts through the cell membrane.
From there, it finds its way to the lungs, where the duplication continues. In some cases, this causes severe immune reactions. “The imbalance between immune response and the threat posed is what we need to figure out. How do we slow down this immune response to stop the body from going into overdrive,” he said.
This “overdrive” refers to an overreaction of the body’s immune system called a cytokine storm, a common complication of Covid-19.
Cytokines are small proteins released by, among others, cells of the immune system during bodily responses against infections. Cytokine release triggers inflammation. Karim explained that the virus behind the Covid-19 pandemic (SARS-CoV-2) enters the lungs, triggers an immune response and results in inflammation. In some patients, too many cytokines are released. This, in turn, activates more immune cells and the result is seriously harming or lethal hyper inflammation – also called cytokine storms.
In countries like Britain and the US, doctors have seen Covid-19 patients with a condition called silent hypoxia. (Hypoxia refers to an absence of enough oxygen in the tissues, rendering the patient unable to perform bodily functions.)
They were not gasping for air and did not display outwardly symptoms to a worrying extent, but their blood oxygen levels were low. According to Karim, hypoxia is difficult to detect and can be lethal. Yet seeing this happen in other countries has allowed our medical practitioners to better manage patients.
“We know clinical features and we are learning as we go. This gives us a better understanding of how to manage patients,” said Karim. Meanwhile, he added that seeing what happened in other countries has allowed medical practitioners in South Africa to better manage patients.
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