Youth Capital was joined by Dr Kerrin Begg for a WhatsApp Webinar on the New Normal following updates to the lockdown regulations following the spread of COVID-19 in South Africa.
Kerrin is a Public Health Specialist. She qualified as a doctor from UCT in 1994 (first class of the new democracy), and did her internship at Victoria Hospital. She later became hospital manager of a district hospital and started specialisingl she went on to qualify as a Public Health Medicine Specialist in 2002. In her career, she has worked in the public sector, the private sector, the parastatal sector, the NGO sector and more recently in academia. She have been appointed as Deputy Dean: Undergraduate Education for UCT Faculty of Health Sciences from 1 May 2020.
In previous webinars we chatted about the curve, which is the rate of new infections. Other countries issued lockdowns to flatten the curve. However, South Africa seems to be having a pretty peculiar trend. Could you please explain it to us?
What we have seen in the case numbers for South Africa is essentially a “tale of 2 curves”. The first curve caused by travelers and their immediate contacts. The second curve of community transmission has not been as steep as we had initially expected. Whilst total numbers of tests and who is being tested is part of the explanation, the “flattening of the curve” to date (between day 10 and day 35 of the epidemic) has been most likely due to a delay in cluster and local transmission (normal stages of an epidemic) by the enforced physical distancing of the state of disaster declaration (Day 10) and the lockdown (Day 18).
This has bought South Africa time to implement active community screening and ensure health system preparedness to treat the tsunami of cases to come. From the Easter weekend (approximately Day 38) we have started to see a sharper increase in cases. On the ground, at the outbreak control centres, we started picking up large clusters of cases in workplaces, where essential services workers congregate, including supermarkets, manufacturing plants, police services, hospitals etc. This is understandable as the virus gets it “legs” to be able to transmit via droplets from person-to-person, from those who are currently moving and connecting with others, viz. workers in essential services.
As a country we are now firmly in Stage 2 of epidemic transmission, and moving to Stage 3 imminently as we see the cluster transmission move to localized transmission in areas where these essential workers reside. Community transmission is of particular concern to us in densely populated informal settlements with limited water supply and sanitation, where engineering and administrative infection prevention and control measures are challenging. So we are working hard to swiftly case and contact trace and move cases to dedicated isolation centres, and contacts to dedicated quarantine centres if their circumstances do not allow for adequate self-isolation and self-quarantine at home to mitigate the community transmission as much as possible.
You can read more about it here.
Easing the lockdown will not mean going back to normal life. What is the new normal going to look like and what behaviours should we adopt?
As the President announced on Tuesday night, there will be different levels of lock-down going forward.
Essentially all restrictions are more and less stringent attempts to reduce the transmission of Sars-Cov-2 virus, which causes COVID-19. Because the virus is droplet-spread, we don’t want to give the virus “legs” by transmitting it person-to-person. That is why most of the measures are related to physical distancing.
The best way to visualise the droplet spread is to imagine the person with COVID-19, that his/her mouth and nose are covered in sticky gold glitter (representing the respiratory secretions filled with virus. As they touch their mouth or nose – their hands get covered in sticky gold glitter. If that person sneezes or coughs close to, or touches another person (hugs, kisses, shakes hands, shares a cup etc) – then that person gets the gold glitter. If the person touches surfaces like door knobs, handrails, table tops, then anyone else touching those surfaces afterwards also gets the gold glitter. So the purpose of all the “golden rules” and lockdown, is to reduce the spread from one person to another of the gold glitter.
These are the five golden rules:
- Wash hands often (get rid of the gold glitter)
- Don’t touch your face (so no ‘glitter from mouth/nose to hands)
- Keep physical distance (so no glitter transferred to others)
- Cover your cough – cough / sneeze into your bent elbow or into tissue (so glitter not sprayed in the direction of others)
- If you are sick – stay home
The essence of the golden rules is that we all behave as if we are infected and making sure we do not transmit the virus to others.
What is the New Normal going to include?
The New Normal is going to include things like:
- No people meeting in large groups: no social or sports events or conferences, no church or mosque, and limited numbers at functions like weddings and funerals with rules about distancing. Restaurants and bars are going to take a long time to open.
- Limited travel: so that we don’t give legs to the virus to other areas with lower rates of infection
- Staggered and slow return to work, studies and school: symptom and temperature checks everyday before starting work so you don’t risk bringing the virus onto the premises, staggered shifts or classes to keep as much physical distancing as possible
- Hand sanitizer before entering any premises – shops, work, school etc
- Wearing of masks whenever out in public – on public transport, in shops, at work, school etc. Remember the gold glitter analogy – the mask is there to stop the gold glitter, so “your mask protects me, my mask protects you”.
President Ramaphosa announced that we will have to wear cloth masks. Could you tell us a bit more about masks?
Droplets sprayed during coughing, sneezing or exhaling can be blocked by a facemask, to a greater and lesser degree dependent on the type of facemask. Facemasks are critical in healthcare settings to protect healthcare workers from becoming infected when treating known and unknown cases. So hope that masks would also help reduce the transmission in a community setting too.
The scientific evidence from similar diseases like influenza show that using facemasks may reduce the chance of infection and therefore community transmission, but it is not a “silver-bullet” and the protection factor is around 8-12% more than no masks.So wearing masks is just one of many imperfect weapons to use in the fight against COVID-19. It is therefore imperative to use masks in combination with all the other golden rules.
Why cloth masks?
Medical masks are critical in healthcare settings to protect healthcare workers from becoming infected. Because the pandemic has led to a global shortage of PPE (Personal Protective Equipment), including facemasks and N95 respirators, these must be prioritized for healthcare workers.
Homemade or cloth masks have therefore been suggested as a stopgap in community settings in order to save medical facemasks for use in healthcare workers.
Remember the gold glitter analogy – the mask is there to stop the gold glitter, so “your mask protects me, my mask protects you”. This is an opinion piece I wrote on the topic.
Can we make masks at home and how many masks should one person have?
You can make them at home. Ideally it should have 3 layers – made from thick weave cotton like materials. Try to avoid t-shirt or stretchy type materials where moisture can get through more easily. There are some visuals that we will share. You can also follow Masks4Africa and Masks4All to get some more ideas. Ideally you should have at least 2 masks. One worn and one in the wash.
In The New Normal, you should:
- Wear a clean mask every day, change when moist
- Make sure it covers your mouth and nose
- It should be big enough to cover from below your chin, to above your nose, and up to the ears
- Wash your hands before and after handling your mask
- Put on and take off only using the straps
- Don’t touch the part that covers your mouth and nose
- Take off at end of the day and immediately place into a basin of hot, soapy water
- Wash in hot soapy water and iron when dry
- Have two masks if possible – one to wear and one in the wash
Very important – DO NOT SHARE MASKS!
How will we develop immunity to Covid-19?
We usually develop antibodies to infectious diseases after we have either had the disease (whether mild or severe), or been given a vaccine which primes our immune system to develop antibodies, so that the next time we are exposed to the infectious agent (in this case a virus), our body mounts an immune response (fights a battle), and we do not get sick again.
Of course the challenge with waiting to be exposed to the live wild virus and getting sick from it, is that you could die, or recover but with long term effects which stop you from living a long, healthy and productive life, or you might recover completely.
So we have over the past 60-odd years developed many vaccines to prevent deaths (mortality) and ill-effects (morbidity) from these diseases, such as polio, measles, Hepatitis B etc. by having sufficient people vaccinated, the “susceptible pool” of people that can be infected by the wild live virus is too small and eventually the disease dies out (like smallpox). For the odd individual that does not get vaccinated, they are protected by herd immunity.
The challenge with COVID-19 is that it is a very new disease, so there is no vaccine currently, Whilst some people have a very mild form of the disease, for many it is very severe, with long term consequences due to lung scarring and damage, and of course many deaths. If we were to wait for enough people to have the disease, recover and develop antibodies for there to be “herd immunity”, we would have to have many 100’s of 1000’s of infections at great cost for the medical care and the cost to the economy of people being off for long periods of time, and of course 10’s of 1000’s of deaths. So we need to continue very stringent preventative measures such as lockdowns, until we have a vaccine to be able to provide us with immunity.
A vaccine is at least a year away. That’s April 2021. The earliest vaccine trials just started late last month. It takes 18 to 24 months to make, test and assess the efficacy of a vaccine.
If you are interested in the concept of herd immunity, watch this video.
How is hunger affecting public health? Many people are struggling because they haven’t earned any money and food parcels aren’t enough.
Poverty and hunger is a huge issue and has been impacting health of populations in Low Income Countries for decades, known as the social determinants of disease. COVID-19 has simply exposed these faultlines in our society to a significantly larger extent.
In these circumstances, physical distancing and other measures are diffucult to implement. It remains an imperative part of the COVID-19 response to address hunger, water supply and sanitation before we can expect people to apply the “golden rules”.
“Nobody can stay home to #stopthespread, if they have no food.”
Stay safe and follow safety precautions – get in touch should you have any doubts.
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