Calm Before The Storm: Why Are South African Hospitals So Quiet?

Last night, South Africa tuned in to watch President Cyril Ramaphosa deliver a speech in which he confirmed our fears that the nationwide coronavirus lockdown, initially scheduled for three weeks, will be extended until the end of April.

In his speech last night, the President spoke about the ostensive improvement in slowing down the increase of new coronavirus cases (the so-called flattening of the curve).

“While it is too early to make a definitive analysis of the progression of the disease in South Africa, there is sufficient evidence to show that the lockdown is working,” he said in his nationwide address.

“Since the lockdown came into effect, the rate at which new cases have been identified here in South Africa has slowed significantly. From 1,170 confirmed cases on the 27th of March, the number of confirmed cases today stands at 1,934.”

Source: Media Hack

And the president is correct, the number of new infections recorded fell from 243 new cases in one day, to just 17 and has since settled on roughly 50 new infections per day. An incredibly strange phenomenon considering not only the exponential increases in infections basically everywhere else in the world. All of the early doubters, who were preparing for a complete collapse of healthcare systems in the country will now be forced to eat their words. It would seem the nationwide lockdown has been incredibly effective. South Africa’s hospitals remain quiet, and the anticipated wave of infections that many experts here have been waiting for has yet to materialise.

“It’s a bit strange. Eerie. No-one is sure what to make of it,” said Dr Evan Shoul, an infectious disease specialist in Johannesburg, according to the BBC.

“We’ve been calling it the calm before the storm for about three weeks. We’re getting everything set up here. And it just hasn’t arrived. It’s weird,” says Dr Tom Boyles in the same feature article.

So the question that’s being asked right now is whether this is a mere lag– the calm before the storm– or is South Africa genuinely outperforming our wildest expectations?

Any answer to that question would be speculative at best, because despite what all the “instant experts” have been telling people from every branch of the media, nobody knows what’s going on. This virus is still very new, no significant research has been done. Clinical trials have not been methodically rolled out for anything, emerging medicines have not been control-tested.

Even the most distinguished doctors on earth are at a loss for words, much less journalists or your friends sharing stories on social media about China’s grand conspiracy to rule the world or Bill Gates’ micro-chip laden vaccination. Do not mistake a hypothesis for an evidence-based conclusion. Right now we don’t have any evidence. Take Alan Knott-Craig’s “miracle” article , where he proposes that the slower spread of COVID-19 cases in South Africa may come down to the BCG vaccine which is mandatory for all children born in the country as part of our efforts to curb a decades-long tuberculosis pandemic in the country. He compares Spain (the second most infected country on earth right now) to Portugal, who also have made BCG vaccinations mandatory to reinforce his hypothesis, indicating that Spain’s infections are so high and Portugal’s so relatively low because the BCG vaccination isn’t mandatory in Spain.

“These stories have been around for a while. I’d be amazed if it was BCG. These are theories. They’re probably not true,” Dr Boyles continues, while Prof Salim Karim, South Africa’s leading HIV expert says “It’s an interesting hypothesis, but nothing more than that.”

Others argue that the presence of antiretrovirals, used to combat the HIV epidemic, throughout the country has also aided in a relatively low infection rate. The other theory you may hear is that different population groups have different enzymes, making one subset more immune to the virus than others.

You will run into countless stories asserting one thing or another about COVID-19, but now is a time where you need to tread incredibly lightly, such is the overwhelming presence of fake news not only on social media, but in the media industry itself.

News24 were forced to issue a retraction for the “Africa vaccine story” that they published, and apologize to the Bill and Melinda Gates foundation.
“The sourcing for the story was a social media post from President Cyril Ramaphosa’s Twitter account about support from the philanthropist Bill Gates for South Africa’s health needs,” the retraction read. In the past, making this kind of mistake as a journalist would have cost you your job. Today, even issuing a retraction at all is surprising. So be very careful about what you read and what you choose to believe.

So if we don’t have any evidence to rely on, what are we supposed to believe? Right now, we can only take the larger data collected and draw conclusions from the perspectives of the social sciences.

“While we recognise the need to expand testing to gain a better picture of the infection rate, this represents real progress,” said President Ramaphosa, and he is absolutely right. As of 10 April, only 68,874 tests had been conducted nationwide; less than 0.0013% of the entire population. And, those 68,874 tests, 1,934 are confirmed infections, meaning 2.8% of the tests conducted have led to infection. Spain, in comparison, has recorded 43% positive tests from the 355,000 carried out by their healthcare experts. In the United States, that number is 20%. So how can we be so far behind in terms of the positive infections from the tests carried out?

The US has carried out over 2.3 million tests, making for a total of 7,181 tests per one million people. In Spain it’s 7,593 tests per one million population Norway has tested over 22,000 per one million population, while Luxembourg and the UAE’s tests per one million population are over 43,000 and 59,000 respectively. In South Africa, we’ve tested 1,161 people per one million population, as per the figures on 10 April.

Source: Media Hack

So, as the figure above shows, the more tests conducted, the higher the number of positive tests are recorded. And most of these tests are being carried out in private hospitals. According to the South African Government newsletter, only just over 6,000 of the tests were performed at public facilities, while 44,000 were carried out in private healthcare facilities (as per 1 April). This means that it’s mostly middle- and upper-income families that are accounted for at this point, bar 6,000 exceptions. In a country with such a massive wealth discrepancy, this disproportionate availability of testing kits tells a story in itself.

While the wealthy are able to live at comfortable distance from another, while they’re able to stockpile food and while they can afford quality treatment, it is the poor that are forced to fit entire families into one-bedroom homes. It is the poor that have to share taps with hundreds or even thousands of other people. It is the poor that lack access to proper sanitation and it is the poor that are most vulnerable. And, as we already know, this is an airborne virus that is asymptomatic for days after infection. Nobody can say so with any degree of certainty, but for all we know, especially considering that there have already been a number of confirmed cases of infection in some of South Africa’s largest townships, this virus could be spreading like wildfire.

But, like I said before, this is a hypothesis. I don’t have a phD, I’m not a doctor or a pharmaceutical expert. I can only look at the numbers available and the expert opinions that have been published and, if you look at the data available, it looks like the circumstances we find ourselves in could be a great deal worse than they’re currently being made out to be. What I can say with near certainty, though, is that extending the lockdown to the end of April will not be enough. Get comfortable, you’re going to be staying at home for a while.

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