South African Health Minister, Dr Zweli Mkhize, has urged the elderly and those living with comorbidities to take extra precaution, avoid leaving home and ensure their chronic conditions are managed.
Citing the National Institute for Communicable Diseases’ report released on 21 June, Mkhize said it confirmed that these population groups are most vulnerable.
“This report brings all these issues home and gives us a sense of the burden we have faced, how the system has coped and marries these lessons to the projections that have been modelled of the coming surge,” he said.
According to the NICD report, 10 700 COVID-19 patients have been admitted from 269 public and private facilities between 5 March and 21 June 2020.
The study revealed that the median age of COVID-19 admissions was 50 years, 338 were patients who are 18 years and younger and 1 386 older than 70, while 5 778 were female.
In addition, 8 245 patients had comorbid conditions, 2 810 had one and 3 126 had two or more underlying illnesses.
“Of the 5 836 patients who had a comorbid condition, the most commonly reported were hypertension 3 419 and diabetes 2 813 and there were 1 116 patients admitted with HIV, 240 with active tuberculosis and 579 patients with the previous history of tuberculosis.”
Clinicians also noted obesity as a risk factor in 297 patients.
“Of the 10 700 admissions, 3 260 patients were in the hospital at the time of the report, 5 925 patients were discharged alive or transferred out, and 1 515 patients had died,” Mkhize added.
Mkhize noted that some of the factors associated with in-hospital mortality were older age groups; male sex; and having comorbid hypertension, diabetes, chronic cardiac disease, chronic renal disease, malignancy, HIV and obesity.
“We wish to detail them for the public to demonstrate the connection between science and the recommendations that we make,” Mkhize said.
Facts about COVID-19 illness caused by SARS-CoV-2
Mkhize said he was pleased with how clinical and epidemiological knowledge around this disease has developed at an extraordinary rate.
Meanwhile, a vaccine has already advanced to the human trial phase, he said in his statement on Tuesday.
“This is how determined we are, collectively, to beat this virus and minimise its impact on us as humanity.”
The Minister said they are constantly learning more about the behaviour of the virus when it enters the body.
“We have since learnt that the virus is shed through the airways and spreads by infected droplets passing from one individual to another.”
Mkhize added that the virus has also been detected in saliva, tear fluid, stool, and men’s semen with acute infection and some male patients who have recovered.
“Having said that, sexual transmission of the virus has not been recorded,” he explained.
There have been intense studies into the duration expulsion and release of the virus as well as determining how long Coronavirus survives on surfaces.
The duration varies from hours to days depending on the severity of disease or the nature of the study itself.
He said COVID-19 ranges from asymptomatic or mild symptoms to severe illness and death.
“Symptoms may develop between two days and two weeks following exposure to the virus.”
Clinical characteristics of COVID-19 include fever and symptoms typical of a viral respiratory tract infection including coughing, sore throat, loss of taste and smell, nasal congestion, and even conjunctivitis.
“Further, gastrointestinal symptoms of nausea, vomiting, and diarrhoea are also common with COVID-19.”
He said the virus could progress to cause lower respiratory tract infection resulting in, pneumonia and its complications.
“Acute Respiratory Distress Syndrome (ARDS) is a serious complication of COVID-19. The lungs may become stiff and difficult to ventilate,” he said, adding that ARDS is associated with a high mortality rate.
Mkhize said there have been two major advancements in the case management of severely ill patients who require ventilator support.
“First is the advent of dexamethasone which has shown that deaths can be reduced by a third for patients on ventilators and can also help patients who only need supplemental oxygen.”
He said they are now recommending early administration of this drug to critically ill patients who require oxygen support.
“Evidence increasingly supports the avoidance of invasive ventilation strategies as far as possible.”
The Minister said they are expecting the Ministerial Advisory Committee on COVID-19 to issue advisories on the use of high flow oxygen for patients who are very ill but can be managed without intubation and ventilation.
Washing hands, cleaning surfaces and wearing a mask a must
Mkhize has once again emphasised the importance of frequent hand washing, avoidance of touching the face and cleaning of surfaces.
“We have recommended social distancing based on the fact that droplets traverse a certain distance from person to person.”
Also, wearing of facemasks reduces the amount of exhaled Coronavirus, he said.
“We also now know that one can shed the virus days before showing symptoms and for days after they recover from their symptoms – and so by wearing facemasks, one can literally save someone else from acquiring the virus. If that person is elderly or living with comorbidity, you can save that life.”
Mkhize emphasised the need to establish and keep new habits and turning them into traditions, customs and working lives forever.
“This is proving to be particularly difficult for South Africans to sustain and we appreciate that it is not easy to become accustomed to a new way of life,” he admitted.
The Minister said government was doing their best for the message to reach the people.
“These are the things that will prevent one from being admitted into hospital in the first place,” he said.
“But for those unfortunate ones who do become ill and need hospitalisation, we should be assured our doctors and nurses in facilities are doing a terrific job.”
He has praised the medical practitioners for keeping the morbidity and mortality rates lower than the global average.
No decision about another lockdown
According to Mkhize, there has not been any decision taken to have another lockdown.
“And certainly the National Coronavirus Command Council does not take lightly a decision of that nature. There may be a need in some areas for restrictions; it may not be national but localised. But no such decision has been taken as yet.”
He has pleaded with the public to work together to fight COVID-19.
“We are riding into the storm, but, together, we will prevail.”
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