ANALYSIS

The new ‘Doctors Pact’ that could help flatten the Covid-19 curve 

By Ferial Haffajee 14 April 2020

Illustrative image | sources: Chairperson of the Ministerial Advisory Committee on Covid-19 Professor Salim Abdool Karim. (Photo: Flickr/Women's Congressional Policy Institute) / Health Minister Zweli Mkhize. (Photo: Gallo Images/Deaan Vivier)

In the late 1940s, three doctors made a pact to fight apartheid together, across racial lines. This time, a new pact is emerging in the battle to contain Covid-19

Health Minister Zweli Mkhize and the head of the ministerial advisory committee on Covid-19, Professor Salim Abdool Karim, have reprised an old relationship to establish a medical bromance that was on display to the public in a three-hour briefing on Monday 14 April.  

At the end of the Zoom meeting, a questioner asked whether Mkhize was indeed a doctor (I don’t know where that came from).

Abdool Karim stepped in to say that he and Mkhize had both been students at what is now the University of KwaZulu-Natal (one of the few places where black people could train as doctors). The two doctors and their doctor partners (Qurraisha Abdool Karim and May Mashego) had all studied together.

What was clear from the briefing is that the two doctors work closely together. And the decision to hold the briefing also suggests that the scientists and the health activists in the Covid-19 National Command Council have, for now, the upper-hand over the securocrats who favour a more punitive approach in how this public health emergency is managed.  It also suggests that a strong lobby to reopen the South African economy from its hard lockdown (among the most draconian in the world) to a lighter version has taken second place to science and safety. 

The briefing revealed that South Africa had bucked the trend of worst-case community transmission until now, and is on course to flatten the rate of infection and lower its peak by September. The two doctors said South Africa is now in stage 4 of the Covid-19 effort and the country now heads into the more tricky stages 5 to 9.  

In his presentation, Abdool Karim said, “South Africa’s epidemic trajectory is unique” which showed that the viral curve had turned more quickly than even best-performer countries like South Korea and Singapore and that community infection (the third stage after imported and local transmissions) are lower than expected.  

While this provided a smidgeon of hope, Abdool Karim and Mkhize both warned that the hard times were still ahead.  South Africa has bought time to flatten its curve by September and to put out “small flames” before they became “raging fires”. 

See the accompanying graphs in the presentation here: 

  Covid-19 presentation on Scribd

The briefing lifted the mood of the country, with the moment hinting at a new doctors’ pact as historic as the first. The first Doctors Pact in South Africa was signed by three doctors in 1947 – Dr AB Xuma, then the president of the ANC, Dr GM Naicker of the Natal Indian Congress and Dr Yusuf Dadoo of the Transvaal Indian Congress. This laid the basis for the concept of non-racial unity in the struggle against apartheid. 

The country’s second ‘doctors’ pact’ heralds an important political moment too: evidence-based decision making and an alliance of science and politics.  

It is a sea-change from the way the last epidemic was managed in South Africa when former President Thabo Mbeki marginalised medical scientists like Abdool Karim in favour of Aids denial scientists.

Abdool Karim is a straight-shooter who does not play politics. He wasn’t in favour under the Mbeki administration and on Monday (13 April) he didn’t beat around the bush. He said it was unlikely that South Africa can avoid the exponential curve of Covid-19, but what South African can do is plan for it.  

He said the country has some things going for it, like an army of 28,000 community health workers, a new and faster diagnostic testing regime and new treatments. The country also needed time to prep hospitals and buy Personal Protective Equipment (PPE) gear like masks and gowns essential to keep healthworkers safe.  

On Tuesday (14 April), Business for SA (B4SA), which is coordinating the stocks of equipment and gear, said it had bought 900,000 sterile gloves, 20,000 face shields, 1.12-million N95 masks, 14.5 surgical masks and 200 ventilators with funds collected by ordinary South Africans; the business community which included the donations from the Motsepe Foundation; the SPIRE fund (RMB); the Solidarity Fund and Naspers.  This is only a portion of what is needed.  

“The focus is to secure PPE stock for the next 6-8 weeks, and monthly thereafter,” said B4SA. 

South Africa’s infection rate is now growing at 67 per week, said Abdool Karim, and if it slows, the lockdown can be eased. But if infections climb to 90 or more a day, as mass testing gains ground, then the tight restrictions will remain.  

The two doctors told South Africans to plan for stages 5 to 9 of the fight against Covid-19, which could last from this week to September. It includes finding the infection hotspots, planning for the peak, thinking through and planning for bereavement and mass deaths and then planning vigilance strategies to last until a vaccine may be found. Most clinicians agree this could take between 18 months and two years. 

Steps might include introducing an age-related lockdown for the most vulnerable people. None of these stages are without problems: community health workers feel underpaid and often unprotected in the face of a terrifying virus and test results are still taking too long to process. 

For the foreseeable future, the double act of Mkhize and Abdool Karim – the politician and the scientist – will be the public face of the fight against Covid-19 in South Africa. DM

 

 

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