Mkhize worried about Covid-19's impact on informal settlements and those with HIV and TB

19 March 2020 - 21:40 By Naledi Shange and Matthew Savides
Almost all of the positive coronavirus cases have been diagnosed through the private healthcare system.
Almost all of the positive coronavirus cases have been diagnosed through the private healthcare system.
Image: 123RF/slasny

Health minister Zweli Mkhize is having sleepless nights about what would happen if the coronavirus started spreading through SA's vulnerable communities.

In particular, he said he was concerned about how the virus - and the Covid-19 respiratory illness it causes - would impact on those who live in informal settlements, have HIV/Aids and tuberculosis and who use mass public transport networks.

“Things you learn in South Africa, you won't learn anywhere else.

“No-one has got 7 million people who are HIV-positive and many who are on antiretrovirals. No-one has got as much tuberculosis as we have. No-one has got the kind of inequality and spatial inequality and distribution of poverty to one part of the country, with affluence to one side. No-one has got that,” he said.

He was speaking in Pretoria on Thursday at a dialogue hosted by the SA Medical Association, alongside medical doctors who have been dealing with patients who fear they have the illness.

So far, the virus has mostly hit those who are middle-class citizens who can afford private health care.

“At least 97% of the patients who have been diagnosed have been from the private sector. I don’t remember anyone that really came from a public hospital or public clinic,” said Mkhize.

Statistics released on Thursday showed that 150 people had now tested for Covid-19, but he said this number was likely to increase to about 200 by Friday morning.  

“We now need to start being ready to test a couple of thousand per day,” he added.

Mkhize said they were considering surveillance of areas where infections could spread. There, they would have health officials embark on “drive-by tests” — spot tests of anyone showing symptoms of the virus.

“This is time to actually have a targeted surveillance, where we go to areas where we think there might be risk and be able to assist there,” he said.

Mkhize said, for example, it was easier to treat and deal with a person using public transport at the first point of access.

“Imagine a person in Langa (a township in Cape Town) takes a taxi, from there into a train, and takes a long distance taxi all the way from Cape Town to Johannesburg and then goes further to Limpopo, and back.

“Now, you want to ask them if they know who their contacts were. The challenge is that even if they could tell you where they were, he or she won't be able to tell you who was in the taxi because half the time you don't know who is sitting next to you.

“Those are the issues we need to be conscious about,” said Mkhize. 

It was for this reason, the minister said, that government put in the restrictions that have been announced subsequent to President Cyril Ramaphosa declaring a state of emergency on Sunday night.

“It was to reduce the rate at which the virus will start spreading to the areas where people are most vulnerable. And that's really what the issue is about. We're trying to flatted the curve. We're trying to delay the onset of the infection,” said Mkhize.

The minister said there was also an understanding that, given SA's spatial inequality, a national shutdown might not work.

“When we start talking lockdown, we are actually aware that there's a lockdown that will never work. You can't say you're going to do a lockdown in Gugulethu. There's no lockdown in Gugulethu. Gugulethu is part of Cape Town. You're talking about the entire ecosystem that is going to be affected.

“So nobody must start thinking, 'No, they'll put a lockdown in Inanda or KwaMashu (both in Durban). We will be fine.' No, there won't be such, because we're one ecosystem.

“It's simple: you can put a lockdown in one place and people will just walk over to where the food is, or to where the workplace is, or where the transport is, or where the facilities are. No-one is ever going to be locked down like that.

“It's going to be a combined sense of goodwill of all SA that we are going to say we want to help each other to get out of this problem. That is really how we need to face it,” he said.

Mkhize stressed, however, that with the flu season fast approaching, many people could possibly dismiss coronavirus symptoms as normal.

Addressing doctors, Mkhize emphasised that no doctor should be getting ill as a result of being exposed to infected patients. He urged them to exercise caution.

Using the example of two doctors, Mkhize said: “A few days ago, a doctor came from abroad. They were discussing this issue that most of these people were getting infections from Italy and so on and they said, 'Doctor so-and-so, you came from one of those countries.' And they agreed he would go into quarantine.

“He quarantined himself and then did a test. He did it and it came out positive. It was nice because everyone took an immediate precaution and we now need to check if anyone was affected.”

This however, was not the case with the other doctor who possibly spread the virus among his colleagues.

“The other one came back well — he was asymptomatic. He had a little bit of an upper respiratory tract infection and all of a sudden, he went around, he operated, he met with people and so on,” he said.

However, a short while later, he complained to his GP that the infection was “irritating me”.

“All of a sudden, he was [tested] positive. We now have to go back to the hospital,” said Mkhize.

Currently, the government has about 2,000 people who have been hired as tracers who work on tracing people who have possibly been in contact with those who have tested positive for the virus.