SA's mostly young population may spare it from a high Covid-19 mortality rate

22 April 2020 - 08:45 By SIPOKAZI FOKAZI
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The young population of SA may work in the country's favour with less deaths expected here compared to other nations that have a significant number of elderly people.
The young population of SA may work in the country's favour with less deaths expected here compared to other nations that have a significant number of elderly people.
Image: Alaister Russell/The Sunday Times

By implementing a strict lockdown early on SA has without doubt been able to contain the spread of Covid-19, but another factor that has counted in the county’s favour is the age structure of the population, which is mostly made up of young people.

So says Prof Graeme Meintjes, a University of Cape Town infectious diseases expert.

Meintjes said with only 5% of the population over the age of 65 there is a good chance that SA will not experience as high a mortality rate as other Covid-19 hotspots like Italy and Spain where more than 20% of the population are elderly.

According to Stats SA's midyear estimates for 2019, youth (aged 18—34) constitute almost a third of the population (17.84 million) in SA.

“One of the mitigating factors that might count in our favour is the age structure of our population. Younger populations are less likely to have a high mortality rate than what we’ve seen in other countries,” he said.  

Meintjes was speaking on Tuesday at an International Aids Society (IAS) webinar on Covid-19 and HIV, which discussed the virus pandemic and the impact on people living with HIV. Other international infectious disease experts from countries like China, Italy, UK, the Middle East and Kenya were also part of the discussion.

While SA has seen the “blunting of the curve” in the past four weeks of lockdown, Meintjes said the country should look at easing the lockdown as its “social and economic cost is not sustainable”.

“We will have to ease the lockdown while we are implementing mitigation factors to minimise the impact. We can’t sustain a harsh lockdown for much longer,” he said.

Challenges

Despite the advantage of the age factor, Meintjes has warned that several factors such as a large immunosuppressed population due to HIV and tuberculosis may actually count against the country.

Of about 8 million that are living with HIV and a high incidence of TB, only 54% of HIV-positive people are virally suppressed, and Meintjes said this might put many at risk of Covid-19 complications.

Social distancing difficulties in overcrowded communities and dependency on public transport may also put a lot of South Africans at greater risk of Covid-19 infection.  

To proactively manage the burden of HIV and Covid-19, Meintjes said tertiary hospitals such as Groote Schuur are now conducting HIV tests for patients who are investigated for Covid-19, and those who are newly diagnosed with HIV are initiated on treatment two weeks after treatment of Covid-19 as a way of strengthening their immune system.

Dr Tracy Flowers, a public health specialist from MSF in Khayelitsha, said as part of discouraging physical contact of patients, different approaches are being implemented such as switching from in-person counselling services to telephonic counselling.

Some Khayelitsha health centres have also dropped non-essential visits to clinics, and have adopted several strategies including home deliveries by community caregivers, combined clinic visits for those with comorbidities, and issuing longer ARV refills such as providing patients with four months’ supply instead of two months.

Dr Tracy Flowers of MSF says HIV patients who are struggling with managing their disease may be particularly at greater risk of Covid-19 complications.
Dr Tracy Flowers of MSF says HIV patients who are struggling with managing their disease may be particularly at greater risk of Covid-19 complications.
Image: linkedin

“But with most of these changes and delivery models there are mostly logistically challenges. Staff often need support. Mostly we have to make sure that there’s adequate stock and pharmacy monitoring,” she said.

But one of the biggest worries during the Covid-19 pandemic is HIV-positive patients who are struggling with treatment adherence, and it is this group that risks being unsupported during the pandemic.

“Patients who are struggling with treatment are particularly vulnerable at this time and one of the reasons they struggle is driven by social determinants of health, and these problems are now magnified, and it could be the response that we have to Covid-19 that could put them at greater risk. Those who are struggling during this pandemic are at greater risk of being unsupported and vulnerable.”


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