There are likely a million cases of Covid-19 in SA right now: Prof Madhi

Prof Shabir Madhi, lead researcher on the Covid-19 vaccine trial that starts in Johannesburg on Wednesday, says there are likely a million South Africans with Covid-19 at this very moment.

Speaking during a webinar on MyHealthTV, he said, “When we say we have reached 100,000 cases, that is a complete underestimate. In my estimate, it is close to 10 times more — probably around a million people. There is increasing evidence that many are asymptomatic but are still spreaders.”

He said that one has to factor in the rate of testing and thus cannot compare countries.

“For example, we have a five to six-fold lower rate of testing than in the UK. If you look at Nigeria, their population is four times higher than ours but their rate of testing is 40 times less than SA's so it is incorrect to make any sort of comparison between countries.”

He said the most meaningful metric for comparison are the rates and numbers of people ending up in hospital, and that the single most important factor is “citizen adherence to non-pharmaceutical interventions” (social distancing, wearing masks and hand hygiene).

“We are still in the first wave and we are probably going to experience three to four waves over the next two years. We haven't even peaked, not even in the Western Cape. It will be completely dependent on the behaviour of South Africans rather than government interventions as to what the peak looks like. Citizens adhering to the non-pharmaceutical interventions is the single most important factor to prevent more peaks. It slows the rate of transmission,” he said.

Madhi says while admissions to hospitals are the best indicator, we need to make sure that the availability is there for those admissions to happen.

Because of this, “there is more of a case to be made for banning alcohol than cigarettes, and that discussion has become unmanageable".

“The changes that take place in the lungs take a while,” he said, explaining that stopping smoking now won’t have an impact on the number of people getting Covid-19 or needing to go to hospital, whereas alcohol intake has increased car crashes and interpersonal injuries and this means general hospital beds and ICU beds are occupied by those patients and become unavailable for Covid-19 patients in need.

Madhi is heading up the groundbreaking trial that kicks off in SA but also gives a realistic account of what people can expect.

On the upside, the development of any of the potential Covid-19 vaccines is being accelerated.

“It usually takes between 10 and five years for a vaccine to be developed. It is an accelerated development pathway. We are trying to condense five to 10 years into one to two years.”

On the downside (or more realistic side), “one must remember that the chances of success of any human trial is only around 10% because of stringent assessment of safety and efficacy. There are more than 200 groups trying to develop Covid-19 vaccines and six are at the human-trial stage.”

Also there is a time lag between development and distribution.

“We are hoping to get an answer by the end of this year but that does not mean the vaccine will be available. They would still need to be reviewed, and then we would need to have manufacturing facilities that can produce the vaccines. Scaling up production for global access takes time,” he said.