We did more things right than wrong: Prof Salim Abdool Karim

Prof Salim Abdool Karim was hiking in the Drakensberg in December 2019 when he first received news of a mysterious respiratory disease that had emerged in China.

But the former head of the ministerial advisory committee (MAC) dismissed it as the SARS virus and believed China would have a handle on it. That was until geneticist Prof Tulio de Oliveira, who operates in the same building as him, raised the alarm about SARS-CoV-2 about a month later.

It was then that Abdool Karim, a world-renowned epidemiologist and head of the Centre for the Aids Programme of Research in SA (Caprisa), sprang into action.

“While we were hiking I got an alert on my watch which said there are cases of pneumonia of unknown origin in the Chinese city of Wuhan. I didn’t give it a second thought. I continued with my hike.

“When I returned to Durban I saw that there were one or two articles about it. Everything changed for me on January 11 2020 when Prof de Oliveira came up to my office and showed me the gene sequence of the pneumonia on Twitter. I looked at it and then realised we had something to worry about. It was significantly different from SARS ...”

Abdool Karim said he was in a “bit of denial” until the World Health Organisation declared Covid-19 as a public health emergency.

It was in early February of that year that he gathered his team to discuss the pending pandemic.

“We realised we had to take leadership, we were not going to sit there and let an epidemic happen to us,” he said.

We realised we had to take leadership, we were not going to sit there and let an epidemic happen to us.

—  Prof Salim Abdool Karim

Already equipped to do PCR testing for HIV at the Caprisa lab, Abdool Karim and his team started testing staff for Covid-19 because they had thousands of patients coming into their clinics.

“We tested our staff every week. We also started testing people presenting with respiratory systems. We also started community testing ... There were no cases yet but we were being proactive.

“We were quite prepared and had done several hundred tests by the time the first patient was identified. Of course all of those tests were negative at the time,” he said.

In early March, President Cyril Ramaphosa’s adviser asked Abdool Karim to assist government with its plan to deal with Covid-19. On March 23 he was invited by then health minister Zweli Mkhize’s office to attend an online meeting.

It was there that it was announced Abdool Karim would chair the MAC. That same evening the president announced the hard lockdown.

“From the initial point when we were dealing with a very high level of uncertainty, I think our actions at the time were appropriate. We couldn’t know whether we could afford not to do something and what damage it would cause. We were watching on television horrific pictures from Italy and New York, and we didn’t want to see that in SA, so we had to act,” he said.

He believes SA’s initial swift action paid dividends.

“We postponed the initial wave by about eight weeks or so. I said at the time that the virus was going to come; we just had to be ready for it.”

He admitted that SA made its “fair share of mistakes”.

“I think we did more things right than wrong. When we did things wrong we did it in the presence of uncertainty ... In my one year on the MAC, I think we did the best we could. I think the country responded quite well,” he said.

We were watching on television horrific pictures from Italy and New York, and we didn't want to see that in SA, so we had to act.

—  Prof Salim Abdool Karim

However, the tide is turning, he said.

“But people are fed up and tired,” said Abdool Karim.

Two years into the pandemic, Abdool Karim believes SA must adopt a long-term view on how to handle Covid-19.

“We have to look at better vaccines and better coverage. First generation vaccines that we have now, they do certain things. The next generation vaccines have to do something more. We don’t know what the next variants are going to look like because variants don’t come from each other. They all evolve in parallel. But we have to prepare.”

Abdool Karim said the virus can’t keep mutating in a way that gives it the advantage.

“It has to come to a point where it will mutate but doesn’t get an advantage. A new variant only comes about when a new virus with multiple mutations has an advantage over the other viruses.

“When you get to that point when you know that the virus can’t mutate, you make vaccines that are much more effective against it,” he said.

Abdool Karim predicted that by the end of this year, the response would have changed, “in that we would have a much higher proportion of people vaccinated, so we have less severe disease”.

“There is a new drug made by Pfizer. You take a five-day course and it's 89% effective in preventing hospitalisation. It should be available by the end of the year.

“It will change the face of Covid from a disease that kills millions of people to a disease that we can treat. We have done exactly the same with HIV,” he said.