While the debate rages, treat this as deadlier than flu

06 December 2020 - 00:41
The writer says the Western Cape might be better run than the Eastern Cape, but things are nonetheless getting worse further south as well.
The writer says the Western Cape might be better run than the Eastern Cape, but things are nonetheless getting worse further south as well.
Image: 123rf/Sergio Delle Vedove

Cyril Ramaphosa got it right on Thursday night when he tightened restrictions on Nelson Mandela Bay/Port Elizabeth as Covid-19 cases surge in the metropole.

Holidaymakers are heading to PE in numbers and, with slightly early restaurant closings, slightly tighter liquor sales times and a ban on drinking on the beach and surrounds, the city has gotten off lightly.

There would have been many voices around him calling for tougher action but he knows that doesn't end well. You'd have to be a numpty though, not to have a good time in PE this Christmas, and I fear Ramaphosa's calls on Thursday spell the holiday-future for the seaboard from PE down to Cape Town. If you're young and possibly still stupid, you may have to do your vomiting in your own toilet and not on the beach. But enjoy!

The Western Cape might be better run and its health services better prepared than the Eastern Cape's, but things are nonetheless getting worse further south as well. Laboratories in Hermanus have told doctors in the area that close to 20% of the Covid-19 tests they are now doing are positive, compared to just 2% in early October.

The key is to prevent health services falling over - easier in the Western than the Eastern Cape. And it isn't that there aren't enough beds. It's the staffing that's short.

Gautengers who get infected while in the Western Cape need to know there's little chance of them finding an intensive-care bed in the province because private hospitals, at least, are full as doctors and hospitals squeeze in elective surgeries postponed during the first wave.

Oh yes, and the four Covid victims in the ICU nearest to me as of three days ago were all below 50.

Nonetheless, the resurgence is a reason to be sensible, not scared. Respect the virus. Fortunately the wind blows hard and often at the coast and for once that may be a blessing.

I made an error here last week when I quoted a study, published by the World Health Organisation (WHO), that suggested that the infection fatality rate (IFR) of Covid-19 was less than 0.2% and therefore roughly as dangerous to the people it infects as influenza.

I failed to say that the study has been widely disparaged and is not available on the WHO website and was never an offial WHO view. It is difficult to calculate a global IFR because the pandemic is still under way and with so many people asymptomatic it is impossible to guess, yet, what proportion of infected people the dead might represent.

It is still an important number to chase, though, if only for our own eventual sanity. But only time tells us that a normal influenza fatality rate is between 0.1% and 0.15%, or that the Spanish flu of 1918 had an IFR of 2% and killed more than 50-million people.

Back in March, US scientists, including Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, wrote that "if one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza."

But the case fatality rate (CFR) and the IFR are different numbers. If Fauci was right then, and the global CFR eventually turns out to be lower than 1%, the conclusion of the original much-derided paper may turn out to be less crazy than first thought. It's the "ultimately" in Fauci's paper that matters, though. For the moment it would be sensible to treat Covid-19 as more dangerous than the flu.

For instance, a study of studies from Imperial College in London, published in October, suggests higher IFRs in wealthy and developed countries. It estimated that the "overall" IFR in a typical low-income country would be about 0.23% (still more than twice as fatal as the flu) and rise to 1.15% (more than 10 times as fatal) in richer countries, which tend to have older populations.

These numbers are a movable feast, though. "Although the elderly are by far at the highest risk of dying due to Covid-19, the risk in middle age is still high," says Dr Lucy Okell, one of the Imperial authors. "We estimate that around 1 in 260 people aged 50-55 years will die if infected. We calculated Covid-19 fatality largely based on the first wave of the epidemic in a number of countries and we hope and expect to see some reduction in fatality now due to new clinical knowledge and treatment, but this remains a dangerous virus." The point, surely, is to be careful out there.

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