Seven weeks into the national lockdown, a big debate has erupted over whether it’s still necessary. Some say it’s run its course, while others say it’s still necessary to curb the spread of Covid-19.
Over the next few weeks some provinces are expected to ease even further the lockdown restrictions. But others are still showing a rise in infection rates.
While the world is waiting for a Covid-19 vaccine, the best thing countries have had to do has been to try and limit the rapid spread through precautionary measures. Several countries, including South Africa, implemented a lockdown to allow the healthcare systems to adequately prepare for the expected spike in cases.
When South Africa detected its first novel coronavirus infection on March 5, the epidemic followed an exponential curve similar to those in the United Kingdom, the United States, China and many other countries.
Although South Africa has followed a phased approach in easing restrictions the reality of coronavirus has hit home. Many people are still fearful and anxious when it comes to infection.
Health practitioners and the World Health Organization have outlined some of the common complications that this virus can produce. But, over the past few months there has been more information about it and its symptoms.
One of the registrars specialising in internal medicine at Tygerberg Hospital, currently working in the Covid-19 unit, Mohammed Aslam Parker says that the most common complication is respiratory failure resulting from pneumonia caused by SARS-COV2.
“The virus may lead to respiratory symptoms ranging from very mild upper respiratory symptoms which includes a runny nose, sore throat, cough and shortness of breath, to respiratory failure requiring ventilation in an intensive care unit (ICU).’’
“Patients with critical disease often have multi-organ failure, which may cause death. Multiple other organs can be affected, including the heart, manifesting as arrhythmias, cardiac injury and shock.
GastroIntestinal system, with diarrhoea, nausea and vomiting, and blood system leading to increased clotting with strokes and heart attacks in younger people being reported. It must be emphasised that most people infected with SARS-COV2, will remain asymptomatic or will only have very mild symptoms," said Parker.
Head of Infectious Diseases Head of Division of Infectious Diseases and HIV Medicine at Groote Schuur Hospital, University of Cape Town, Professor Marc Mendelson say the complications are similar to other countries.
Currently, Mendelson is working at the clinical interface in infectious diseases which now includes wards with persons under investigation for Covid-19 and confirmed Covid-19 cases.
“”This is predominantly a respiratory infection and thus the complications are those of pneumonia and Acute Respiratory Distress Syndrome (ARDS), with patients requiring various levels of oxygen therapy, escalating to requiring intubation and ventilation. Interestingly, we see a number of patients with loss of sense of smell (anosmia) and taste (ageusia). As this is a rapidly evolving clinical situation, we are learning as we go about the effects of this infection on our South African population”
When It comes to treatment, Mendelson says treatment is predominantly supportive. “Persons with mild infection require only symptomatic treatment with analgesics and antipyretics. Those with severe infection that need hospitalization usually need oxygen support in some form.”
“There are currently no proven treatments for the virus itself, although there are a number of medicines, some old, some new, that are the subject of large clinical trials to see if they work. These include chloroquine and hydroxychloroquine, a new antiviral called remdesivir, the antiretroviral medicine, lopinavir/ritonavir and a drug called toculizimab, which inhibits a specific pathway of the immune response to the virus that is overactive in some with Covid-19," added Mendelson.
The National public health institute of the United States, Centers for Disease Control and Prevention (CDC) website, regarding those Covid-19 individuals, who are isolating at home, they are deemed to have recovered if they meet these criteria:
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No fever for at least 72 hours without using fever-reducing medications
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Improvement in other coronavirus-related symptoms, such as cough or shortness of breath
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A period of at least seven days has passed since symptoms first appeared
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CDC's criteria includes two consecutive tests that are negative, which must be done 24 hours apart, along with no longer having a fever and seeing improvement in symptoms.
Here in South Africa, Parker says the incubation period of the virus is two to 14 days from contact. It is generally accepted for someone testing positive for Covid-19 to remain isolated for 14 days after last contact with a positive patient if asymptomatic.
If symptomatic, the isolation should last for 14 days after the symptoms start improving. In severe disease (patients admitted to hospital) isolation is 14 days after discharge.
“There has been a lot of speculation about antibody tests to determine whether someone is immune after infection, but none has been sufficiently validated yet," concluded Parker.