Adam Welz's Weblog

South Africa: Why We Must Act As If Everyone Is Infected With the Coronavirus

Posted in Uncategorized by adamwelz on March 18, 2020

Open Letter To South Africans #2

Why We Must Act As If Everyone Is Infected

On Sunday night, President Ramaphosa made a speech that instantly changed South Africa. He made it very clear that the new coronavirus that causes Covid-19 is an extraordinary challenge, and that we need to act quickly and decisively if we are to have any hope of containing it and preventing the deaths of enormous numbers of people.

People are beginning to understand how serious the situation is. There has been panic buying in supermarkets. Many people are confining themselves to their homes. Tourism has dried up and small businesses are closing down. We are justifiably worried about the future.

But one important fact has not yet been well communicated to the public: This fact is that the new coronavirus can be transmitted by people who appear to be healthy. It is not only transmitted by people who appear sick.

Medical research shows that many people, especially children, teenagers and young adults, can be infected by the new coronavirus and not show obvious symptoms of illness. They can appear to be just slightly sick or even perfectly healthy, but at the same time they are infecting other people.

You will see messages like this on government websites, in shopping malls, and other places in South Africa:

Screen Shot 2020-03-18 at 10.05.29

Notice that it says “3 – Avoid close contact with people who are sick”? That makes it seem like only obviously-sick people, like people who are coughing and sneezing, can infect you with the virus if you get near them, which is not true. The truth is that even people who look healthy can infect you if they have the virus.

The new coronavirus is mainly spread through physical contact (touch), through droplets of spit when people cough and sneeze, on objects that infected people have recently touched (especially eating utensils that have spit on them) and via faeces (poo).

So experts say that in addition to paying special attention to hygiene (like handwashing), we must also try to stay at least two metres away from other people at all times, even if they appear to be healthy. 

This means that we must stay two metres away from other people in the shops, while waiting for transport, and while walking in public (and we need to figure out how to prevent virus transmission in taxis and other transport). We must close bars and restaurants and other places where people get close to each other (restaurants must do take-away only).

And when our kids’ schools and universities close down, we must keep them at home and away from other people. This is not the time to let our kids socialise with their friends, play in the streets, have parties or sleepovers. Our kids can infect each other and then bring the virus home. It is good for kids to get out into the fresh air, but they must be supervised and stay at least two metres away from everyone else while they do it.

Government and business need to update their messaging on physical distancing urgently. All images about the coronavirus outbreak must show people standing far apart. We need to work hard in our communities to close down places where people gather unnecessarily. Government needs to work hard to make sure that people who have lost their jobs get some form of income.

As I described in my earlier open letter, we need to do everything we can to slow down the spread of this virus or a lot of people will die. We must buy time for our medical system to prepare. We mustn’t panic, but we must act fast and decisively.

To fight this deadly virus together, we need to stay two metres apart.

Please pass this message on!

Best,

Adam Welz

YOU CAN FOLLOW ME ON TWITTER HERE: @AdamWelz

Those of you who would like to read more about the research and science behind this open letter can follow these links:

This is a good summary for non-scientists about ways of spread: http://www.cidrap.umn.edu/news-perspective/2020/03/study-covid-19-may-spread-several-different-ways

Here is a good article from CNN about asymptomatic transmission:

https://edition.cnn.com/2020/03/14/health/coronavirus-asymptomatic-spread/index.htmlhttps://edition.cnn.com/2020/03/14/health/coronavirus-asymptomatic-spread/index.html

This study details asymptomatic spread in a shopping mall in China: https://wwwnc.cdc.gov/eid/article/26/6/20-0412_article
Here’s a relevant Twitter threat from Harvard epidemiologist Eric Feigl-Ding: https://twitter.com/DrEricDing/status/1239050029605814273
Here’s an excellent article by a top epidemiologist about how different countries’ actions can change how COVID-19 will affect their population:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/fulltext 
Here’s an article about how the virus can spread via faeces (poo) and how that can endanger the population:
https://www.journalofinfection.com/article/S0163-4453(20)30111-0/fulltext

South Africa: Why We Must Close Almost Everything Now

Posted in Uncategorized by adamwelz on March 14, 2020

Open Letter to South Africans

WHY WE MUST SHUT DOWN NOW

[Update Monday 16 March 2020: Wow. This open letter got over 40,000 views in the first 24 hours it was up. Most of you now know that President Cyril Ramaphosa last night announced emergency measures to slow the spread of the new coronavirus. I think Ramaphosa gets how serious it is, and a couple of sources have told me that this letter made it to top CEOs and govt officials prior to his speech, which is great. One quibble with Ramaphosa’s message: I don’t think we should use the elbow greeting, especially if we’re sneezing into our elbows. I don’t think we should touch at all. We must stay at least 2 metres away from everyone else; when at the shops, when talking with friends, etc. It’s heartening to see that the South African govt and the private sector gets how serious this is, but we are now faced with the huge challenges of ramping up testing and treatment. We need to do everything we can to buy time!]

I am a parent of three children and live in Cape Town.

As you know, the coronavirus that causes COVID-19 is now here in South Africa, with an ever-increasing number of cases being confirmed nationwide and in Cape Town, including in at least one local school.

This has a lot of people worried.

I am trained as a biologist and work in the media. I’ve been researching the coronavirus and its effects, collating information from credible sources and consulting with healthcare professionals.

I am deeply concerned that the response in Cape Town and South Africa in general to COVID-19 is not yet strong enough. The real dangers of the disease, that it can spread largely unnoticed and overwhelm healthcare systems, have not been sufficiently publicised, in my opinion.

Because the disease is so new, medical scientists are still developing a full understanding of it, but enough is known to consider it a threat like we have not seen since the influenza pandemic of 1918, which killed tens of millions of people.

A few relevant facts:

– Older people are more seriously affected than younger people. [Update 15 Mar 2020 Although there are early indications from France that younger people are now also being seriously affected: https://www.5newsonline.com/article/news/nation-world/over-half-of-frances-300-coronavirus-icu-patients-under-age-60/] Almost no children have died, whereas people over 50 years old are at significant risk of becoming seriously ill or dying. (See graph below.) Death rates are significantly higher in areas without good medical care, or where medical facilities have been overwhelmed. People who are immunocompromised or have other health conditions like asthma are at far higher risk from COVID-19 than those who do not have other health conditions.

Screen Shot 2020-03-13 at 18.32.40

– The new coronavirus is more infectious than the regular flu. It can be transmitted by physical contact, by cough and sneeze droplets, and by contact with a surface that an infected person has touched (the virus can survive for days on certain surfaces).

– An infected person can be contagious days before symptoms of the disease are seen in that person. You can spread the virus before you feel sick.

– Even though younger people are less seriously affected, they can still transmit the virus to older people.

– There is currently no “cure” for COVID-19 (doctors treat the symptoms and hope that patients survive) and it will probably take between a year and 18 months to roll out a vaccine.

This means that the new coronavirus can spread rapidly through a population.

About 80% of those who contract the new coronavirus will get better without serious medical intervention. This figure has been widely publicised by various governments, including our own.

However, this is not the important figure to focus on, in my opinion: The 20% that need medical help is more important, especially because about 5-10% of COVID-19 sufferers require high-level hospital care to survive. Many require advanced life support like ventilators, not just for a few days, but for weeks, in order to survive. These systems need specially-trained staff to operate them.

Italy, which has an advanced healthcare system, has had its hospitals totally overwhelmed by COVID-19. The virus spread quickly, before experts were able to detect the spread. The country has now run out of ICU beds and ventilators. Many Italian hospital staff have themselves become sick with COVID-19, putting them out of action. Death rates have risen sharply because many patients are not getting the care they need to survive.

You can read horrifying accounts from Italian doctors here: https://www.independent.co.uk/news/health/coronavirus-italy-doctors-intensive-care-deaths-a9384356.html

In South Africa, our government hospitals already do not have enough ICU beds, ICU nurses and equipment like ventilators for those who need them. Private hospitals have barely enough, with very little spare capacity. If the new coronavirus spreads fast in South Africa, there is a very high likelihood that our medical system will be overwhelmed. Not only will large numbers of COVID-19 sufferers die, but large numbers of other people (like car crash victims or people suffering from other diseases) will also die, because there will be no ICU beds for them.

This means that we need to immediately enact serious protective measures to slow down the spread of the virus to avoid this nightmare scenario and the social and economic devastation that will follow. In the words of experts, we have to “flatten the curve”.

Screen Shot 2020-03-13 at 20.48.25

This virus spreads because people move around and come into contact with each other. So anything that stops this will reduce its spread.

Currently, the most effective means for slowing the spread of the virus is what experts call extreme social distancing, which means avoiding contact with other people as much as possible.

In practical terms:

– Do not touch, shake hands or hug, even with people who appear completely healthy.

– Keep a distance of 2 metres away from other people at all times, even if they appear healthy, to avoid cough and sneeze droplets.

– Isolate yourselves and your families in your homes, only going to populated places like shops if absolutely necessary. (You can go outdoors in the fresh air, so long as you keep a good distance from other people.)

– Close down events and places where large numbers of people gather, like concerts, sports matches, restaurants, churches and schools (a single infected person in Korea passed on the virus to well over 1,000 others by going to church and spending time in public places – read here: https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.html ).

Research has shown that testing underestimates the number of people infected with the virus in a particular area, because it often takes days for infected people to start showing symptoms and get tested, and days to get test results back from labs. For every COVID-19 infection confirmed by testing, there can be ten or twenty more that have not yet been confirmed. (https://www.businessinsider.com/coronavirus-uk-estimates-up-to-10000-british-people-already-infected-2020-3?IR=T )

Also, because the virus spreads so rapidly, and case numbers rise exponentially, it can be just a few days between everything seeming fine, with very few infections around, to thousands of sick people, collapsing health systems and social and economic chaos.

Because South Africa’s healthcare system is already so close to collapse, the smart and caring thing to do is to implement extreme social distancing measures before COVID-19 becomes an obvious problem, because by the time it becomes an obvious problem, it will be too late.

Some people – including many politicians – say that we can’t shut things down too much because that will hurt the economy, that we must just carry on our business as normal while taking a few precautions like washing our hands and sneezing in our elbows, and take the risk of losing a large percentage of our older people to a horrible death.

And it’s true that lots of people will lose income if we close sports stadiums, cinemas, music venues, tourist attractions, schools and restaurants. It’s not an easy decision to close these venues down.

But experts who study disease epidemics say that if we don’t close many things down, and we get hit by a rapid rise in COVID-19 cases, not only will our health systems collapse and death rates from everything (not only COVID-19) skyrocket, but our economy runs the risk of falling to pieces more rapidly and seriously than if we slow down the spread of the disease as much as possible.

If immediate shutdowns and extreme social distancing work to slow the virus down, then people will say we overreacted. THIS IS COMPLETELY OK. Experts say that the only way to get ahead of this virus is to do things that seem to be overreactions. (You can watch a short video clip about this here: https://twitter.com/ConallMcD/status/1238865202868883461)

I think that we should rather take the risk of overreacting at first, and then relaxing shutdowns later on if needed, than run the risk of not shutting things down in time and having out-of-control spread of the virus.

The more we slow down the spread of the virus, the more time we give medical science to develop effective treatments that can allow COVID-19 sufferers to survive.

So I’m asking you close your school, your church, your business etc. today. Not at the end of the week — today.

I’m asking you to use your influence in the community to immediately cancel all events at which numbers of people gather – religious services, fun runs, sports events, political rallies etc.

Everyone who can stay at home, should stay at home. Businesses should allow employees to stay at home and still get paid. Parents must make sure their kids who are off school *stay at home* and don’t spread the virus around their communities.

Research shows that even one day’s delay in acting can increase the number of people affected by COVID-19.

I don’t think it’s moral to risk the lives of our older people, and to risk catastrophic collapse of our health systems, just to keep certain financial measures looking OK for a little bit longer and avoid embarrassment for politicians.

It will be very hard for some families, who will need to make childcare plans for kids no longer in schools. [Schools may need to remain partially open to care for the children of medical workers, who are fighting the virus.] It will be very hard for many kids, who get meals at schools. Many in our community will lose income as COVID-19 bites. Many will become lonely as they isolate themselves in their homes. Learning may have to move online or into homes, if there is no internet. Extreme social distancing might have to go on for months, as we wait for a medical science to catch up with the disease.

We will have to rise to the challenge and find creative ways of dealing with all the problems that arise from extreme social distancing and shutdowns. We have no option, in my opinion. Viruses have no morals and can’t be negotiated with; they just do what they do, and it’s up to us to change our behaviour to deal with them.

Best regards,

Adam Welz

YOU CAN FOLLOW ME ON TWITTER HERE: @AdamWelz

NOTE: I believe we should take strong action right now to halt this virus, but this is not an invitation to panic. If you can, you should store some food, to prevent over-frequent trips into public spaces. But you should NOT go on a panic-buying spree, and you should NOT hoard masks, gloves, sanitisers, etc. Healthcare workers will need this equipment! They should have it.

NOTE: I updated the title of this post on the morning of 15 March to remove the emphasis on schools and emphasise that all places where large numbers of people gather should be closed immediately.

I recommend the following links

About how closing schools helps:

https://www.sciencemag.org/news/2020/03/does-closing-schools-slow-spread-novel-coronavirus

Why closing down in general helps:

https://www.vox.com/2020/3/10/21171481/coronavirus-us-cases-quarantine-cancellation

https://medium.com/@ariadnelabs/social-distancing-this-is-not-a-snow-day-ac21d7fa78b4

A long article with detailed explanation of the effectiveness of shutting down:

https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

ALSO: Here’s a huge guide for teaching online: https://www.theedublogger.com/teaching-online-school-closures/