As the COVID-19 pandemic unfolds, and the scientific community continues to gather evidence on the coronavirus, we should not lose sight of the two other epidemics that affect millions of South Africans daily, namely HIV and TB.
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The world is bearing arms against an unprecedented pandemic. South Africa is no exception. Due to its increasing spread and severity, the World Health Organisation (WHO) officially declared COVID-19 a global pandemic in March 2020.
Soon after the declaration by the WHO, South Africa initiated a national response and entered into a state of disaster. With this came rules of self isolation, social distancing and quarantine to reduce the spread of the virus.
As these events unfold, and as the scientific community continues to gather evidence on the coronavirus, we should not lose sight of the two other epidemics that affect millions of South Africans daily, namely HIV and TB — both are amongst the comorbidities with which people who are hospitalised for COVID-19 present.
The need for our healthcare systems to support essential health services has not diminished as a result of COVID-19. Our country still has well over seven and a half million people living with HIV, according to the Health Sciences Research Council’s 2017 household survey. Western Cape government data shows that HIV-infected people are about two times more likely to fall seriously ill with COVID-19.
We have evidence that shows that more than 4 000 people die of TB each day globally. Specific data on South Africa shows that this could be as high as 175 deaths each day. Furthermore, 2018 estimates suggest that over 300 000 South Africans developed TB in that year. Whilst these may appear to be just numbers, putting these into context places us amongst the top 7 countries with high TB global deaths, amongst countries such as India and Nigeria. The reality is that patients that are not treated are more vulnerable to other infections including coronavirus disease.
We are starting to see an increasing amount of research linking COVID-19 to various social and health conditions. There is no doubt that there is much we still do not know about this disease. As scientists and epidemiologists the world over continue to discover more information about the manifestation and transmission of the virus, advocacy groups and other research organisations globally and within our own borders are drawing links between COVID-19 and TB.
Recently, a report conducted by the Stop TB Partnership in collaboration with academic and donor organisations suggested that lockdown implemented over a 3 month period, could lead to over 1.4 million additional TB deaths over the next four years globally. In perspective, a three month lockdown could lead to as many TB deaths as those recorded in an entire year.
These numbers are indeed worrying, even more so when a recent analysis by our own National Institute of Communicable Diseases shows that the number of TB tests reduced suddenly after the lockdown was implemented at the end of March, and have continued to decrease thereafter.
It is evident that as we adhere to the national state of disaster, we also remain dedicated to seeing positive outcomes for TB patients. We take pride in the strides that we as a government and as a country have achieved over the past two decades to manage both TB and HIV.
We are cognizant that the pandemic has placed additional pressure on our healthcare system. Therefore, additional measures have been implemented specifically for people living with HIV and TB:
Services
We are of the opinion that interrupted treatment can lead to poorer outcomes for comorbid patients. As such, eligible, stable patients can receive more than a single month’s supply of treatment to take home. This means there are fewer patients visiting clinics, fewer people using public transport to visit clinics and fewer people standing in queues. In this way, we support the call by our president to stay at home as much as possible and limit the spread of the virus.
As noted, testing and diagnosis of TB has decreased since the lockdown began. A recent report shows that daily TB diagnostic tests using the GeneXpert decreased by 59%. Government has however increased the number of community mobile testing centres in response to COVID-19. This provides an opportunity for integrating screening patients for COVID-19 and TB symptoms, including different HIV testing protocols for those that show COVID-19 symptoms and those that don’t. During this period, patients with drug resistant TB are also screened for COVID-19 when they visit clinics. Moreover, safety measures have been implemented within our clinics to reduce the spread of the disease. We have also ramped up community level testing, in collaborating with NGOs and community health care workers, to reach as many people as possible.
As noted, testing and diagnosis of TB has decreased since the lockdown began. A recent report shows that daily TB diagnostic tests using the GeneXpert decreased by 59%. Government has however increased the number of community mobile testing centres in response to COVID-19. This provides an opportunity for integrating screening patients for COVID-19 and TB symptoms, including different HIV testing protocols for those that show COVID-19 symptoms and those that don’t. During this period, patients with drug resistant TB are also screened for COVID-19 when they visit clinics. Moreover, safety measures have been implemented within our clinics to reduce the spread of the disease. We have also ramped up community level testing, in collaborating with NGOs and community health care workers, to reach as many people as possible.
Misinformation
We live in an age of so-called fake news where we need to act against misinformation. We as the government therefore need to continuously amplify messages across our platforms that TB and HIV health services are still available and will continue to be available to the public. We also recognise that the world is gripped by fear. People may be afraid to leave home to seek healthcare, unless they feel seriously ill. In light of this, we do not take lightly the psychological effects of COVID-19. This is why we take advantage of the digital age and are exploring ways to implement telemedicine for counselling and support.
North West
Despite Gauteng and the Western Cape bearing the brunt of the virus, recent data shows that the mining sector in the North West province has been disproportionately affected by COVID-19. The North West provincial government continues with its test and trace efforts, as well as its TB and HIV test and treat strategies, — as recommended nationally — especially in vulnerable communities.
The North West province works with the National Institute for Communicable Diseases to manage the risk of SARS-CoV-2 infection within the healthcare system. We maintain our commitment to make more beds available in our hospitals. With over 25 000 cases currently reported in the Northwest, our essential services for TB and HIV are crucial. As such we have ramped up community case finding, follow-ups and tracing. We will do everything we can to ensure that patients are tested for HIV and TB, that those who test positive are initiated on treatment, and adhere to their treatment well enough so that they have suppressed viral loads (the amount of virus in their blood), which a large body have research has shown, significantly reduces their ability to infect others.
Honourable Madoda Sambatha is the Health MEC in North West province.
Honourable Madoda Sambatha is the Health MEC in North West province.
