The Western Cape has released South Africa’s first local data, which finds that although people with these common illnesses are more vulnerable to COVID-19, they are less likely to die from the new coronavirus than many previously thought.
People with TB and HIV have a two to three-fold increased risk of dying of COVID-19, according to data released by the Western Cape health department today. Although the data shows an increased risk, the risk is lower than what researchers expected.
As part of its analysis, the Western Cape reviewed 12 987 COVID-19 cases in its public sector, including 435 deaths. The department found that just over half of COVID-19 deaths were due to diabetes. In contrast, about one in 10 fatalities from the new coronavirus was due to being HIV positive and 2% were due to having active TB, departmental public health medicine specialist Mary-Ann Davies announced during a Bhekisisa and Aurum Institute webinar on Wednesday.
Almost all people living with HIV who died of COVID-19 had other underlying health conditions such as diabetes that put them at an increased risk of death. However, Davies said her team accounted for this when calculating the risk of COVID-19 death attributable solely to HIV.
“[Until now] we haven’t known whether we should consider people with HIV as being at higher risk [for COVID-19] or not,” said Davies. “So we should consider them as a risk group, both people with HIV and TB, but that increased risk is relatively small.”
Davies highlighted that people living with HIV tend to be younger and the risk of developing serious COVID-19 illness for young people is very low. But she added that many deaths among people living with HIV occurred in those with other underlying health conditions, such as diabetes and high blood pressure.
The preliminary results, which Davies cautioned was not a formal study, also found virtually no difference in the risk of dying from COVID-19 between HIV-positive people who were virally suppressed and those who were not.
When people living with HIV take their medication every day, it can lower the level of the virus in their blood down to very low levels, which is also called being virally suppressed. People who are virally suppressed cannot transmit the virus, shows almost two decades of research.
But Davies says these are early findings and that about two-thirds of Western Cape HIV patients are virally suppressed, which means that data on unsuppressed patients is relatively scarce.
The Western Cape dataset is not only the first in Africa but likely one of the largest such analyses released globally on coronavirus and HIV as well as TB.
“This is the first proper Africa data we have to start comparing ourselves to the rest of the world,” says Francois Venter, the divisional director of Ezintsha at Wits University’s faculty of health sciences. “It has huge implications for how we run our health programme and how we respond to COVID.”
Although not being on HIV treatment may not put people at an extremely higher risk of serious COVID-19 than others, it does place them at an increased risk of developing other diseases such as TB, which remains the leading cause of natural death in South Africa, according to Statistics South Africa.
Davies explains: “I think it really strengthens the message that we shouldn’t take our eye off our routine services for TB and HIV.”
Local research fills international gaps
Until now, South Africa has largely relied on data about the new coronavirus from other nations, such as China, to try to predict how the coronavirus might impact the country.
However, China and many other countries with early outbreaks of the new coronavirus have lower rates of HIV and TB than South Africa and lacked data on how these two diseases might impact COVID-19 outbreaks.
Without this kind of data, many scientists previously believed that having HIV and TB would likely sharply increase people’s risk of dying from COVID-19 if they were not on treatment.
Meanwhile, new data from the Western Cape mirrors that same pattern seen internationally, with those most at risk being people with diabetes, those over 70 years old, and people with high blood pressure.
Research from China, for instance, found that more than 80% of deaths among about 1 000 deaths were among those aged 60 or older, according to a study released earlier this year by the Chinese Centre for Disease Control and Prevention.
The Western Cape currently has the highest number of infections in South Africa with 33 568 cases and 829 deaths reported as of 8 June. Davies says the size of the Western Cape’s outbreak and its robust data systems puts the province in a unique position to provide South Africa with large-scale local data finally.
Given that the province has seen the majority of the country’s COVID-19 cases, this puts it in a unique position to provide the rest of the country with a roadmap for how we can expect the epidemic to progress.
[11:59am 12 June 2020: This story was updated to include additional information on underlying health conditions in HIV-positive people who died of COVID-19]