Doctors weigh in on extended lockdown

● Dissenting members of medical fraternity argue harm to livelihoods much more serious

As SA’s Covid-19 lockdown nears the end of the fourth week, some medical doctors are raising concerns about the approach taken by the government.

The doctors have highlighted the relatively small percentage of deaths compared with the number of infections and argue this needs to be considered against the huge damage being inflicted on the economy and human livelihoods.

The South African Medical Association has responded comprehensively, saying the strategy adopted by the government is the responsible one but that it is clear a tipping point will be reached when the lockdown becomes more damaging than beneficial. A wellknown Port Elizabeth physician, who asked not to be named, pointed yesterday to a new study in the latest heavyweight Lancet Infectious Diseases journal showing that just 0.66% of people infected by Covid-19 will likely die.

This new rate includes undetected asymptomatic cases.

The previous death rate without these cases included was calculated much higher at 1.38%.

According to the journal, even among the most vulnerable group of people over 80 years old, 90% would recover.

The doctor said the figures did not support the drastic lockdown imposed in SA.

“Fifty-seven million people die annually [worldwide] — that is 160,000 daily from heart attack, stroke, cancer, infections, trauma, etcetera.

“As of today there are 170,000 deaths due to Covid19, which is only 1,400 deaths daily since the first death on January 11.”

These figures needed to be measured against the human and economic effects, he said.

“An extended lockdown in SA has caused and is going to cause immeasurable economic hardship, and the social consequences could be catastrophic.”

Cape Town rheumatologist Dr David Gotlieb said in a post on his Facebook site that the virus was not going to disappear after the lockdown.

“We will not get rid of it for the next year or more, as it burns its way across the world, until we gradually develop resistance or, even better, get some real treatments or vaccines against it.

“We have to accept that it will be an ongoing risk for all of us, especially the elderly, and social distancing will be needed for the populations who are at risk.”

However, the country was right now at a crossroads in terms of the lockdown, he said.

“A country as a whole and its people cannot continue to exist without income.

“We have to resume life and the economy, and the politicians have to start to verbalise the truth: that the virus is not going to go away for a long time and that some — but, in fact, relatively few people compared to the number of infections — are going to die.”

Gotlieb said while global lockdowns had not helped to cure the virus, they had lowered the curve of acute admissions, buying time and improving the ability of public health systems to cope.

“But the time of lockdowns is passed. Economies will have to open up. Life will go on.

“Hopefully, humanity will learn from this and henceforth look after the entire planet including the environment.

“People need to learn the fundamentals of life, especially togetherness and caring and thought for the less fortunate.”

In a letter to The Herald on Friday, reader Karl Beyleveld quoted New York epidemiologist Prof Knut Wittkowski as agreeing that precautions about the sick and elderly should be taken but arguing that lockdowns were, in fact, counterproductive.

“The policy of social distancing prevents the necessary and desirable rapid spread of the virus to create herd immunity.

“Flattening the curve prolongs the virus life cycle. A rapid spike followed by a rapid plunge is preferable.

“Going outside kills respiratory viruses. Being locked indoors actually keeps the virus ‘healthy’,” Wittkowski said.

In a comprehensive response to the points raised, South African Medical Association chair Dr Angelique Coetzee said SA’s strategy was partly based on its heavy existing disease load.

“SA has high rates of hypertension, diabetes, and the big unknown factor — HIV.

“We really don’t know yet how this virus will affect HIVinfected people or those with existing or latent TB.

“So not taking measures to try to stem the spread and damage from the virus in the South African context might be considered very irresponsible.”

Coetzee said SA’s lockdown strategy had also taken cognisance of the state of the country’s health facilities.

“SA’s hospitals are already stretched particularly in the public sector.

“We have one of the highest disease burdens in the world, and already a low concentration of doctors in relation to the population.

“If the system was overrun before we had time to organise that might have resulted in additional lives lost.”

Coetzee said there was no way to determine which lockdown measures were appropriate and which were not given that they had been implemented differently and in some cases poorly across the country.

“There will absolutely be some tipping point at which the deaths and disease prevented through the lockdown measures are outweighed by the damage and the deaths and disease caused because of the lockdown, but we do not yet know what that tipping point is.”