Comorbidity and Covid-19

Ensure that those with pre-existing conditions take their chronic medication

FOR EVERY South African, the Covid-19 pandemic has been a herald of change, with the deadly plague creeping into nearly every nation and state on the planet.

The virus is a red thread that has been woven into the very fabric of our being.

We experienced an unprecedented national lockdown, the likes of which have never been seen before. Even after some of the regulations have been lifted, some now fear the outside world because of this invisible foe that we face.

But we cannot allow this fear to force back the progress we have made in the fight against chronic ailments like Tuberculosis and HIV/AIDS, which have long beset our country, and which remain an issue even during this time of the corona crisis.

In this time of Covid-19 calamity when comorbidities may be the difference between life and death, taking chronic medication is all too important.

HIV has has held pandemic status globally for decades.

In South Africa, it is estimated that 7.6 million citizens are carriers of the virus, with 4.5 million undergoing antiretroviral therapy.

During the lockdown, there has been a 17% decline in viral load tests, and a consequent decline in HIV testing and the initiation of antiretroviral therapy.

According to data from Médecins Sans Frontières (Doctors Without Borders) in Khayelitsha on the outskirts of Cape Town, the initiation of antiretroviral treatment had halved in March and dropped by more than 50% in April.

The implications of these declines are both stark and grim.

With fewer people starting antiretroviral therapy and viral load monitoring, we may see an increase in viral resistance, a spike in transmissions of the virus and a surge of life-threatening co-infections like tuberculosis.

In May, the National Institute of Communicable Diseases (NICD) recorded a significant drop in TB testing since the first day of lockdown in March.

Before the lockdown, the institute conducted an average of 47 520 TB tests every single week.

This plunged to a median of 24 574 tests a week, representing nearly a halving of tests critical in detecting and monitoring the disease.

According to their report, the NICD attributed this to restrictions on movement and public transport.

Regarding drug-resistant TB, there has been a massive decrease in case finding and treatment, figures here also almost halving during the lockdown.

But while HIV and TB carry a certain notoriety, chronic diseases like diabetes cannot be forgotten.

Research conducted by the Human Sciences Research Council in March indicates that 13% of South Africans surveyed were unable to access their chronic medication during the lockdown.

Of greater concern, the study found that 13-25% of people living in informal settlements or rural areas revealed that their chronic medication was anything but easily accessible.

These figures should startle, for the simple fact that comorbidities like diabetes or high blood pressure are a harbinger of doom for most of those who will contract Covid-19.

Make no mistake, South Africa is dealing with what is arguably the biggest health crisis in our recent memory.

This is a war that is waged on many fronts, and while attention is drawn to the advance of the coronavirus, we must take heed of the fact that there are other threats on the horizon.

These threats have long been an albatross around our necks and losing ground in this theatre would be devastating.

Not only because it sets the scene for more death and sadness because of those lost to Covid-19, but that it renders our sustained effort to eradicate them completely an exercise in folly.

While the threat of Covid-19 remains a reality, it has never been more important for people to take their medication.

Memeh is a general practitioner based in Johannesburg