Change the world


The government’s guidelines on containing Covid-19 require considerable revision. They rely far too heavily on the strategy of testing as many people as possible (contact tracing), which has limited yield, and, given the shortages of test kits and the processing backlogs in the labs, this approach will not assist in dealing with this pandemic.

We also don’t have the systems to reach people in remote areas.

So how should we change the guidelines to deal with the continuing exponential rise and expected spike in Covid19 cases at a time when increasing numbers of people are returning to work?

We need to stratify testing, with the most-at-risk groups prioritised. Broadly, the stratification should be in three priority groups: priority A, B and C, which can be further subgrouped.

Priority A would have five subgroups: group 1 should be people with chronic cardiorespiratory problems such as Chronic Obstructive Pulmonary Disease, including emphysema and chronic bronchitis, history of destructive lung TB, structural lung disease, chronic heart disease and hypertension; group 2 would be patients with diabetes mellitus, particularly with end-organ involvement; group 3 would be individuals on immune suppressing treatment for cancer, transplants or immune disorders; group 4 would be people over 60; and group 5 would be HIV-positive patients at high risk (those with a CD4 count below 350 and an unsuppressed viral load).

Priority B would be all workers in health-care facilities including clinics, hospitals, frail care centres and old age homes.

Priority C would be all people who are not in the first two priority groups and this would be the low-risk category.

If anyone in any of the priority A groups experiences symptoms or has been exposed to someone who has tested positive for Covid-19, they must immediately get tested and quarantine or isolate.

Priority B group need to be tested immediately if symptomatic or exposed to a Covid19 positive individual to avoid the risk of transmitting in the workplace.

Subsequent management steps would depend on proximity of the worker to the positive individual, use of PPE at time of exposure, and test results.

If you are in priority C group and you are asymptomatic, keep to the basic measures of avoiding spreading Covid-19, and if symptomatic but not requiring hospital admission, then isolate.

If symptomatic and needing admission to hospital, you get tested immediately and are isolated.

Every citizen must be vigilant about observing safety and hygiene measures at all times.

Under the proposed new guidelines, if, for example, you are not in a priority category A or B, and someone in your workplace contracts Covid-19 and you were observing all the safety measures and wearing PPE, do you need to be immediately tested and isolated for seven days to two weeks?

No, you should not be immediately tested but you need to be vigilant about any early Covid-19 symptoms, such as a dry cough and shortness of breath, in which case you must immediately isolate.

Immediately testing a contact who is asymptomatic has a high chance of yielding a negative result during the incubation period of the infection. Should an individual be symptomatic, then they should isolate and be treated as having Covid-19 but only get tested if they are admitted to hospital.

Regarding isolating those who come into contact with a person with Covid-19, the Western Cape has produced new guidelines that suggest you do not need to be isolated for seven days to two weeks.

This differs from province to province. The Eastern Cape still stipulates that all those who come into contact with a person who has contracted Covid-19 must be isolated for 14 days.

We hope this will change. As long as preventive measures of Covid-19 are applied, the virus spread will be contained.

Most importantly, we have to educate the population that testing is only part of the fight.

Every citizen has to guard against contracting Covid-19 by treating all people you encounter as potential carriers.

You might be seeing your best friend for the first time in weeks but you still need to maintain the safe distance of 1.5m, wear your mask, sanitise and wash your hands.

Soap and water works well, and every person needs to be aware of what they touch at all times, including notes or coins, ATM cards or keys.

We all need to get into the habit of being hygiene-aware.

This is the most powerful defence we can exercise, not only to protect you from Covid-19 but from other diseases such as TB.

There is no problem with people returning to work and society returning to normal if everyone is committed to observing safety measures, including the use of PPE.

It is futile to keep people at home in congested circumstances where they can easily infect each other if they do not practise protective habits at all times.

We are not seeing enough education about this, or strong executive management of all the systems that need to work together to fight the pandemic, including the management of the quarantine and isolation sites.

Any guideline changes will only be as effective as their executive management, and thorough, continuous education of all our people.

This article appeared in The Herald (South Africa) on 10 June 2020 written by Profs Lungile Pepeta and Fikile Nomvete. 

Professor Lungile Pepeta (right), is a paediatric cardiologist and Executive Dean of the Faculty of Health Sciences at Nelson Mandela University; and Professor Fikile Nomvete, is a gastroenterologist and Medical Programme Director of NMU’s Medical School.

Contact information
Prof Fikile Nomvete
Director: Medical School
Tel: 0415041099