COVID-19: the effect on our personal health and on societal health

A panel discussion with Dr Michael Mol (renowned TV personality and founder of Hello Doctor), Dr Rudzani Muloiwa (Head of Paediatric HIV Clinical Services at Groote Schuur Hospital) and Dr Boshoff Steenekamp (Senior Strategy Advisor MMI Health) on personal health affecting social wellness, with particular emphasis on the COVID-19 pandemic in South Africa.

Michael asked Dr Muloiwa how coronavirus infects the human body.

Dr Muloiwa explained that viruses are not really alive so they must access live cells in order to reproduce. Viruses need very specific receptors to get into the human cells and these are mainly found in cells lining the respiratory tract and blood vessels. They hijack the cell and multiply themselves while the body tries to respond by fighting back. Medical science has had limited success in treating viruses because they merge with human DNA in order to reproduce, so to kill them there would be damage caused to the cell too. Scientists must find those unique differences between human cells and the virus then develop a way to target those differences. Bacteria on the other hand are very different to human cells so antibiotics have been developed to effectively destroy them but are ineffective against viruses.

Dr Muloiwa elaborated on how the human body fights back against these viral hijackers. The body mounts an immune response to fight against the virus, first by producing antibodies which help to attack the virus and secondly by stimulating cell mediated immunity which allows the body to kill the virus by eliminating the infected cells. It then retains the memory of how to fight the virus if it should attack the same individual again at a later time. The antibodies would then reproduce very quickly as they would know what to do to destroy that particular virus.

Michael asked if reinfection with COVID-19 was possible once one has had the disease and fully recovered. Because COVID-19 is a very young disease which doctors have had little more than six months to study, Dr Muloiwa said they simply do not know for certain at this stage. There is some evidence that the body may be able to retain memory of how to fight the virus the next time it attacks but there is also evidence of people losing antibodies after a number of weeks. This could be caused by the virus changing slightly as it infects other people, in this way confusing the body and making the virus unrecognisable on reinfection.

Michael asked Dr Steenekamp if the COVID-19 crisis has shown up our healthcare system and maybe the greater social system in South Africa. According to Dr Steenekamp,  in many ways South Africa has done exceptionally well in dealing with the crisis. It has shown that one of the central elements in controlling public health is stewardship of the health system and there has been excellent stewardship during this time. When there is a massive social disturbance such as COVID-19 has caused, society usually responds in a positive way. Since the 1918 pandemic there have been massive improvements in healthcare, insurance and funeral insurance. However, COVID-19 has shown up the great inequalities between South Africa’s public and private health systems. “This now creates an opportunity for us to actively engage to see how we can strengthen our whole system and improve our public system to such an extent that it is sustainable and serves all the people of the country,” explained Dr Steenekamp.

Since the country seems to have done well in the present crisis Michael asked Dr Steenekamp what should be learned from it, how the healthcare system should change and what should be improved upon in future to make sure everyone has access to healthcare.

Dr Steenekamp mentioned that for every 100,000 people on public health there are about 7 specialists while for every 100,000 on private health care there are 69 specialists. A big difference, but in OECD (Canada and the Organisation for Economic Co-operation and Development) countries, there are about 300  for every 100,000. This is just one example which shows that even private health care in South Africa is not top notch. Equity in healthcare financing is needed and there are certain steps that need to be taken to achieve it. For universal coverage cross-subsidisation will have to be addressed, from young, healthy people to sick, old people; from high income to low income. This will be a difficult system to design if all the needs in the country are to be met. Universal health coverage is redistributive… taking from the rich and giving to the poor… but it will require strong political leadership and stable systems in order to sustain it. It must also be affordable and there are ways of approaching this, but it will be a complex system to design. The country needs to get experts in healthcare financing around a table for some robust discussions on this topic. Now is the time to move forward on this problem.

Michael asked Dr Muloiwa to suggest when there might be a vaccine available for worldwide use and whether South Africa might have one soon. “Developing a vaccine is a long process which cannot be predicted,” explained Dr Muloiwa, “but it seems there are about 250 vaccine candidates worldwide, some of which are already at the stage of clinical trials and may prove to be effective. Producing sufficient quantities of the vaccine could be a problem, but it is hoped that there will be an effective vaccine available by early 2021.”

On being asked whether people should be afraid of coronavirus, Dr Muloiwa replied that more success has been achieved with communal involvement than with medical science. People following the rules of social distancing, washing hands, wearing masks etc., has helped to prevent the healthcare system from becoming overwhelmed. Doctors have also learned more about how to treat the infection. By continuing with these measures,  the populace will buy enough time for an effective vaccine to be developed.

Michael thanked Dr Muloiwa and Dr Steenekamp for their meaningful input in the panel discussion.

This panel discussion took place at Nation Builder’s 6th annual In Good Company conference (September 2020) looking at how we can “build back better”.