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Infectious Diseases

10 June 2020

Coronavirus morning update: Latest on cigarettes, booze and spotlight on comorbidities

Difficult to say when the cigarette ban will be lifted; stop the booze fake news; and comorbidities and Covid-19 - hypertension, diabetes, TB, and HIV in the spotlight.

WHAT'S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 52 991.

According to the latest update, 1 162 deaths have been recorded in the country.

There have been 29 006 recoveries.

So far, 968 070 tests have been conducted, with 25 012 new tests.

READ MORE | All the confirmed cases of coronavirus in SA

Latest news:

It is difficult to say when exactly the cigarette ban will be lifted, President Cyril Ramaphosa said in response to a written parliamentary question.

DA MP Annette Steyn asked what empirical evidence the National Coronavirus Command Council (NCCC) relied on to "collectively ban" the sale of tobacco products during the national lockdown and to contradict Ramaphosa's initial announcement on 23 April that the sale of tobacco products would be permitted during Level 4 of the government's risk adjusted strategy.

She also asked on what date it's envisaged that the ban on the sale of tobacco products would be lifted.

Ramaphosa's response read: "At this stage, it is difficult to determine when the ban on the sale of tobacco and related products will be lifted. This will depend on such factors as the progression of the disease in South Africa, the readiness of our health systems and evolving knowledge on the nature and impact of the virus itself."

Ramaphosa said the decision to promulgate the Disaster Management Regulations, including regulation 27 which prohibits the sale of tobacco products "was taken after careful consideration, not only of the submissions received, but also the relevant medical literature focusing inter alia on the effects of smoking on public and individual health, especially in the face of a respiratory illness such as Covid-19".

READ MORE | Difficult to say when cigarette ban will be lifted - Ramaphosa

The Beer Association of South Africa (BASA) has called on South Africans to refrain from peddling fake news, following rumours the ban on the sale of alcohol will be reinstituted as it is not only a criminal offence, but can also lead to panic buying.

On Monday, News24 reported on WhatsApp voice notes and messages that were circulating which claimed a decision had been taken to re-impose the prohibition on the sale of alcohol.

Department of Cooperative Governance and Traditional Affairs spokesperson Lungi Mtshali said a statement would be issued, but he confirmed the rumours were nothing more than misinformation.

"The Cabinet has not even met since the regulations came into effect, so there hasn't even been a discussion on the matter," Mtshali added.

In a statement, crafted alongside South African Breweries (SAB) and others in the alcohol industry, the BASA reiterated liquor sales would not be suspended this week.

"We call on all South Africans to refrain from spreading fake news," it said.

READ MORE | Sale of liquor will not be banned, beer association reiterates, amid rumours

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.

"[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.

READ MORE | People living with HIV, TB at 2- to 3-fold higher risk of Covid-19 death

Here are the most prevalent accomplices which conspire with Covid-19 to kill, according to Western Cape data: diabetes and hypertension.

Since the global pandemic arrived on South African shores, health authorities have warned that certain "comorbidities" are most-often prevalent.

Now, data compiled by the Western Cape government on deaths has broken down which comorbidities were prevalent by age, and has also given more insight into the impact of HIV and TB.

Last week, President Cyril Ramaphosa was briefed on the most life-threatening, as he visited the embattled province which leads the country by cases.

The top five are diabetes, hypertension, HIV, obesity and asthma/chronic respiratory disease. This was part of an exhaustive 68-page presentation to the first citizen by the Western Cape government on Friday.

But it was not just single illnesses to which Covid-19-infected succumbed: A full 65% of the patients cited had more than one comorbidity. And two out of five had three or more.

INFOGRAPHICS | Covid-19: Diabetes, hypertension and HIV - what Western Cape's deaths data shows

WHAT'S HAPPENING IN THE REST OF THE WORLD 

Cases update:

For the latest global data, follow this interactive map from Johns Hopkins University & Medicine.

Late on Tuesday night, positive cases worldwide were more than 7.18 million, while deaths were close to 409 000.

The United States had the most cases in the world - more than 1.97 million, as well as the most deaths - almost 112 000.

READ MORE | All the confirmed cases worldwide

Latest news:

When epidemiologists talked about "flattening the curve," they probably didn't mean it this way: the US hit its peak coronavirus caseload in April, but since that time the graph has been on a seemingly unending plateau.

That's unlike several other hard-hit countries which have successfully pushed down their numbers of new cases, including Spain and Italy, which now have bell-shaped curves.

Experts say the prolonged nature of the US epidemic is the result of the cumulative impact of regional outbreaks, as the virus that started out primarily on the coasts and in major cities moves inward.

Layered on top of that are the effects of lifting lockdowns in parts of the country that are experiencing rising cases, as well as a lapse in compliance with social distancing guidelines because of economic hardship, and in some cases a belief that the threat is overstated.

"The US is a large country both in geography and population, and the virus is at very different stages in different parts of the country," Tom Frieden, a former director of the Centers for Disease Control and Prevention told AFP.

READ MORE | Why the US is experiencing a coronavirus plateau

LATEST RESEARCH

High blood pressure, medically known as hypertension, is a serious medical condition that affects an estimated 1.13 billion people worldwide, according to the World Health Organization (WHO) – most of them in low- and middle-income countries.

According to new research published this month in the European Heart Journal, patients with this condition have a double risk of dying from Covid-19, the disease caused by the new coronavirus, than patients without it.

The study was carried out by researchers in China and Ireland who looked at data from 2 866 patients with Covid-19. The patients were admitted to Huo Shen Shan hospital in Wuhan, China, earlier this year. Out of these patients, 850 presented with a medical history of high blood pressure.

The researchers found that 34 out of 850 patients (4%) with Covid-19 died, compared to 22 out of 2 027 (1.1%) patients without hypertension. This was after they took into account factors that may have affected the results, such as age, sex and other medical conditions.

READ MORE | Covid-19 patients with high blood pressure face higher risk of death, study says

As the world grapples with the pandemic, social distancing and lockdown measures have widely been implemented on the basis that many carriers might not know that they have the coronavirus, with mild or no symptoms to prompt getting tested.

During a briefing on Monday, a top World Health Organisation official a made a startling statement on asymptomatic carriers of the virus, prompting backlash.

Dr Maria van Kerkhove - head of WHO’s Emerging Diseases and Zoonosis Unit - said that it would seem that it’s rare that asymptomatic people spread Covid-19.

“We have a number of reports from countries that are doing very detailed contact tracing. They are following asymptomatic cases, they’re following contacts and they’re not finding secondary transmission onward - it’s very rare and not much of that is published in the literature,” said Van Kerkhove in the conference.

READ MORE | Top WHO official backtracks on comments that asymptomatic spread of Covid-19 virus is 'rare'

On 29 May 2020 Health24 published an article on the possible repercussions that false negatives for coronavirus could have in containing the spread of Covid-19.

According to the latest research published in the Annals of Internal Medicine, the odds of a false negative through RT-PCR, the most commonly used test, is one in five.

Now, further research from the Geisel Medical School of Dartmouth suggests that even more emphasis should be placed on addressing these inaccuracies, as testing is crucial to containing the pandemic.

According to lead author, Prof Steve Woloshin from the Geisel School of Medicine at Dartmouth and of the Dartmouth Institute for Health Policy and Clinical practice, there are two ways in which the current diagnostic tests, which involve a swab from the nasal passage, can be inaccurate:

"A false-positive result mistakenly labels a person infected, with consequences including unnecessary quarantine and contact tracing. [Secondly], false-negative results are far more consequential because infected persons who might be asymptomatic may not be isolated and can infect others," he stated in a news release.

READ MORE | More emphasis on accuracy of tests vital before Covid-19 pandemic can be fully contained

Scientist across the world became interested in the drugs hydroxychloroquine and chloroquine after an in vitro study (done in a lab) in China in February showed promising results in combatting Covid-19.

The drug which has anti-inflammatory and anti-viral properties, also showed promising signs in animal studies and in some small clinical studies done early in the Covid-19 pandemic. Soon the rush was on and countries like Australia and the US began stockpiling the drug previously best known as a treatment for malaria.

Hydroxychloroquine has however to date not been proven effective to treat Covid-19 in humans, especially in placebo-controlled, randomised controlled clinical trials, considered the gold standard for medical evidence.

While low-dose chloroquine has an extensive safety track record of long-term use for malaria prevention and treatment of auto-immune disorders like lupus, higher doses of chloroquine and hydroxychloroquine can be toxic and, among others, cause heart problems. Hydroxychloroquine is a less toxic version of its close cousin chloroquine.

READ MORE | Covid-19: What’s next for hydroxychloroquine?

HEALTH TIPS (as recommended by the NICD and WHO)

• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing

• Practise frequent hand-washing, especially after direct contact with ill people or their environment

• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus

• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.

Image credit: Getty Images