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Infectious Diseases

04 July 2020

Coronavirus morning update: Latest on Covid-19 treatments in SA, and lost test samples

A dexamethasone producer in SA has sold out its stock; a generic of remdesivir is coming to SA; and NHLS fires courier company after losing Covid-19 samples.

WHAT'S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 177 124.

According to the latest update, 2 952 deaths have been recorded in the country.

There have been 86 298 recoveries.

So far, more than 1.74 million tests have been conducted, with 39 025 new tests.

READ MORE | All the confirmed cases of coronavirus in SA

Latest news:

A local manufacturer of dexamethasone has temporarily run out of stock amid strong demand for the medicine.

The cheap steroid, which is available from R149 an injection in South Africa, has been hailed as a breakthrough treatment to reduce fatalities among severely ill Covid-19 patients.

Since a study by the University of Oxford showed that dexamethasone can reduced deaths by one-third in patients on ventilators, demand for the medicine – which is also crucial in the treatment of cancer patients in South Africa – has surged.

The global group Fresenius Kabi, headquartered in Germany, has a plant in Port Elizabeth which produces dexamethasone injections.

A spokesperson told Business Insider that there is currently “dramatically increased demand” for the medicine.

READ MORE | A dexamethasone producer in SA has sold out its stock - as demand for the Covid19 drug surges

The United States has purchased more than 90% of the world's supply of remdesivir, the only proven treatment for Covid-19, in a move that leaves little for the rest of the world for at least the next three months.

However, a generic version of the drug is heading to South Africa later this month, and it will be much, much cheaper than in the US.

Gilead Sciences, the US-based company that makes the drug, agreed to sell more than 500,000 treatment courses to the US until September, which is almost the entire amount it has the ability to produce.

Remdesivir, which was originally developed to treat Ebola, has been shown to help moderately ill patients recover more quickly from Covid-19.

Generic alternatives for the drug exist, but patent laws means that only low- and middle-income countries can produce their own. Gilead Sciences has licensed companies to do this in 127 countries – including South Africa.

The drug will be manufactured and distributed in South Africa through Cipla, and that company says the initial batch of 30 000 be ready at the end of the month.

More good news is that the drug will be much, much cheaper in South Africa, than in the US. In an emailed response to questions from Business Insider South Africa, Cipla said it will charge $55 (about R940) for a vial of generic remdesivir. A typical course uses about six vials, so you might end up paying in the region of R5 600. Cipla is charging the same price for public and private hospitals.

READ MORE |The US is buying Covid-19 drug remdesivir like crazy. A generic is coming to SA – cheap. 

The courier company that lost a cargo of Covid-19 samples in transit on the N2 in the Eastern Cape has been fired after the actions were found to be negligent and risked human life, the National Health Laboratory Service (NHLS) said in a statement.

NHLS chief executive Dr Kamy Chetty said the pathology institution terminated the services of Gibela Trade and Invest 1328 CC with immediate effect.

Chetty said the actions of the courier company and their staff were found to be negligent and a risk to human life.

Announcing the sacking, Chetty said: "The loss of the specimens amounts to a violation of the patient's rights to protection of their medical records, privacy and confidentiality and the right to dignity. It potentially places the lives of those patients and their families at risk as well as those members of the public that may have come into contact with any positive specimens."

On Monday, eNCA reported that a jogger discovered hundreds of test kits on the N2.

READ MORE | NHLS fires courier company for 'risking human life' by losing Covid-19 samples

Plans to relocate 1 600 Johannesburg residents in Covid-19 hotspots to safer areas are officially underway, with residents set to move in the next four months.

As Covid-19 cases spike in Gauteng, especially in Johannesburg, Mayor Geoff Makhubo says the programme must be implemented quickly, adding that he has been given a time frame of four months.

On Friday, Makhubo revealed the land which would be used to relocate residents from Wards 109 and 108 (made up of Marlboro, Eastgate, Kelvin, Wendywood, Morningside Manor and Alexandra).

"We realised… that some places, you can't practice social distancing. As part of our intervention, we decided to identify some areas here in Marlboro, Zandspruit, Ivory Park [and] Soweto, where we will be relocating some communities," he said.

"In four months, the first project will be on the ground and we will be moving people from Ward 109 and 108 into this programme.”

READ MORE | Covid-19 hotspots: Joburg residents to be relocated in next 4 months, says Mayor Makhubo

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.

Early on Saturday morning, positive cases worldwide were more than 10.98 million, while deaths were more than 523 000.

The United States had the most cases in the world - more than 2.78 million, as well as the most deaths - more than 129 000.

READ MORE | All the confirmed cases worldwide

Latest news:

Poor Italians are significantly more likely to die of the coronavirus than higher-income groups, the country's first significant study into the disease's disproportionate social impact showed on Friday.

Italy is one of the world's worst-hit countries with almost 35 000 Covid-19 deaths since its outbreak emerged on 21 February and it was the first European nation to report large-scale infections.

In its annual report, national statistics bureau ISTAT studied mortality rates for each month from January 2019 to March 2020, when the outbreak took off, focusing on the education levels of those who died.

On average, Italians who leave school early with few qualifications have lower life-expectancy than those who study for longer, ISTAT said, and this "excess mortality" remained roughly constant through February this year.

READ MORE | Coronavirus mortality in Italy is highest among poor, study shows

LATEST RESEARCH

Respiratory issues, fever and a loss of taste and smell – these are well-reported symptoms of Covid-19. However, delirium is another, almost forgotten, symptom of the disease that is sweeping across the world.

This cognitive condition is generally caused by an underlying condition, which reduces awareness, instils extreme confusion and even causes hallucinations in affected patients.

One of the causes of delirium is a lack of oxygen in the brain, and Covid-19 has been proven to reduce oxygen levels in the blood, causing hypoxia.

Before the pandemic, delirium mostly presented itself in elderly hospitalised patients. It is something that can easily be prevented. But the coronavirus changed all that.

READ MORE | Delirium: The forgotten, preventable symptom of Covid-19

Research on Covid-19, the disease caused by the new coronavirus, is ongoing, and while information is still limited, we do know that it is not infecting children as frequently or severely as adults.

Given that millions of South Africans live with long-term conditions including allergic disorders such as eczema, hay fever and asthma (one of the most common chronic diseases affecting children), parents and caregivers are being extra cautious, especially considering that asthma, like Covid-19, is a lung disease.

Professor Claudia Gray, paediatrician and allergist at Kids Allergy – Paediatric and Allergy Centre answered some pertinent questions on the topic in a live interview hosted by the Allergy Foundation South Africa (AFSA). Here’s what families of children with asthma and allergies should know.

Although there are certain risk factors that put one at greater risk of developing Covid-19 complications, such as being over 65, diabetes, hypertension, and chronic heart disease, people are concerned about whether asthma counts as one of those chronic lung diseases which might increase their predisposition to severe Covid-19.

The answer is that it could "possibly" put you at risk, said Gray, but only if you have severe, uncontrolled asthma, or asthma with other comorbidities such as damaged lungs, high blood pressure or diabetes, for example.

READ MORE | Asthma, allergies, Covid-19 and your child: here’s what you need to know

While the scientific understanding of the SARS-CoV-2 virus is constantly improving, so is our understanding of practical methods to treat this life-threatening disease.

Doctors at two of the Western Cape’s most impacted Covid-19 hospitals say they have seen positive outcomes from using high-flow nasal oxygen (HFNO), a non-invasive oxygen therapy, instead of mechanical ventilation. They say they are now using HFNO for many patients who would have been intubated in the early days of the epidemic.

Dr Saadiq Kariem, Chief of Operations for the Western Cape Health Department, said in a media briefing last week that the province had 121 HFNO machines available at hospitals, with another 42 on order, bringing the province’s total to 163.

“It’s made a real difference in Groote Schuur and Tygerberg and preparing for high-flow oxygen as an alternative to people having to be on ventilators,” says Kariem. “[HFNO] can be provided not only in a high-care bed, but we have also been providing [it] in a normal, acute bed. That relieves some pressure on our high-care beds, and that’s generally the strategy at all our hospitals and facilities.”

READ MORE | Covid-19: How high-flow nasal oxygen is saving lives and sparing some patients the trauma of intubation

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