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Infectious Diseases

14 May 2020

Coronavirus morning update: Level 3 by end-May - but not for all, and symptoms to look out for in kids

Your latest coronavirus news: The president says SA will drop to Level 3 of the lockdown by the end of May, but some areas with higher infection rates will stay at Level 4; and a new study suggests that gastrointestinal symptoms might be the first hints of infection in children.

WHAT'S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 12 074.

According to the latest update, 219 deaths have been recorded in the country.

Total recoveries are 4 745.

So far, 386 352 tests have been conducted, with more than 16 650 new tests.

READ MORE | All the confirmed cases of coronavirus in SA

Latest news:

President Cyril Ramaphosa has announced the country will drop to Level 3 of the nationwide lockdown by the end of May, but some parts of the country with higher infection rates of Covid-19 will remain at Level 4.

Ramaphosa made this announcement during his address to the nation on Wednesday.

He said the National Coronavirus Command Council (NCCC) will begin a process of consultation on proposals for the implementation of the next level.

The president also announced that business activity under Level 4 will be expanded. "In the coming days, we will also be announcing certain changes to Level 4 regulations to expand permitted business activities in the retail space and e-commerce, and reduce restrictions on exercise." Ramaphosa said the government's objective has been to slow down the infection rate.

READ MORE | Most of SA can prepare for Level 3 lockdown at the end of May - Ramaphosa

The past seven weeks of lockdown has saved 1 752 lives - 35 people per day.

This was the calculation presented to the nation on Wednesday by President Cyril Ramaphosa in his first public address since 23 April.

He began with the plea that "despite its duration and severity, the lockdown we imposed was absolutely necessary". 

"Without the lockdown, the number of coronavirus infections would have soared uncontrollably. Our health facilities would have been overwhelmed and many thousands of South Africans would have died."

READ MORE | Lockdown has saved thousands, death toll could have been 8 times higher - Ramaphosa

Restrictions on retail and e-commerce during Alert Level 4 will be reduced by new rules soon, President Cyril Ramaphosa said on Wednesday night – but he provided no further detail.

Ramaphosa spent much of his address to the nation calling on South Africans to adhere to measures such as hand washing and wearing face masks, justifying South Africa's initial hard lockdown, and promising consultation and transparency.

By contrast he used only a handful of sentences to speak about new measures and regulations.

This, he said, will include lesser restrictions on exercise, and a likely move to Alert Level 3 for much of the country, except for the local areas where the rate of infection is high, at the end of May.

READ MORE | Retail, e-commerce rules may be relaxed soon, Ramaphosa says – but details still to come

The SA economy will likely endure pain for a little longer, with the economic hubs in the country likely to remain at Level 4 of the lockdown for the foreseeable future.

President Cyril Ramaphosa on Wednesday night announced that government would be working on getting most of the country onto alert Level 3, with the parts of the country with the highest rates of infection remaining at Level 4.

Data shows that infections are mostly concentrated in metropolitan municipalities and districts in the country. Government will, however, be announcing changes to the Level 4 regulations to expand business activities which may be permitted in the retail space and e-commerce.

Hugo Pienaar, chief economist at the Bureau of Economic Research, said that it appeared government was starting to heed calls for a quicker relaxation of the lockdown regulations. But with Level 4 being applied nationwide for the next two weeks, as well as metropoles like Cape Town likely to remain at Level 4 beyond May, means "economic pain" will persist. "Day-to-day life will continue to get worse, especially for the most vulnerable in society," he said.

READ MORE | Ramaphosa walks a tightrope as SA braces for further economic pain

Three million South Africans have already applied for the state's new R350 a month grant, President Cyril Ramaphosa said on Tuesday evening in an address to the nation. 

Applications for the grant opened on Monday. 

The R350 a month special grant is intended to provide money to unemployed South Africans who receive no other form of assistance from government.

If all three million applications are successful, the state would pay out an additional R10.5 billion a month, about half its current monthly social grants bill.

Government has also upped payouts to other grants by R5 billion a month, during "a time when other sources of income have been disrupted".

READ MORE | Ramaphosa: Over 3 million South Africans applied for new R350 a month grant in 3 days

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 Thursday morning, positive cases worldwide were more than 4.33 million, while deaths were more than 295 500.

The United States had the most cases in the world - close to 1.39 million, as well as the most deaths - more than 83 500.

READ MORE | All the confirmed cases worldwide

Latest news:

Pinning down the source of the coronavirus pandemic should help in working out how Covid-19 has "invaded the human species" so quickly, a senior WHO official told AFP.

The outbreak has triggered a fierce diplomatic spat between China and the United States -- with the World Health Organization at the centre of the row.

In late March, US President Donald Trump and his Chinese counterpart Xi Jinping struck an informal truce in the war of words over the origin of the deadly disease.

But it quickly broke down. Trump has been accusing Beijing of being slow to alert the world to the initial outbreak in Wuhan, and openly suspects China of covering up an accident at the eastern city's virology lab.

READ MORE | WHO stresses need to find source of coronavirus

LATEST RESEARCH

Coronavirus in children has been a bit of a mystery since the start of the outbreak. While initial research suggested that children are not as susceptible to severe Covid-19 as adults and those with co-morbidities, further studies indicated that children may be hit harder by Covid-19 than initially thought.

Because of guidelines telling us to look out for mainly three symptoms (a dry cough, fever and breathlessness), we might be missing Covid-19 in children, according to a new study published in Frontiers in Pediatrics.

The study suggests that gastrointestinal symptoms such as diarrhoea and an upset stomach might be the first hints of coronavirus infection, as SARS-CoV-2 doesn’t only attack cells in the lungs, but also cells in the digestive system.

Dr Wenbin Li from the Department of Pediatrics at the Tongji Hospital in Wuhan, China, explains this connection between the stomach and coronavirus: 

"The gastrointestinal symptoms experienced by these children may be related to the distribution of receptors and the transmission pathway associated with Covid-19 infection in humans. The virus infects people via the ACE2 receptor, which can be found in certain cells in the lungs as well as the intestines. 

This suggests that Covid-19 might infect patients not only through the respiratory tract in the form of air droplets, but also through the digestive tract by contact or faecal-oral transmission."

While Covid-19 is mostly a respiratory disease, the full scope of the disease is not yet fully understood and we may miss other symptoms.

READ MORE | Cough may not be key symptom of coronavirus infection in children

New information about the new coronavirus (SARS-CoV-2) is constantly emerging, which is critical in the race to develop a vaccine and treatment for Covid-19. In a recent discovery, scientists found that a patient’s genes may provide clarity on why one young, healthy individual can be almost unaffected by the virus, while another can become seriously ill and end up in the intensive care unit (ICU).

In looking for rare, ‘silent’ (hidden) gene mutations that are triggered by the virus, researchers are hoping it will take them one step closer to potential treatments.

It’s agreed that the Covid-19 virus causes severe disease and kills older people with chronic illness; those with underlying medical conditions such as diabetes and lung disease; and men, at a greater rate than young people.

However, in an unexpected twist, we’re seeing a minority of patients who are under 50 take up space in ICUs around the world as well – without any underlying medical conditions.

Speaking to AFP, and quoted in a ScienceAlert article, geneticist Jean-Laurent Casanova – director of the human genetics of infectious diseases laboratory jointly based at the Imagine Institute in Paris and Rockefeller University in New York – revealed that this amounts to roughly five percent of patients: "Someone who could have run the marathon in October 2019, and yet in April 2020 is in intensive care, intubated and ventilated."

Casanova’s goal is to find out if these patients may possibly have rare genetic mutations. "The assumption is that these patients have genetic variations that are silent until the virus is encountered," he explained.

READ MORE | Why can two young and healthy individuals be affected so differently by coronavirus?

The general goal is to try and distance yourself as much as possible from the novel coronavirus. However, a controversial approach called 1 Day Sooner is aiming to purposely infect a large number of volunteers with the virus to speed up clinical trials. 

When Health24 reported on this approach in late April 2020, 2 300 volunteers had already signed up for this grassroots effort. But that number has now grown to more than 16 000, according to the latest reports.

Co-founder Josh Morrison wants to use this campaign to demonstrate that many people are keen to participate in helping to speed up clinical trials and the possible success of a vaccine.

Without a successful vaccine or treatment, the only reality is to live with the virus and practice measures of physical distancing. A vaccine is the only way to return to a normal world as we know it. Unfortunately, developing a vaccine takes a long time and comprises several stages – the four phases of clinical trials being crucial to establish safety and efficacy in a large, diverse group of people.

Morrison stated that the goal of 1 Day Sooner is to recruit as many people as possible to pre-qualify them as suitable to participate in human trials as they occur.

But what about the ethics and risks involved in voluntarily being infected with a virus? Dr Nir Eyal, director of the Center for Population-Level Bioethics at Rutgers University agrees that it’s not a standard approach, but that it may hel

READ MORE | 16 000-plus people have volunteered to be infected with coronavirus - but no sign trial will go ahead

Two new reports suggest that the warm summer months will not significantly slow the novel coronavirus as it spreads around the globe.

"Summer is not going to make this go away," said Dionne Gesink, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health who co-authored an 8 May report in the Canadian Medical Association Journal that found neither temperature nor latitude altered Covid-19 infection rates. However, school closures and other public health measures did.

"It's important people know that," Gesink said in a journal news release. "On the other hand, the more public health interventions an area had in place, the bigger the impact on slowing the epidemic growth. These public health interventions are really important because they're the only thing working right now to slow the epidemic."

American researchers came to a similar conclusion in a paper that has not yet been peer-reviewed.

In that report, researchers led by Hazhir Rahmandad, an associate professor of system dynamics at MIT Sloan School of Management, found that summer weather is not likely to halt the transmission of the Covid-19 coronavirus.

"Even though high temperatures and humidity can moderately reduce the transmission rates of coronavirus, the pandemic is not likely to diminish solely due to summer weather," Rahmandad said in an MIT news release.

READ MORE | Will warmer temperatures help contain coronavirus? Two studies say not really

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.

READ MORE: Coronavirus 101 

Image credit: Getty Images