OCCUPATIONAL HEALTH SERVICES

“This makes it more urgent that more and more people come forward to be vaccinated because we want everybody in our country to be protected from this inevitable fourth wave.

“If we all vaccinate, we can have a safe and enjoyable festive season. We call on all South Africans to head the Vooma [Vaccination Weekend] call and come forward and be vaccinated,” he said.

At least 23 million people in South Africa have received at least one jab with at least 70 000 doing so on Election Day; constituting just under 40% of the country’s adult population.

The Western Cape, Free State, Eastern Cape and Limpopo are close to reaching at least 50% vaccination of their populations.

Some 13 million people are now fully vaccinated.

The Minister said the vaccination rollout plan remains resilient with the department having enough capacity to vaccinate all eligible residents of the country against the virus.

“We can do this by the end of December. Our teams in the provinces are taking vaccines to the people over and above the fixed vaccination sites.

“As we start to use more and more of the one dose Johnson and Johnson vaccine, we will be able to cover more full vaccinations in the next few days and weeks,” he said.

Some 63% of the more COVID-19 vulnerable 60+ age group has been vaccinated; about 57% of those over the age of 50 have been vaccinated.

At least 250 000 children aged between 12 and 17 have now taken the vaccine.

The Minister said the country’s younger population between the ages of 18 and 34 were not taking up vaccination as well as hoped.

“The uptake…is worrisome [and] moving very slowly at the current moment with just under 25%. It is clear that in this population of young adults, fake news on social media is making a huge impact driving away [or] keeping away many of our young adults from vaccination.

“We are hoping that as we get closer to the festive season – because they will be more at risk because of social and entertainment activities – that many more of our young adults will come forward,” he said.

Sisonke study booster shots programme

The Minister revealed that at least 83 000 health workers have registered to participate in the programme.

“Out of those, just over 9 000 have already received their booster doses. We are hoping that all the 500 000 health workers who received the Sisonke one will come forward to participate in the Sisonke Two study.

“The results of this study will give us a better indication of the role of booster doses…how much immunity was waning and if so, how much additional strengthening of immunity will happen after the…booster doses,” he said.

Vaccination certificates

According to the Minister, more than three million vaccination certificates have been downloaded by vaccinated residents since the launch of the Vaccine Certificate system in October.

He added that the QR scanning technology – which allows users to create a code which verifies their inoculation status – is expected to be available from next week.

Minister Phaahla said although the certificates are now available in South Africa, not all countries would be accepting them as proof of inoculation.

“The reason is that countries have to come to an agreement on recognising each other’s certificates. So because this is still new and developing…even from our side we had not yet started negotiating with other countries because…the certificates still needed a lot of improvements.

“There are more security features which will be enhanced during the course of this month so as security features improve…we will be negotiating with countries and multi-lateral bodies,” he said.

This article was first published on businesstech.co.za

SARS-CoV-2, the virus that causes COVID-19, was first identified in December 2019. By December 11, 2020, the Pfizer vaccine became the first to receive emergency use authorization from the Food and Drug Administration (FDA).

Creating a vaccine in under 1 year is no small feat. While the coronavirus pandemic made a new normal of mask-wearing and physical distancing, it also spurred global cooperation for vaccine research and distribution.

However, a vaccine is only effective if people are willing to receive it. With rapid research development, some may be concerned that the vaccine was rushed, and with these concerns comes vaccine hesitancy.

A study that appeared in Nature Medicine in October 2020 surveyed 19 countries to investigate the acceptance of COVID-19 vaccines. The researchers found that only 71.5% of the respondents would consider taking a COVID-19 vaccine and that only 48.1% would take it if their employer recommended it.

By October 2021, healthcare workers had delivered more than 7 billion doses of the COVID-19 vaccine globally. However, vaccine hesitancy remains.

According to an ongoing Kaiser Family Foundation survey, 16% of respondents will “definitely not” get the vaccine.

Considering that the fastest vaccine — the mumps vaccine, which is now part of the MMR vaccine — took 4 years to develop, it is natural to have some apprehension over the safety and effectiveness of a new vaccine.

Dr. Sam Sun is a chief resident at Baylor College of Medicine in Houston and the director of the inDemic Foundation, a non-profit organization that provides information about COVID-19.

He told Medical News Today that transparency throughout the vaccine process will be key to debunking misinformation and building the public’s trust.

Other coronaviruses

Researchers were not starting from scratch when they learned about SARS-CoV-2, the virus that causes COVID-19.

SARS-CoV-2 is a member of the coronavirus family. According to the National Institute of Allergy and Infectious Diseases, there are hundreds of coronaviruses. These include four that can cause the common cold, as well as the coronaviruses that sparked the SARS, or severe acute respiratory syndrome, epidemic in 2002 and the emergence of MERS, or Middle East respiratory syndrome, in 2012.

Dr. Eric J. Yager, an associate professor of microbiology at Albany College of Pharmacy and Health Sciences in Albany, NY, told MNT that scientists have been studying coronaviruses for more than 50 years. This meant that scientists had existing data on the structure, genome, and life cycle of this type of virus.

Dr. Yager explained, “Research on these viruses established the importance of the viral spike (S) protein in viral attachment, fusion, and entry, and [it] identified the S proteins as a target for the development of antibody therapies and vaccines.”

He continued: “Early efforts by scientists at Oxford University to create an adenovirus-based vaccine against MERS provided the necessary experimental experience and groundwork to develop an adenovirus vaccine for COVID-19.”

Worldwide collaboration

Under normal circumstances, making a vaccine can take up to 10–15 years. This is because of the complexity of vaccine development.

Dr. Michael Parry, the chair of infectious diseases at Stamford Health in Stamford, CT, told MNT that vaccines train our immune system to remember an infectious agent without us having to contract it.

“Traditionally, they have contained weakened or inactivated parts of a particular virus (antigen) to trigger an immune response within the body. These vaccines will prompt the immune system to respond, much as it would have on its first reaction to the actual pathogen.”

However, amid a global pandemic, time was a luxury the world could not afford. Researchers quickly mobilized to share their coronavirus data with other scientists.

Dr. Yager said that thanks to advances in genomic sequencing, researchers successfully uncovered the viral sequence of SARS-CoV-2 in January 2020 — roughly 10 days after the first reported pneumonia cases in Wuhan, China. The ability to fast-track research and clinical trials was a direct result of this worldwide cooperation.

Funding for COVID-19 vaccine research

Vaccine research is costly. In 2018, a study in The Lancet Global Health estimated the cost of early development and initial clinical safety trials for a typical vaccine to be in the range of $31–68 million. Large scale trials to determine the efficacy of a vaccine candidate would add to these figures.

In an accelerated timetable with a new coronavirus, this cost might be higher. For this reason, funding from sources ranging from the government to the private sector was critical in making COVID-19 vaccines.

In the United States, Operation Warp Speed (OWS)Trusted Source partnered with multiple institutions, including the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), to develop, manufacture, and distribute 300 million doses by early 2021.

“By providing resources and assuming the financial risk, OWS allows companies to produce and stockpile vaccine doses even before the company knows if the vaccine is going to work,” said Dr. Yager.

“Also, by investing in multiple companies and vaccine platforms at once, OWS increased the odds of having a vaccine, or vaccines, available by the beginning of 2021,” he added.

The European Commission has also funded several vaccine candidates and worked with others in pledging $8 billion for COVID-19 research.

The United Kingdom government’s Vaccine Taskforce has also been a significant contributor to a wide variety of vaccine research. Recipients of this funding helped develop the AstraZeneca vaccine. The designers of this vaccine were the first to publish peer reviewed efficacy results from phase 3 trials.

This article was first published on www.medicalnewstoday.com

The programme, which aims to vaccinate 40 million South Africans, entails procurement, distribution, vaccination, monitoring, communication and mobilisation.

This COVID-19 vaccination messaging guidelines aim to assist communicators in the formulation of messages on the vaccine rollout and help address key questions stakeholders may be asking. The guidelines provide supporting content and resource links on the key areas for communication. The content contained in this version of the guide is relevant as of 8 March 2021.

The rollout will take place in three phases to provide vaccinations to a minimum of 67 per cent of the population in order to achieve herd immunity. It means that the majority of the population would be immune to the virus, indirectly protecting those who are not and making the spread easier to manage and contain.

The vaccination programme is a key intervention to mitigate the public health and economic impact of the COVID-19 pandemic. It also demonstrates how far the country has come in in the fight against the pandemic. On 5 March 2021 South Africa marked one year since the first case of coronavirus was reported in the country.

Since then, we have learned a lot about the pandemic and made strong inroads into turning the tide against the virus. Through instilling behaviour change by profiling everyday preventative measures and adopting a scientific approach to fight the virus, we helped stem the spread of COVID-19. Today we know much more about the pandemic and this has allowed us to respond more effectively to it.

This article was first published on www.coronavirus.co.za

BACKGROUND

What is the new SARS-CoV-2 variant?
This new variant of the virus was discovered through routine genomic surveillance of SARS-CoV-2 performed by a network of laboratories around the country (Network for Genomic Surveillance South Africa, NGS-SA). The new variant has been identified in almost 200 samples collected from over 50 different health facilities in Eastern Cape, Western Cape and KwaZulu-Natal. The new variant is different from the others that were circulating in South Africa because it has multiple mutations (changes) in the spike protein – this is the very important part of the virus that binds to the receptor on the cells inside our body and that is also the main target for many of the antibodies produced during infection or after vaccination. Work is being done to understand what effect these mutations have on the behaviour of the virus and our body’s response to it – particularly whether it makes the virus spread more easily, whether it might lead to more severe COVID-19, and whether the virus can evade our immune response.

What is the geographical distribution of this mutation?
The variant was first identified in Nelson Mandela Bay but has rapidly spread through the rest of the Eastern Cape and to the Western Cape and KwaZulu-Natal provinces. Testing in other provinces is being undertaken to understand the extent of geographical spread but it is likely that this variant has spread to other provinces too.

Is the new variant associated with an increase in the severity of the disease?
At this stage, there is no clear evidence of the new variant being associated with more severe disease or worse outcomes but clinicians are undertaking more studies to establish if this new variant does change the course of the disease.

Is this the same or different to the London variant?
It is definitely not the same variant, but there are similarities as they both share the same change in the spike protein at the 501 position. What it does tell us is that if we do not control the spread of the virus then it is likely to evolve in similar ways in different parts of the world.

The new variant of infection leads is associated with a higher viral load. Does this mean a higher rate of transmission?
We do not know for sure that it is associated with a higher viral load, but some of our findings suggest that might be the case. We need to gather more information to help us understand this. Overall there is some evidence that this new variant might be being transmitted more readily than other variants, although the mechanism of this remains to be fully worked out.

Will this new variant cause the second wave to be different from the first wave?
The role of the variant in the second wave is being examined. The second wave is the same as the first in many respects. The cause of COVID-19 remains the same – SARS-CoV-2. The virus still affects the same cells of the body, and causes people to be ill in the same way. This second wave may be different in some ways – it may be that people who had the virus before it changed can now be infected with SARS-CoV-2 for a second time. It may be that the virus spreads more easily, or causes slightly more severe infection. These are all questions that the clinical doctors and scientists will be asking and watching out for.

Did these changes in the virus happen because of Matric Rage?
No, the changes in the virus were already detected well before Matric Rage. However, it is likely that Matric Rage helped to spread the new variant of the virus.

Where did this new variant come from?
SARS-CoV-2, like all other viruses, mutates as a natural process. The new variant will have evolved naturally.

How long until there is more information on this mutation?

Several people are working around the clock to learn more about this and to understand the significance of the finding. We will release more information when available. It is also important to make clear this is a global effort and we will be working with scientists around the world to understand the significance of this finding.

CLINICAL INFORMATION

Will the new variant cause different symptoms?
There is no reason to think the types of symptoms you get will be different. Patients will in all likelihood present with the same spectrum of symptoms as before. Whether the overall severity will be different, remains to be seen.

If we become infected do we need to know whether or not it’s the original virus or the new virus? Does the new virus need different clinical management compared to the original virus?
The clinical management remains exactly the same – that is oxygen therapy when people need it, steroids (like dexamethasone) for people with more severe disease, and blood-thinning medication to prevent blood clots, a common complication of COVID-19. It is important to note that the main therapy that has been proven to reduce mortality is dexamethasone and that targets the overactive immune response to the virus, not the virus itself.

Can you get re-infected with the new variant if you have already had COVID-19 from one of the older variants?
This is not known at present. This will be an area of intense study in the coming weeks and months. However, at present, we strongly encourage those who have previously had COVID-19 to continue to adhere to non-pharmaceutical interventions such as wearing masks in public, social distancing, avoiding large gatherings, and hand hygiene.

TESTING

Will the PCR tests be able to detect the new variant?
The current PCR tests employed by South African testing laboratories will detect the mutated SARS-CoV-2 lineage. The mutated lineage from the Eastern Cape province has been detected in over 150 samples using South Africa’s current repertoire of real-time PCR tests. In addition, each test typically detects at least two or three different gene targets to act as a backup in the case of a mutation arising in one.

Will the antibody test be able to detect it?
Antibody tests detect response to the virus, not the virus itself. It is likely that the antibody test will perform in same way. Note antibody tests are not used for diagnosis of patient with suspected COVID-19 infection.

CONTACT TRACING, ISOLATION AND QUARANTINE

Is there any change in contact tracing?
No – contact tracing remains the same.

Is there any change in the isolation or quarantine periods with infections form this new variant?
No – isolation and quarantine remain at 10 days.

• People who have been exposed to the virus should quarantine for 10 days.
• People who are ill with COVID-19 should remain in isolation for 10 days.

PREVENTION (NON-PHARMACEUTICAL INTERVENTIONS)

Do these changes in the virus change the way the virus is spread from person to person?
No, they do not. The virus still has the same proteins and the same way of entering the body and causing illness. The virus will still be spread by droplets and by contact with surfaces where the virus has been.

What do these changes in the virus mean for prevention measures like social distancing, mask wearing and sanitising?
Prevention measures like social distancing, mask wearing, handwashing and sanitising still remain the best ways of preventing infection. There is no change to these messages and to the actions that we need to take. Rather than relaxing our guard, we need to do all we can to prevent transmission.

THE HEALTH SYSTEM

How has the health system prepared for the resurgence?
The National Department of Health has issued an advisory to all provinces to scale up the treatment facilities in a stepwise manner to meet the progressive demand for hospitalisation during the second-wave resurgence. This includes increasing the proportion of beds available to patients presenting with symptoms for investigation or admission. In addition, the bed occupancy status in each district (both private and public) will be closely monitored using the DATCOV system managed by the National Institute for Communicable Diseases (NICD). The scaling up of infrastructure to deliver oxygen is a focus of the Department of Public Works and Department of Health, aimed at providing liquid oxygen and reticulation at district hospitals throughout the remote districts of South Africa. The Department of Health is working closely with the providers of oxygen to monitor the consumption and resupply in all provinces. Medicine distribution and availability is continuously monitored by each provincial pharmacy division. The availability and provision of personal protective equipment (PPE) to healthcare workers is monitored in each province and by the National Department of Health. In various provinces new and additional positions for healthcare workers have been advertised, applications should be directed to the Provincial Department of Health.

What steps are the private and public hospitals taking to increase the available COVID-19 treatment bed numbers?
In accordance with the resurgence guidelines, each province has been requested to increase the proportion of hospital beds for COVID-19 admissions. In the first instance this is undertaken by dedicated beds and wards, then increasing the proportion of beds available to COVID-19 in each hospital, followed by a reduction in elective procedures. At the peak, the proportion of hospital beds available to COVID-19 may rise to 85% of all hospital beds in the district. Oxygen therapy is a key element of COVID-19 treatment, and all high-care and Intensive Care Unit (ICU) beds may be occupied. A reserve capacity for non-COVID admissions is maintained, focused on maternal-child health and deliveries and emergency care. Only when the patient numbers are expected to exceed the available hospital bed capacity are the field hospitals activated. In addition, each province is requested to plan step-down and isolation facilities to support the patients who cannot isolate at home.

Is the country prepared for the increased demand for staff, equipment, oxygen and treatment?
The health system is under significant pressure due to the sustained COVID-19 response, potential infection and re-infection of healthcare workers, and loss of staff from the system. Although equipment has been made available, the supply of oxygen is under pressure. Many hospitals still require bulk liquid oxygen installations to facilitate the use of continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) oxygen to treat moderate to severe COVID-19. The Emergency Medicine Services are under significant pressure. In addition, the Ministerial Advisory Committee on COVID-19’s advice is to reduce the number of patient transfers between towns and cities to avoid transporting severely ill patients, as transport is associated with poor outcomes.

Has the increase rate of infection led to a hospitals shifting resources from the routine health care and planned admissions to providing support for COVID-19?
Yes, both private and public hospitals are under significant pressure from the resurgence in the last four weeks. Reports from multiple private hospitals in the four most affected provinces (Eastern Cape, Western Cape, KwaZulu-Natal and Gauteng provinces) is that elective procedures are no longer possible. Numerous key hospitals have dedicated the High-Care and Intensive Care Units to COVID-19.

VACCINES

Will the new variant have an impact on the effectiveness of vaccines?
It is not currently known whether or not this mutation will impact on the effectiveness of vaccines. More research is needed to see whether or not this is the case, and in the event that the mutation significantly reduces vaccine efficacy further vaccine development will be required.

Does the delay in payment to the COVAX facility mean that we will not get COVAX vaccines or that we will get them after many other countries?
The National Department of Health and the Treasury are currently concluding agreements with the COVAX Facility. The Department of Health anticipates that we will get a small quantity of vaccine through the COVAX Facility in the second quarter of 2021. In addition, we anticipate that over the next few months additional vaccines will be found to be safe and efficacious, and this is likely to increase the numbers and types of vaccines available through the COVAX Facility.

Is the National Department of Health talking to vaccine developers to secure other doses of vaccine?
Yes, the National Department of Health is in discussion with other companies who are at the forefront of clinical trials to explore whether their vaccine is suitable for a South African setting, and if there is a possibility of vaccine supply at an affordable price.

Is the South African Health Products Regulatory Authority (SAHPRA) reviewing any vaccine application?
Yes. The first application to SAHPRA for a COVID-19 vaccine is from Johnson & Johnson and has been submitted as a rolling review. This means that the company will sequentially submit data to SAHPRA as it becomes available. In addition, other vaccine developers have been in discussion with SAHPRA. All COVID-19 related applications are being fast tracked and SAHPRA has established a specialist COVID-19 Vaccine Committee to rapidly review all COVID-19 vaccine applications. SAHPRA is also working with other regulatory authorities in the African region and globally, as well as, with the World Health Organisation (WHO), to harmonise and accelerate the regulatory review of vaccines.

TRAVEL AND BORDERS

Will this affect international travel requirements?
The amendments to the regulations of the Disaster Management Act that were published on 03 December 2020, Gazette 43954 will remain in effect. This includes needing proof of a negative PCR test within 72 hours of the result to be presented on entry into South Africa, screening on arrival and adhering to all non-pharmaceutical intervention (NPI) requirements during travel. These requirements apply to people travelling into South Africa through any of the ports of entry. The regulations for travel to other countries are determined by those countries and the public should check what these are if they are planning international travel.

Should South Africa close its international borders?
Given the information we currently have on this virus we do not think it is necessary to be considering closing international borders.

Will interprovincial travel be banned?
There are no restrictions on interprovincial travel and the current regulations will continue to apply. These include requirements to adhere to the regulations relating to wearing of masks, sanitising and keeping windows at least 5cm open. Taxis travelling distances great than 200km are only allowed to be at 70% capacity.

What about local travel – will there be any changes?
People travelling on public transport are urged to comply with the current regulations of wearing a mask and sanitising their hands on entering any public transport. The regulations will continue to apply i.e. local travel may be at 100% capacity, windows should remain open, all passengers and the driver should be wearing masks and sanitising their hands before and after travel.

Are there any further restrictions in movement or changes to regulations planned?
At this stage there are no further restrictions in movement or changes to regulations per Gazette 43954 of 3 December of the Amendment of Directions issued in terms of Regulation 4(1)(a) of the regulations made under Section 27(2) of the Disaster Management Act, 2002 (Act no 57 of 2002): Measures to address, prevent and combat the spread of COVID-19. However this may change depending on new information that becomes available on the spread or behaviour of this new viral lineage.

Will beaches remain closed?
At this stage none of the regulations will change.

Are there any further restrictions in movement in South Africa planned?
At this stage there are no further restrictions in movement planned, however this may change depending on new information as it becomes available on this new viral lineage.

It was seemingly inevitable that the second wave was going to come crashing home. As the Matric Rage starting events showed, the super-spreaders become the youth, specifically those aged 15 to 19. This week, Zweli Mkhize announced that the country was officially there. A Wednesday night broadcast by Mkhize highlighted how the non-adherence to mask-wearing and social distancing, and the summer-time partying of the nation has wrenched the country very much back into a surge of new cases.

On Thursday, South Africa registered over 8,000 new Covid-19 cases, on the back of over 6,000 the day before.

Christmas is cancelled

At least, Christmas should be observed in as responsible a manner as possible, was the warning from Mkhize. As the holiday season looms near, and hospitals in the Eastern Cape buckle under the pressure of the second wave, this should be a far more muted Christmas season than what most South Africans are used to.

The vaccine is still months away for most ordinary South Africans, but the coronavirus persists as dangerous as it has been throughout the year.

This article was first published on Daily Maverick on 12 December 2020.

A resurgence is when the number of active cases increase, week-on-week, by more than 20%. Over the last week alone, the province has witnessed a 52.1% jump in new cases, with an established pattern over time.

There is also now established community transmission of the virus again in this province, which means that it is spreading within communities at a faster rate.

This growth is primarily driven by two districts in the Western Cape: the Garden Route and the Cape Metro.

Last week, we issued a hotspot alert for the Garden Route, following an alarming growth of cases in the area. This surge has continued to gain momentum and there are now more active cases in George and Knysna sub-districts than at any point in the pandemic to date.

The City of Cape Town is following a similar trajectory to this region and looks to be about 10-14 days behind. We are therefore also issuing a hotspot alert for the Metro.

It is important to highlight that the growth in cases in the City is being recorded in every sub-district and is not being driven by any one area. This is verified by waste-water treatment testing.

While the growth in cases province-wide has mainly been driven by these two districts, we are also worried about the Cape Winelands, which is starting to record a concerning number of new cases.

The Overberg District, Central Karoo District and West Coast District are being closely monitored given their proximity to these hotspots.

This established Covid-19 resurgence in the Western Cape is also reflected in the proportion of positive tests, which has now grown to 16%. This is comparable to the test positivity rate experienced in the Western Cape in early May 2020.

My biggest concern is for our health platform, which is under growing pressure. We need to ensure that every person gets healthcare when they need it.

Hospitalisations reached a low of under 500 in September, and they have now reached 904 as of yesterday. There are currently 431 people in public hospitals and 473 in private hospitals in the Western Cape.

In the last 24-hour reporting period alone, the number of people being hospitalised for Covid-19 increased by a staggering 54 people.

Our Brackengate Hospital of Hope, went from having just a few patients in September, to 109 as of today.

In fact, since the start of November, COVID-19 hospitalisations across the province have increased by 63%. The private sector has increased by 94%, while the public sector has increased by 39%.

Critical care admissions have increased by 75% since the start of November. This is particularly concerning as an admission to a critical care unit is an indication of severe illness that might lead to death.

“We need every person in the Western Cape to help prevent a Lockdown and to ensure that there are enough empty beds in our hospitals for those who need them.”

We must be under no illusion as to how serious the situation is, and how quickly it can deteriorate further.

The Western Cape Government has intentionally reintroduced key healthcare services to our facilities because we need to provide comprehensive care to everyone who needs it, not just those with Covid-19.

This means our hospitals are already fuller than they were earlier this year, during the first wave of hospitalisations.

We want to avoid at all costs having to once again de-escalate these essential services because this will have a detrimental impact on the health of our people. We have to save all lives, including those who don’t have Covid-19.

We also cannot afford a Lockdown again, as is being witnessed in many European countries right now. Our economy simply cannot afford it. A lockdown would kill jobs and cause our humanitarian disaster to worsen. This will also cost lives in the future.

There is therefore only one option available to us all. We have to bring the situation under control through our own actions. We have to do everything possible to ensure that we do not get infected by Covid-19 and that we do not spread Covid-19.

The virus is not gone but will be with us over the holidays and beyond. Therefore, we need to remain safe and protect each other by:

• Wearing a mask properly is of life-saving importance. You must wear your masks at all times when outside of your home. There can be no exceptions.
• You must avoid crowded and confined spaces at all costs. This is where super-spreader events take place.
• You must urgently reconsider hosting all non-essential gatherings of people this year, especially indoor gatherings with poor ventilation.
• You must ensure there is good ventilation at all times whenever you’re in public. The virus droplets spread by air in confined spaces, and so fresher is better.
• You must wash your hands regularly with soap and water or use sanitiser.
• If you feel sick, you should not leave your home unless it is to get healthcare treatment. You must first call our hotline on 080 928 4102 for guidance on the next steps.
• You should also not visit someone who is sick, and find other ways to provide support, like delivering a meal to a neighbour’s doorstep.

Every single resident should assume that Covid-19 is everywhere they go and take all the necessary precautions at every point along their journey.

For business owners and managers, you cannot in any way cut corners on Covid-19 safety protocols and you must abide by all the regulations. You are our best hope for policing all points of gathering, because you can ensure the behaviour needed by people when they are at your establishment. Help us keep the economy open by ensuring that your staff and customers are safe at all times.

We all have a critical role to play over the next few weeks so that we keep our economy open and to ensure that there is a hospital bed for ourselves or our loved ones, should we need it. Let’s show the world again that we are capable of flattening the curve in the Western Cape.

“Resurgence response plan will result in increased high visibility enforcement”

The Western Cape, through our Disaster Joint Operations Centre, will be drastically increasing high visibility enforcement of Covid-19 regulations to help slow down the spread of the virus.

The JOC, which has linkages to local joint operations centres across the province, is best placed to coordinate law enforcement. It has a direct link to the SAPS, as well as law enforcement and environmental officers in the Western Cape.

We urge members of the public, businesses and other organisations to report violations of Covid-19 protocols immediately so that our teams can take action.

You can report violations using the online complaint form available here:

• https://coronavirus.westerncape.gov.za/covid-19-business-safety-complaintform
• Dial *134*234# to report non-compliance of public transport

For Covid-19 health related queries, the provincial Covid-19 toll-free hotline number is 080 928 4102.

For general queries, the Western Cape Government’s contact centre can be reached on 0860 142 142.

 This statement was issued by Premier Alan Winde at a weekly digital press conference on 25 November 2020.

Click here to watch the interview.

As the virus is new and moved so fast from China to the rest of the world; scientists are playing a catch-up race and are looking for shreds of evidence that some people may be spared from the full brunt of the epidemic.

It did appear that older people were more likely to die from coronavirus complications than the young and judging from how the flu virus mainly effects people in the cold months; scientists are predicting that people in warmer countries like South Africa could expect less severe outbreaks.

The higher fatality rate among men has also been ascribed to vaccinations that teenage girls receive to prevent complications when they become pregnant. And now a study by a professor at the New York Institute of Technology, Dr Gonzalo Otazu has found that there is a correlation between countries that require citizens to get the Bacillus Calmette–Guérin (BCG vaccine) to prevent tuberculosis and lower death rates from the coronavirus.

South Africa has mandated this 100-year old vaccine since the 1940s and many will remember it as a stamp on the upper arm.

This is clearly good news for South Africa where the infection rate and death rate are still relatively low compared to outbreaks in Italy and the United States.

In the UK, BCG vaccines are only administered to people who travel to high risk areas and in some pockets in London. Dr Otazu told Biznews founder Alec on the Inside Covid-19 podcast that clinical trials need to be done to find out if there is indeed a causal relationship between the BCG jab and low Covid-19 fatality rates.

This is not an indication that South Africans should become less cautious as he emphasised the importance of combining it with social distancing and many HIV/Aids patients do not receive this vaccination.
– Linda van Tilburg

Welcome to Dr. Gonzalo Otazu who’s with the New York Institute of Technology. Dr. Otazu, you, some of your students and a colleague, have put together a research report that is giving hope to many people around the world, focusing on the TB vaccine BCG. What made you have a look at it in the first place?

I was surprised – as were many other people – at how differently the disease was spreading and the  strong differences between countries. My attention was caught by the Japanese who had some of the first cases. However, the disease has not spread as widely compared to other developed countries, like Italy, which has been very strongly affected. There are many differences between these countries, but I knew that the BCG vaccination had this property which has been described before as having this broad immunity. So when I looked at the policies of universal vaccination, what immediately jumped out was that the countries that were being hit especially hard by the Covid-19, turned out to be the countries that never implemented a BCG vaccination policy.

This was what started this study. We compiled a lot – at least as comprehensive as possible given the circumstances (of more than 100 countries) – and compared the BCG policies with the number of deaths per million people. This is when we saw these relationships. However, let me point out that our study is a correlational study, it’s possible that there might be some other explanation. It could be for example that the countries who have a BCG vaccination policy might have a younger population. We are doing some analysis that could take that into account. That’s why it’s very important that we wait for the results of the ongoing clinical trials where, in a controlled population, we have randomised; some individuals will get a placebo and some will get the BCG – we’ll then be able to know if indeed there is a causal relationship.

In South Africa – going back to 1940 – we have had BCG vaccinations. Clearly, within this country there is concern given the high HIV/Aids rate that any little bit of help – any little bit of hope – that could come through, is very warmly greeted. If your research turns out to be accurate would there potentially be a problem with HIV/Aids being more of a threat?

That’s a really good point. In fact, the Centre for Disease Control advises against the use of the BCG vaccination in immuno-compromised populations. So that would be a factor that has to be taken into account. But let me point out something very important –  although there are countries in East Asia that have managed to control the disease or have managed to reduce the number of cases – these countries did have BCG vaccination policies but all of those countries have implemented social distancing, quarantines and widespread testing. I’m not aware of any country that – just by having a BCG vaccinated policy – has been able to control the disease. All these measures might complement the BCG vaccination policy, but again, we have to wait to see the results of clinical trials.

In the research report that you put together, you made a very interesting distinction between Italy and Japan. Could you take us through that?

Actually, we are doing more analysis; I would like to point out some comparisons between Italy and India. One possible explanation that has been brought up, is that the countries that have been hit earlier, have been more strongly hit by the epidemic. So for example Italy; those countries might have been hit early and the spread of the disease is going to be the same – independent of the country. However, the first reported case was the same in India as it was in Italy, though the number of cases in Italy are much higher for the size of the population.

How much greater – per million people – have the infections (and indeed the mortalities) been in Italy than they have in India?

In Italy as of March 30; there were 11,591 deaths for a population of 60 million, whereas in India – on this same day of March 30 – the number of deaths were 32 for a country of 1.38 billion people.

So it’s many times for the non-BCG vaccinated country?

Yes, but there are many differences and there might be something else that I’m missing – it’s not about the age distribution – but there are other things that might be there. So that’s why a controlled clinical trial is crucial to finding out if this correlation – if this relationship is a causal relationship.

What about the countries where the vaccination has been sporadic and again – in your report – you compared Spain with Denmark?

I wouldn’t say sporadic; it was that historically BCG vaccination was used, but then in some countries, as their rate of tuberculosis cases dropped, there was a switch of policy because, if the whole population has been BCG vaccinated, you wouldn’t know if somebody actually has the infection. So, that is why in some countries this remains in their policy, as is the case in Spain where they had this kind of policy – which they kept for longer times – and in doing so, covered more of their population.

With regards to the countries that have come to the party late (with the BCG vaccinations), as in Iran in 1984, you make the point that this also supports the conclusions that your initial report reached.

That’s correct. As is the case in Iran – which has a universal occurring vaccination policy – it just started in 1984.

So when you have an overall look at it, from the evidence that seems to be available from the United States, the Netherlands, Belgium, Italy – countries that never vaccinate (that never used BCG vaccinations) – are the hardest hit by far. Is there any other reason potentially why this might be the case; did they not practice social distancing? Were they earlier affected?

Those are good points. Right now, I’m in the middle of the quarantine here in New York – so social distancing has been practiced in these countries and they’re a developed country. They’re rich countries with advanced medical technology available to people. However, the death rates are high. But there might be other factors – that’s why a randomised trial should take care of all those factors that I cannot even think of right now.

And what kind of trials would they be?

First of all let me be very clear, I’m not involved in any of the clinical trials. So as I found these correlations –  which I will submit in our report – we found out that there were actually other researchers that have started or were about to start clinical trials. So, I’m not directly involved in the research but these clinical trials are, as far as I understand, using the health care personnel which is now on the front lines being exposed to the virus. This will further the research regarding BCG vaccinations.

So these are not people who were vaccinated as children or as babies but, if they’re vaccinated now, is there potential that this could also help them?

I’m not familiar with the exact details of the trials but I would imagine that they would divide the population, because some people who are immigrants to this country, might have already had the vaccination. I don’t know if they’re being included.

There was something else in your report where you mentioned that mice (animals) had been used for testing. How exactly did that work?

Usually you have a vaccine for a particular disease, so you introduce that in activated organisms then the body mounts a defence against that and then the next time you get the infection (our memory of that very specific to that particular pathogen), you get a response -that’s the usual mechanisms whereby vaccines work. In the case of the BCG, it was called learning immunity – which is a broad response to most of the pathogens. So remember, the US stocked up for BCG – that was developed for tuberculosis – then later people found that it has this broad protection against other pathogens. So people have found this in animal experiments but also they have found in human observational trials where they compare populations of children in Guinea Bissau where the children that got a BCG vaccination; six months later had a reduced mortality rate compared to the children that did not get any vaccinations.

If you were advising the president of South Africa – remembering we have a population of 58 million people, we are in lockdown, we are on day 10 of lockdown now, 7.7 million people are HIV positive – the country has moved very early or relatively speaking, but the infection and mortality rates are very low, relatively speaking. What is the consequence of your study that should be taken into account by those who are making these decisions?

Again, it’s a correlational study. So I wouldn’t base any policy based on that study. Luckily, there are already these clinical trials and those clinical trials will give us an answer which you could base policy on.

So it’s too early to act on it but it’s a very hopeful sign in a world that is full of fear at the moment.

When I saw that correlation, my objective was for clinical trials to start – it’s worth looking at the clinical trial – luckily there were other researchers around the world that had the same idea and had already started clinical trials.

Are you updating your research as you go along?

Yes, I am in the process of doing that. So, the latest data we have is going to be for March 30 – that’s the data I just gave you. It’s been pretty busy and I’m not finding the data to finish but we are about to release an updated version.

And are you finding that it’s supporting the original hypothesis?

Oh! Yes.

This article was first published on biznews.com on 6 April 2020

Allopathic medicine is defined as relating to or being a system of medicine that aims to combat disease by using remedies, such as drugs or surgery, which produce effects that are different from or incompatible with those of the disease being treated.

There are times when we are ill that we may need prescription medication which I will refer to as drugs.

My concerns arise from the experienced I gained working for a medical malpractice insurer where several of the negligence / malpractice claims were the result of prescription medication interactions that led to disastrous outcomes for the patient.

That being said, let’s look at some key points relating to the use of medication that your doctor probably does not tell you.

• Every drug prescribed has at least two side effects. There are many drugs on the market that have pages and pages of side effects but because they are fairly tolerable the benefits outweigh the risk. However you may be the one person who has the unusual reaction and this is misdiagnosed or unrecognised.
• Many drugs are brought to market with fairly limited testing. Only once they have been used by a wide range of people do unexpected side effects emerge. These side effects are not always added to the information on the package insert. A good example here would be that Ritalin can cause constipation. Because there are several causes of constipation it might take some time before a GP (General Practitioner) treating your child for abdominal pain may make the connection that the Ritalin prescribed by the Psychiatrist is the source of the problem.
• When you take 2 or more drugs you have the risk of several side effects and also drug interactions.
• Your treatment regime should be watched very carefully and any new symptoms reviewed as a possible drug side effect before another drug is added to your cocktail to treat a new problem. A good example here is some drugs that are used to lower your blood pressure causes an irritating dry cough. You don’t need medication to treat the cough; you need to change the type of blood pressure medication that was prescribed! The cough will go away.
• Your chronic medication should be reviewed regularly for relevance. Do you really still need to be on anti-depressants for post natal depression when your baby is 5 years old??
• Are prescription drugs the treatment choice when your symptoms are indicators of nutritional deficiencies? Let’s use the post natal depression example again. Supplementation with good quality Omega 3, Zinc and other micronutrients may be all that the new mother needs to re-balance her body. Instead she may be given a class of anti-depressant that depletes the body’s melatonin resulting in poor sleep and accelerated brain aging. This is the last thing a new Mom needs.
• Are your prescription drugs causing nutritional deficiencies? My favourite examples here are:
  • Cholesterol lowering drugs called ‘statins’ and ‘fibrates’ interfere with the body’s natural ability to produce Co-enzyme Q10 resulting in a deficiency. A deficiency of Co-enzyme Q10 may be associated with heart disease, high blood pressure, gingivitis (gum disease) and weakened immune function.
  • Birth control pills that are a combination of oestrogen and progesterone deplete Magnesium, Zinc, Vitamins B2, B6, B12 and folic acid. Let’s unpack this lot:
    • Magnesium deficiency affects calcium and vitamin D levels, is associated with muscle cramps, heart irregularities, insomnia, high blood pressure, diabetes and osteoporosis
    • Zinc deficiency includes loss of appetite, sense of taste, impaired immunity, growth retardation, skin changes, reduced hormone production, decreased sex drive and increased risk to infection.
    • Vitamin B2 deficiency presents with cracks in the corners of the mouth, inflammation of the skin and impaired wound healing.
    • Vitamin B 6 deficiency includes weakness, nervousness, insomnia, mental confusion, irritability and anaemia. Long term low levels of this nutrient may also increase the risk of heart disease as well as colon cancer and prostate cancer.
    • Vitamin B12. It can take years to develop complications associated with the long term depletion of this nutrient. You may experience irritability, weakness, numbness, and anaemia, loss of appetite, headaches, personality changes and confusion!
    • Low level folic acid has been linked to anaemia, heart disease, increased cancer risk, birth defects and elevated homocysteine levels and risk of heart attacks and stroke.

    So what to do?

    • As our food sources are compromised eat the freshest, seasonal least processed food you can.
    • Ask a person well versed in nutrition and supplementation about organic nutrition supplements appropriate for your age, gender and current health status. Remember to take your supplements!! This is your foundation for wellness.
    • If you are taking prescription medication ask your doctor to review your medication with possible nutrient depletion in mind as well as possible drug interactions and side effects. Can any medications be reduced or stopped?
    • Be aware that whatever you put into your body will affect your health either positively or negatively.
    • Be mindful and make healthy choices.

    This article was first published on LinkedIn on 3 June 2014.

By Jeanette Philips – 7 June 2018

Starting 11 October, Singapore Airlines’ newest plane, the Airbus A350-900ULR will travel on a record-breaking, globe-spanning flight that will reconnect Singapore to New York, nonstop in almost 20 hours.

While it is worth marvelling at the advancements in aviation technology, travellers might understandably wonder what might happen if they—or fellow passengers—experience a medical emergency during such a long journey.

From minor stomach upsets to life-threatening situations, the Association of Southern African Travel Agents (ASATA), takes a closer look at what happens when there is a medical emergency onboard.

The stats

Unbeknown to most of us, in-flight medical emergencies on commercial flights occur every day.

In 2013, it was estimated that 44 000 such events occurred worldwide every year. And, with air travel on the rise, the aging of the population, and the increasing number of air travellers with acute or chronic illnesses, there’s definitely a need for medical expertise in the air.

Lufthansa reported that the airline alone handles roughly 3 000 inflight medical emergencies each year, ranging from minor upsets to life-threatening situations. Around 50 situations annually are so serious that they require diverting the flight to the nearest airport. A few babies are born mid-flight every year.

According to Doctor Axel F. Sigurdsson’s blog, Doc’s Opinion, in-flight medical events occur at a rate of 15 to 100 per million passengers ,with a death rate of 0.1 to 1 per million.

Doctor Sigurdsson adds that it has been estimated that a physician is present in approximately 40 percent of in-flight medical emergencies. However, these numbers have been shown to vary widely. The Lufthansa registry reports that in more than 80% of cases, a physician or other medical professional (e.g., nurse, emergency medical technician) gave help on board.

Airline protocol during medical emergencies

The pilot, together with the co-pilot, has overall responsibility of each flight – passengers, the crew, the flight and the aircraft.

Dr. Sigurdsson explains that the cabin crew is responsible for managing in-flight medical emergencies. Cabin crew as part of their ongoing training are trained to recognise common medical problems and provide first aid and basic cardiopulmonary resuscitation. It is thus also the cabin crew who normally make the initial assessment of the ill passenger and are responsible for informing the captain about the situation.

The crew may then request assistance from onboard medical professionals as needed. A notable example is Lufthansa, which has its “Doctors on board” programme, encouraging physicians to put their name on a list of those willing to be called on should there be an in-flight emergency.

The idea is that, using the membership rolls, flight attendants will automatically know when a member doctor is on the plane and where he or she is seated. The plan has since been expanded to cover flights on partner airlines Austrian and Swiss. More than 10,000 doctors have signed on, mostly located in Europe and North America—culled from an initial outreach to some 15,000 doctors known to Lufthansa. Those who sign up can receive perks for their service, including bonus miles, but are not paid.

It is worth mentioning that a doctor does not have a legal obligation to step forward when assistance is requested. Yet, on the other hand, the doctor has an ethical and humanitarian duty to provide emergency care, unless circumstances prevent him/her from doing so or he/she is assured that others are willing and able to give such care.

Basically, by responding to the in-flight call of assistance, the doctor has taken on the role of what is known as a “Good Samaritan”. However, good intention does not protect against gross negligence or misconduct. The key is to do the best you can in the circumstances with the resources available, working within the limits of your competence, explains Doctor Sigurdsson.

In most instances, “Good Samaritans” are protected against negligence in the event of a worse case scenario, given that they followed and adhered to a list of strict conditions, which can include:

• The Samaritan is medically qualified to perform the service
• The Samaritan acts voluntarily
• The Samaritan acts in good faith
• The Samaritan does not engage in gross negligence or misconduct
• The Samaritan receives no monetary compensation (seat upgrades and travel vouchers do not count as compensation)

Once a thorough medical assessment of an ill passenger is made, the captain may also decide to call ground-based medical support (GBMS) for advice. In this way, specialists in aviation and emergency medicine may assist from the ground.

Based on the condition of the passenger the captain may determine to continue the flight plan but request medical assistance upon arrival, he/she can also request expedited landing at intended destination or decide to divert the aircraft to a closer location.

Medical resources on board

Airlines are bound under set legal requirements when it comes to the medical equipment that must be carried on board any commercial airplane, determined by the responsible aviation authority such as the Federal Aviation Administration (FAA) in the United States, and the European Aviation Safety Agency (EASA) in collaboration with the Joint Aviation Authorities (JAA) in Europe.

However, it is important to note that European airlines flying to the USA must meet both the requirements of both the FAA and the JAA.

The International Civil Aviation Organization (IACO) calls for three types of medical kits; First Aid Kit (FAK), Emergency Medical Kit (EMK) and Universal Precaution Kit (UPK):

FAK: Primarily for the care of wounds and burns, but may also include non-prescription medication.

EMK: The EMK is to be used only when a medically trained doctor is available for assistance. It contains medical equipment and drugs that can be used for the clinical assessment and treatment of the passenger. Diagnostic tools available in the EMK include a stethoscope and a sphygmomanometer. Some international aircraft have electronic blood pressure cuffs, pulse oximeters (for measurement of the oxygen saturation of blood) and glucometers (for measurements of blood glucose) in their EMK.

UPK: Contains personal protection equipment for crew members and volunteer health professionals who may be exposed to communicable disease.

Most airlines also carry automated external defibrillators on board.

Common In-Flight Medical Emergencies

According to a new study released by the University of Toronto, the top in-flight medical emergencies are:

Light headedness/loss of consciousness (37.4%)

Respiratory symptoms (12.1%)

Nausea or vomiting (9.5%)

Cardiac symptoms (7.7%)

Seizures (5.8%)

This article was published on http://insidetravel.co.za/ on 7 June 2018

Are the ambitious UNAIDS 90-90-90 targets for 2020 realistic and achievable, considering the end goal of ending the AIDS epidemic by 2030?

By Alan Brand – 18 August 2015

Ending the AIDS epidemic is more than a historic obligation to the 39 million people who have died of the disease. It also represents a momentous opportunity to lay the foundation for a healthier, more just and equitable world for future generations. Ending the AIDS epidemic will inspire broader global health and development efforts, demonstrating what can be achieved through global solidarity, evidence-based action and multi-sectoral partnerships.

Although many strategies will be needed to close the book on the AIDS epidemic, one thing is certain. It will be impossible to end the epidemic without bringing HIV treatment to all who need it.

As the world contemplates the way forward following the 2015 deadline for the targets and commitments in the 2011 Political Declaration on HIV and AIDS, a final target is needed to drive progress towards the concluding chapter of the AIDS epidemic, promote accountability and unite diverse stakeholders in a common effort. Whereas previous AIDS targets sought to achieve incremental progress in the response, the aim in the post-2015 era is nothing less than the end of the AIDS epidemic by 2030.

In December 2013, the UNAIDS Programme Coordinating Board called on UNAIDS to support country- and region-led efforts to establish new targets for HIV treatment scale-up beyond 2015. In response, stakeholder consultations on new targets have been held in all regions of the world. At the global level, stakeholders assembled in a variety of thematic consultations focused on civil society, laboratory medicine, paediatric HIV treatment, adolescents and other key issues.

Powerful momentum is now building towards a new narrative on HIV treatment and a new, final, ambitious, but achievable target:

• By 2020, 90% of all people living with HIV will know their HIV status.
• By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
• By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

A personal researched perspective on the 90-90-90 UNAIDS targets.

The Benefits of Knowing Your Status

Knowing ones HIV status is no longer a death sentence and as such like many other health conditions testing and screening is the first step to living a healthy life. Knowing your status is empowering oneself  through the gaining of knowledge while engaging with medical practitioners who specialise in HIV treatment and care so that regular monitoring of the effects of the HI virus on one’s immune system will ensure that you can initiate treatment at the most effective time. It also ensures that one has the ability to find psychological support through support networks and support groups and hence one is fully able to take responsibility for one’s life. Not knowing ones status denies one the ability to make these important choices and is simply foolishness. Some of the benefits of knowing your status include:

• Knowing your HIV status will help you to reduce the risk of transmitting the virus to others
• Knowing your HIV status can alleviate the stress and anxiety of thinking that you may be infected but not knowing your actual HIV status.
• If you test negative for HIV, you can make decisions and take steps that will help you remain HIV negative.
• If you test positive for HIV, you can seek medical treatment earlier. Early medical treatment can slow the progress of HIV and delay the onset of AIDS. Pregnant women who test positive for HIV can take action to prevent their baby from becoming infected with HIV

Point-of-care Testing

HIV-related point-of-care testing (POCT) technologies have become widely available, and they serve as a catalyst to attaining the UNAIDS-led 90-90-90 HIV treatment targets by improving access to diagnostics in resource-limited countries. The treatment targets aim to accomplish specific goals by 2020 – the first 90-target being that 90% of people living with HIV know their HIV status. Increasing access and maintaining the high-quality of POCT is essential to better patient outcomes and achieving an AIDS-free generation.

In its continued efforts to improve the quality of POCT, the African Society for Laboratory Medicine (ASLM) recently partnered with the World Health Organization (SEARO and WPRO regional offices), PEPFAR, the US Centres for Disease Control and Prevention (CDC), and other global partners, to organise a regional consultation in Phnom Penh, Cambodia, aimed at improving the quality of HIV and syphilis POCT.

A new ‘Phnom Penh Statement’ gives momentum to the global conversation aimed at improving access and increasing the quality of HIV testing. The Statement endorses the UNAIDS 90-90-90 HIV treatment targets and captures the principle of the rapid test quality improvement initiatives under way in Africa.

The benefits of early and sustained antiretroviral therapy

Viral suppression is defined as, literally, suppressing or reducing the function and replication of a virus. When discussing antiretroviral therapy for HIV, a regimen is considered to be highly successful if it reduces a person’s viral load to undetectable levels. The term “viral load” refers to the number of copies of HIV per mL of blood, i.e. the amount of virus in the blood.

In general, people with HIV need to use a combined antiretroviral therapy (cART – also known as highly active antiretroviral therapy or HAART) to achieve long term viral suppression – where the level of circulating virus in the blood remain quite low or undetectable.

Benefits:

Prevention of transmission: Antiretroviral therapy (ART) for HIV infection provides lasting protection against the sexual transmission of the virus from infected men and women to their HIV-uninfected sexual partners, investigators from the HIV Prevention Trials Network (HPTN) have reported at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada in July 2015.

Improved health for the HIV infected individual: People, who start antiretroviral therapy (ART) immediately after HIV diagnosis, while their CD4 cell count is still high, rather than waiting until it falls below 350 cells/mm3 have a significantly lower risk of illness and death, according to long-awaited findings from the START trial. The final study results were presented on Monday at the Eighth International AIDS Society Conference (IAS 2015) in Vancouver, Canada, and published simultaneously in the July 20 advance edition of the New England Journal of Medicine.

These findings suggest that HIV causes persistent immune system damage soon after infection, and “clearly indicate that ART should be provided for everyone regardless of CD4 count.”

It is well known that starting ART before CD4 cell counts fall to low levels dramatically reduces the frequency of opportunistic illness and improves survival. A growing body of evidence shows that earlier treatment is associated with decreased disease progression and death, as well as minimising the risk of onward transmission of HIV.

Viral suppression a key to the success of the UNAIDS targets?

To be successful, HIV test-and-treat programs in South Africa need to focus more on getting patients to return for ongoing treatment. Fewer than half of patients who tested HIV-positive at a Johannesburg, South Africa, clinic returned to complete eligibility testing for antiretroviral therapy (ART), according to a new study. The study, published in the journal PLOS ONE, tracked 380 patients who had tested positive for HIV. Researchers found no evidence that 142 of them returned for a blood draw—a CD4 count measuring levels of infection-fighting white-blood cells—that would determine eligibility for ART treatment. Of the remaining 238, only about 39 percent completed eligibility testing for ART within three months.

Of those who had blood tests showing they were eligible for ART treatment, 88 percent initiated ART within six months. Among the 185 patients in that ART cohort, 22 transferred out and were excluded from further analysis. Of the remaining 163, 81 percent were retained in care through two years of treatment. About 9 percent of the patients who either never had a blood draw or never returned to the clinic were known to have died.

Factors contributing to dropping out from and returning to HIV treatment

Dropping out was associated with drug/alcohol use, unstable housing/homelessness, psychiatric disorders, incarceration, problems with HIV medications, inability to accept the diagnosis, relocation, stigma, problems with the clinic, and forgetfulness.

Returning to obtain assistance and treatment was associated with health concerns, substance abuse treatment/recovery, stable housing, and incarceration/release, positive feelings about the clinic, spirituality, and assistance from family/relocation.

Patients aged between 15 and 24 years are significantly more likely to drop out of HIV care compared to individuals in other age groups. The research was conducted in four sub-Saharan African countries and involved patients newly entered HIV care or initiating antiretroviral therapy (ART) between 2005 and 2010. Patients in the 15- to 24-years age group were significantly more likely to be lost to follow-up compared to both younger and older age groups.

This study provides important insights on program outcomes previously not sufficiently described. In addition to confirming attrition 1 year after starting ART the study found that youth were substantially more likely than young adolescents and older adults to die or be lost to follow-up before initiating ART.

These findings suggest that test-and-treat programs must focus on retention, particularly in the pre-ART period, in order to reduce morbidity, mortality, and transmission.

Conclusion:

The tools and strategies now exist to end the AIDS epidemic by 2030. However, getting there requires unprecedented action now to scale up early antiretroviral therapy, as delay will merely allow the epidemic to continue to outpace the response. While new thinking and new ways of operating will be needed to achieve these ambitious targets, the partnerships that have enabled the AIDS response to make history provide a firm foundation on which to embark on a worldwide effort to end the AIDS epidemic by 2030. Hence the 90-90-90 UNAIDS targets for 2020 are key to achieving this goal and although ambitious can be achieved.

This article was published on http://alanbrandpositivelyalive.blogspot.co.za/ on 18 August 2015

The concept of disability is widely misunderstood, resulting in the continuation of existing myths and stereotypes on disability in general.  In order to understand the concept of disability, one must first understand the difference between an impairment and a disability.

According to the White Paper on the Rights of Persons with Disabilities (WPRPD) which was approved by Cabinet on 9 December 2015, an impairment “is a perceived or actual feature in a person’s body or functioning that may result in limitation or loss of activity or restricted participation of the person in society with a consequential difference of physiological and/or psychological experience of life.”  In other words, impairment is a fact, something which can be either touched or proven physiologically.

On the other hand, inclusion “is regarded as a universal human right and aims at embracing the diversity of all people irrespective of race, gender, disability or any other differences.  It is about equal access and opportunities and eliminating discrimination and intolerance for all.  It is about a sense of belonging, feeling respected, valued for who you are, feeling a level of supportive commitment from others so that you can best fully participate in society with no restrictions or limitations.” Disability is therefore a concept.

The United Nations Convention on the Rights of Persons with Disabilities, signed and ratified by South Africa in March 1997, recognises disability as an evolving concept and states that “disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others”.

What does this mean?

Simply put, the person has an impairment but whether they are disabled or not depends on the barriers they face in society, be they of an environmental, attitudinal, or communication in nature.  In order to be regarded as disabled by society, one must have an impairment but not all persons with impairments are disabled.  Someone with impaired vision who uses spectacles would not be regarded as having a disability unless there were barriers in society that prevented them from participating equally.  Once that person’s vision declines to a point where they require additional assistive devices, like a white cane or a guide dog, they may be regarded as having a disability when public attitudes prevent them from accessing public spaces on an equal basis with others.

This is called the Social Model on disability. This model acknowledges that disability is a social construct and assesses the socio-economic environment and the impact that barriers have on the full participation, inclusion and acceptance of persons with disabilities as part of mainstream society. It is a model that focuses on the abilities of persons with disabilities rather than their differences, that fosters respect for inability and that recognizes persons with disabilities as equal citizens with full political, social, economic and human rights. The social model does not locate the “problem” within the person with impairment; rather it acknowledges and emphasizes barriers in the environment which disable the person with the impairment aimed at inclusion rather than exclusion of persons with disabilities from mainstream life. It emphasises the need for broader systemic and attitude changes in society; the provision of accessible services and activities; and the mainstreaming of disability to ensure full inclusion of persons with disabilities as equals. The model further encourages that persons with disabilities must actively participate in transformation processes that impact on their lives. Also it does not deny the reality of “impairment”, (an incident of human diversity), nor the impact this may have on the individual.

This is a far cry from the historic perception of persons with disabilities who were regarded negatively as being “defective”, the actual source of the problem, and the means of normalising the problem was for teams of medical and other professionals to fix the person as far as possible.  The social model turns this thinking on its head.  No longer is the person with a disability the problem, but rather society who does not accommodate the full spectrum of human diversity.

How does this affect the ordinary person in the street who comes across anyone with a disability in their everyday life?  The key is to recognise that it is society (including the attitudes of so-called “able-bodies”) which disables others.  Persons with disabilities are people first and should be treated with due respect and dignity.

Unfortunately, despite the advances we have made in securing access for persons with disabilities, there is still much to be done as persons with disabilities do not have the freedoms that the rest of us take for granted.  Do you want to make a difference?  Contact us to arrange a sensitisation workshop for your workplace, ladies’ group, sports club, place of worship or other and be the change!

This article was first published on www.wcapd.org.za

The SAB Foundation has contributed R2,100,000 to Hub Employment Ecosystems for People with Disabilities (HeePD) as part of its partnership. Launched earlier this year, HeePD seeks to benefit people with disabilities by creating a hub ecosystem that provides employment, enterprise and innovation, including job prospects and placements for corporate partners.

“HeePD came in to being based on my own experience as a person with a disability, as well as from my observations as someone who’s worked in, and recruited for the corporate world. HeePD is a way of equalising the playing field for people with disabilities on a meaningful level by addressing the main issues facing people with disabilities in getting jobs – creating permanent jobs in convenient locations and providing transport,” explains founder of HeePD, Riad Masoet.

“The government target is to have 7.5% of people with disabilities employed in corporate South Africa. The actual employment figure is closer to 1%,” says Masoet. “Our goal, with the help of the SAB Foundation, is to create 100 jobs over the next two years with this pilot project. Naturally, those 100 jobs will have an exponentially positive effect in the community.”

Uplifting people with disabilities

The partnership came about as part of the SAB Foundation’s focus on building opportunities for some of the most vulnerable of South Africa’s society, particularly people with disabilities.

“The SAB Foundation is committed to supporting projects aimed at uplifting people with disabilities and HeePD is absolutely groundbreaking. It’s the first project of its kind – and we are delighted to contribute to its success with funding. It is our hope that this pilot will prove the beginning of a successful model that can be replicated elsewhere,” says Bridgit Evans, director of the SAB Foundation.

This working pilot project with HeePD focuses on three distinct areas; the establishment of contact centres and help desks, urban farming and recycling.

Skills development and training

“We’ve started upgrading the infrastructure to create the ecosystem at our pilot site – the Cape Town Association for the Physically Disabled in Bridgetown, Athlone. We’ll be offering skills development and training, bridging courses for students and jobs for people with disabilities here,” explains Masoet. “Eventually, companies will be able to support their services with our contact centres and help desks, staffed by people with visual and hearing impairments.”

The urban farming project is up and running and the infrastructure development for the recycling project is under way. Ultimately, HeePD aims to establish 20 more hubs by 2020. In addition to the hubs, HeePD will also be providing transport with its ZiPD shuttle service which is launching towards the end of June. “At the moment we have two vehicles and will be operating in the Cape Flats for now, but hope to roll this out further,” says Masoet.

This article was published on www.bizcommunity.com on 20 July 2017

However, employment for disabled individuals goes unnoticed in the 17^th CEE report. The report mentions disability twice, reporting that 1,2% of the workforce at top management level is disabled.

“The Employment Equity Act states that at least 3% of the workforce should be employees with disabilities. The national disability prevalence rate in South Africa is around 7,5%, but it could be higher because of under-reporting,” says Tendai Khumalo, MD of Qunu Workforce, a Workforce Holdings company which provides disability solutions for corporates and government.

“Disability is not inability,” says Khumalo who became a paraplegic in 2003 after undergoing a spinal biopsy, after which a blood clot damaged the nerves in his spine.

There are far too few opportunities for disabled individuals in the workplace, despite the EE Act. The Act is merely on paper, says Khumalo who further notes that ramps and modified parking bays are not successful indicators of embracing disability.

“A paradigm shift is needed regarding the job roles typically ear-marked for persons with disabilities. There is a tendency to link contact centre jobs, admin roles and menial back-office jobs to people with disabilities with no career path and defined growth plans,” says Khumalo.

Khumalo’s commitment to increase opportunity for disabled individuals is reflected by his work, Qunu Workforce, which assists businesses to source, hire and train people with disabilities, transforming their lives and adding value to the business including improving the company’s B-BBEE scorecard.

This article was published by Business Report Online