Researchers at Tel Aviv University have discovered evidence of ear infections in the skull remains of humans living in the Levant some 15,000 years ago.

Concrete is one of the most abundant and durable building materials used in modern-day infrastructures, but it has a weakness — ice — which can cause it to crumble and spall. Now, inspired by organisms that survive in sub-zero environments, researchers in Colorado are introducing polymer molecules with anti-freezing abilities into concrete. The method, which tests if the new concrete can stop the damage caused by freezing and thawing, appears in the journal Cell Reports Physical Science on May 27.

Researchers at MIT and elsewhere have combined the power of a super collider with techniques of laser spectroscopy to precisely measure a short-lived radioactive molecule, radium monofluoride, for the first time.

Restrictions could be introduced if there is a local flare-up of coronavirus, a minister says.

Influenza, also known as the flu, is one of the most common viral diseases in the world. It, however, took a backseat when the new coronavirus, SARS-CoV-2, rapidly took over earlier this year.

Now, new research, published in BMJ, shows that governments’ implementation of lockdowns and physical distancing measures, in an effort to curb the spread of SARS-CoV-2, have shortened the flu season – by up to six weeks, and that tracking infectious disease cases “could be a complementary approach to assessing the effectiveness of general infection control measures against Covid-19”.

Flu viruses circulate worldwide at different times of the year. Seasonal flu usually peaks in February and dies down by the end of May in the northern hemisphere, and runs from April to September in the southern hemisphere, often peaking during August.

Death by flu: a global perspective

Statistics from the World Health Organization (WHO) indicate that the seasonal flu typically kills around 290 000 to 650 000 people annually and causes as many as five million cases of severe illness. According to Nature, the 2020 flu season was set to be the most severe in decades, until Covid-19 crossed borders and was declared a pandemic.

In South Africa, flu kills between 6 000 and 11 000 people each year, according to the Department of Health. So, if flu seasons are shortened around the world, it could mean that more lives are spared.

Lab-confirmed cases from this year so far reveal that the incidence of flu dropped steeply in early April in the northern half of the world. This was revealed just a few weeks before the new coronavirus was declared a pandemic on 11 March. The data came from FluNet, a global surveillance system, and included tests of more than 150 000 samples from national influenza laboratories in 71 countries. 

Business Insider reported in March that at least 20% of the global population was on lockdown, with South Africa, India, China, France, and Italy, among others, having the world’s most restrictive quarantines. By the end of March, more than 100 countries worldwide had instituted either a full or partial lockdown, the BBC notes.

On the other hand, an article in Nature points out that, looking at the total number of lives lost to Covid-19 and other diseases in 2020, it’s hardly a rosy picture that emerges. 

The case with other infectious diseases

A number of other infectious diseases such as chickenpox, measles and rubella were also positively impacted so far in Hong Kong this year, the study’s co-author, infectious-disease researcher Pak-leung Ho at the University of Hong Kong, told Nature, with measles and rubella being at their lowest, globally, since 2016. Ho explained that the closure of schools during lockdown could have been the reason behind this, as these diseases typically affect children, adding that this “may have had the biggest impact”.

By contrast, there are other infectious diseases, such as tuberculosis (TB), that are likely to see an upsurge in cases, as programmes to fight the disease have been cast aside since the Covid-19 outbreak. TB is ranked as the ninth leading cause of death worldwide.

A recent release of modelling on the impacts of the initial Covid-19 response on TB revealed an estimation that, globally, a three-month lockdown and a protracted 10-month restoration could lead to an additional 6.3 million people falling ill with TB and an additional 1.4 million TB deaths over the next five years, Health24 reported. According to the latest statistics by WHO, TB caused around 63 000 deaths in South Africa in 2018 (figures for 2019 are not yet available). 

Tracking ILI cases

Of course, the reported decline in flu cases may also be due to people with flu-like symptoms simply avoiding health clinics during this time, and self-isolating at home instead. But tracking the number of flu cases and other influenza-like illnesses (ILI), can, however, help shed light on the effectiveness of public health policies aimed at containing the Covid-19 pandemic, the authors of the paper note. This recommendation comes after the team looked at the epidemic response in Hong Kong, whose 2019–2020 flu season was 63% shorter than those of the previous five years. Lab-confirmed flu deaths showed that the number was 62% lower.

In their paper, they explain, based on the statistics, the key infection control strategies undertaken in the country against Covid-19 – case identification and isolation, quarantine, physical distancing, and mass wearing of masks – provide evidence that surveillance of these diseases can provide crucial information about the impact of general infection control measures.

“By monitoring the transmission patterns of ILI, we can approximate the overall performance of a population’s general infection control measures, including enhancement of personal and environmental hygiene and physical distancing,” the authors wrote.

WHO also told Nature: “Public-health measures such as movement restrictions, social distancing and increased personal hygiene likely had an effect on decreasing influenza and other respiratory virus transmission.”

Covid-19, which started as a local outbreak in China and quickly led to a pandemic, has infected over 5.4 million and caused more than 346 000 deaths worldwide – as of 26 May 2020.

Compiled by Zakiyah Ebrahim

Salons are asking the government to let them open before July to cut hair.

The tiny passageway leading to gogo Nobude Ngqola’s shack in the densely populated TR Informal Settlement in Site B, Khayelitsha is difficult to navigate. Washing hanging from fences and shacks built metres from each other makes it difficult to move freely. Despite the warnings about physical distancing, women sit in groups in the shade busy with laundry. They are not wearing masks. It’s an unseasonably hot day for May.  

We talk inside the tiny three-room shack that the 82-year-old gogo shares with her eight children and grandchildren. Seated on a worn-out sofa sipping tea, Ngqola says she has been terrified to leave her shack ever since she first heard news of the spread of Covid-19.

On 24 May, the Western Cape government reported that there have been a total of 1 853 confirmed Covid-19 cases in Khayelitsha – a number that is greater than that in some of South Africa’s provinces.

Leaky shack

It may be sunny outside today,  but Ngqola’s  daughter, Nomawesile Adonis (39), says when it rains things can get bad very quickly. Winter is not the best time for Ngqola and her family. “Water pours through the gaps and turns the shack into a mud pool,” she says pointing at the holes in the roof. 

To keep warm during winter, the family often relies on an imbawula (a makeshift fireplace/coal stove), but when a neighbour got burnt and killed by an imbawula, the children decided to buy a paraffin heater. “But many of our neighbours still rely on an imbawula to stay warm despite all its dangers,” says Adonis. “We are just hoping that our long wait to get a house can come to an end soon,” she says.

Ngqola says “back in her day” there were no deadly diseases like Covid-19. “We only heard tales from our grandparents about a deadly flu disease that claimed many lives some years ago,” she recalls. “I have gathered a lot of information on the radio about this virus. I always cover myself with my scarf whenever I sneeze. Fortunately, I am always alone in my bed.” 

Ngqola recalls how she arrived in Khayelitsha in 1987 from the Eastern Cape in search of greener pastures. “I found a job as a domestic worker. Despite the little money I earned I managed to save some and bought material to build my own shack,” she says. Now, 33 years later and still living in an informal settlement where there are limited basic services, Ngqola has to share an outside tap and toilet with dozens of her neighbours.

She recalls attending several rallies in Khayelitsha prior to the elections in 1994, where politicians promised houses for the poor. “I registered together with many others in the hope that I would move into a new house soon. But a number of years passed without getting any house,” says Ngqola.

Now aged 82, frail and battling diabetes, Ngqola tells Spotlight her only wish is to finally get keys to a new house before she dies. With the Covid-19 pandemic ravaging the Western Cape, Ngqola lives in constant fear of contracting the disease, mostly because her living arrangements are particularly dire for someone her age.

‘Mission Impossible’

Ngqola’s fears are not misplaced. People over the age of 80 years and those with chronic diseases have been shown to be most vulnerable to Covid-19. Dr Tom Boyles, an Infectious Diseases specialist at Helen Joseph Hospital in Johannesburg, recently raised concerns about the effect of the deadly virus on the poor. “If and when there is significant community transmission in SA, I think people living in informal settlements will be at the greatest risk of infection because they will find the preventative measures [physical distancing, hand washing] more difficult to adhere to,” Boyles was quoted as saying.

The People’s Health Movement (PHMSA) has been calling on government to fix the social determinants of health that include decent housing, access to clean water and sanitation and good nutrition.

While the Covid-19 lockdown regulations state that people should stay at home and practice physical distancing, Ngqola says where she lives, is a “mission impossible”. Sharing an outside toilet and tap with dozens of other shack dwellers puts her at high risk.

“I often listen to the radio and hear them say we must practice physical distancing. How do you do that in an environment like this? This Corona is going to claim many lives in informal settlements. I know I am old and sickly and can die anytime. But I’m just worried – more about my children,” she says.

With winter approaching Ngqola’s daughter is also worried.

“Winter in Cape Town means shack fire season. Our biggest concern is what will happen to her in case of a shack fire. Her legs are failing her, and someone has to help her to the outside toilet. But we always have someone with her in the shack in case of an emergency,” she says.

Adonis says winter also means shacks are flooded during heavy rains. They have to mop up water whenever there is flooding, she says. Ever since the outbreak of Covid-19, Ngqola’s children have ensured that they keep their distance and wear masks whenever they serve her porridge or help her go to the outside toilet. 

But it is difficult.

‘No elderly person deserves to live like this.’

Adonis, who works as a domestic worker, knows the high risks of Covid-19 and says she always buys sanitiser for her mother and siblings. They are however grateful for the food donations they regularly receive from neighbours during the Covid-19 pandemic.

Recently Ngqola was also among 10 families who benefited from food parcels donated by local football stars Mark Mayambela and Ayanda Patosi who both grew up in Khayelitsha.

“No elderly person deserves to live like this. I just can’t imagine how she has managed to survive all these years. We will definitely return and see what we can do to improve her situation. With winter approaching, something needs to be done to repair the leaking roof. But she needs a house as a matter of urgency,” Mayambela said.

Umelwane (neighbourhood friend)

Ishrene Davids from the organisation Ikamva Labantu tells Spotlight that for an older person like Gogo Nobude who is frail, accessing help can be nearly impossible.

Davids says their home-based model provides an essential safety net to support both frail older persons and their caregivers in township communities. “Our fieldworkers walk door-to-door throughout Cape Town’s townships, searching for senior citizens in need of support,” says Davids.

They refer to these fieldworkers Umelwane, which means “neighbourhood friend” in isiXhosa. “These clubs follow a stimulating programme which includes education around healthy living practices, creative activities (beading, choir practice, sewing etc.), social entrepreneurship, as well as eating breakfast and lunch together every day. Importantly, they are able to be among their peers in a social environment, away from the stress and isolation of their homes. Our senior participants also have access to the emotional and physical support that our field workers provide,” she says.

The organisation operates 21 Ikamva Labantu Seniors Clubs around Cape Town’s township neighbourhoods but had to stop on 17 March 2020 as a precautionary measure to ensure physical distancing.

Government responds

When approached for comment on what the department is doing to safeguard older people like Ngqola in township communities, Mark Van Der Heever, spokesperson for the Department of Health in the Western Cape referred Spotlight to the Western Cape Department of Social Development.

During a media briefing this week, however, Dr Keith Cloete, Head of the Western Cape Department of Health, said Khayelitsha is among the hotspot areas the department is prioritising. Cloete said part of the department’s refined strategy is to focus and streamline testing and screening on “high-risk groups such as health workers and the vulnerable people”. Those older than 55 with comorbidities like diabetes are deemed “vulnerable”.

Spokesperson for the MEC for Social Development, Joshua Chigome, said there are facilities such as old-age homes where the sick and elderly are accommodated but a decision is taken by the family of the elderly whether they want their loved one to be taken to an old-age home. “Most families prefer to take care of their elderly themselves. We are unfortunately unable to decide for them if their granny needs to be taken into one of the facilities that we provide as the department,” he said.

Chigome said that if the elderly people, like Gogo Nobude, show symptoms of the Covid-19 they should “immediately go to the clinic and get tested” He said older persons in communities that are not living in care facilities are targeted and exposed to the same messaging and campaigns aimed at all citizens by the media. 

Khayelitsha Development Forum (KDF) chairperson Ndithini Tyhido told Spotlight the Covid-19 lockdown period has left many elderly shack dwellers high and dry.

“The sad part is that these are people who are at high risk of contracting the coronavirus. Our call to government is that they should prioritise densely populated informal settlements by providing free sanitisers and masks,” he said.

Meanwhile, ward councillor Lulekwa Jali said they are aware of Ngqola’s plight and her matter was forwarded to authorities for urgent intervention. “We’ve engaged with relevant authorities in the City (local government) and they agree that something needs to be done to assist her. It is painful to see an elderly woman living under such poor conditions,” she said. 

This article was produced by SPOTLIGHT – health journalism in the public interest. SIGN UP for our newsletter.

^{Image credit: Siyabonga Kamnqa, Spotlight}

Siyabonga Kamnqa

While department of health officials in the North West debate what defines a “crisis” of essential medicine supplies, *Tendai is panicking. Two weeks of going without drugs for her thyroid condition and her debilitating symptoms are back.Tendai is a patient at Klerksdorp/Tshepong hospital.

In January this year, her loss of appetite, swollen feet, shakes and constant thirst led her to seek help at the hospital. She was diagnosed and prescribed medicines for long-term treatment for her overactive thyroid. “The medicines helped me so much and all my symptoms stopped,” she says.

Since January she’s made monthly trips to the hospital to pick up her two medicines, paying R40 each time. But in the middle of April, her usual hospital visit ended with a nightmare of worry. The pharmacy could only dispense one of her drugs. “They gave me a piece of paper and told me to phone first to check before coming to the hospital because they didn’t know when they would have the medicine. I have been phoning every day and now it’s been two weeks,” she says.

Tendai tried to source Carbimazole at private pharmacies. For 100 tablets she says the price is around R800 and she needs 350 tablets a month of this drug. She cannot afford it. “I’m hurt and my symptoms are back. I don’t know what I can do; only to watch myself die,” she says. Doctors say that her condition can become so severe it can weaken her heart and threaten her life. 

Numerous drug shortages

Tendai is one of dozens of patients whose lives are at risk as various medicines on the province’s essential drugs list (EDL) are not available. Physicians at Klerksdorp/Tshepong Hospital and Rustenburg Hospital who spoke to Spotlight believe that the province currently only has about 40 to 50% of the items on the EDL. One doctor at Rustenburg Hospital says it should never drop below 75%. “It means I know I can’t do the best for my patients. It’s very demoralising for the staff,” the doctor says.  

Among the drug shortages they say are painkillers, Vitamin B12, calcium tablets, iron tablets, the flu vaccine, urine test sticks, antibiotics and drugs to treat hypertension, diabetes, epilepsy, psychiatric conditions, cryptococcal meningitis, epilepsy and pneumonia. Drugs used for sedating and paralysing patients for intubation in intensive care are also not available. 

Doctors have flagged these problems for at least two years and they say the shortages have occurred intermittently for the past few years. In 2018 the province’s medicines depot in Mahikeng was at the centre of a go-slow that severely compromised healthcare services in the province that year. Since then Spotlight understands the depot has run sub-optimally.

There have been problems with staff being suspended, staff shortages, alleged incompetence and maladministration. Suppliers have gone unpaid, leading to terminated service agreements. Other companies that won tenders could not meet obligations but have not been penalised or forced to pay back monies. An accrual system now means new budgets are used to pay old debts, inevitably leaving shortfalls towards the end of each financial year. 

‘Our duty to say when things are not right’

Doctors who spoke to Spotlight asked not to be identified for fear of being singled out as “troublemakers” and “complainers”. There is also a fear that being identified will make them easy targets for officials who would rather go after them than addressing the problems. But the four doctors who spoke to Spotlight say they “cannot in good conscience remain silent”. They say they have followed all the official channels to raise their concerns. 

“After Life Esidemeni (the tragedy in 2016 when 144 mental health patients died when the Gauteng Department of Health moved about 1 700 mental health patients from Life Esidemeni facilities to unsuitable facilities) the ombudsman criticised doctors for not speaking out. It set a precedent and it should be our duty to say when things are not right and we know our patients are being turned away at the pharmacy windows,” one doctor says.

Impact on healthcare services

A doctor at Tshepong Hospital tells of how they must delay discharging patients so they can receive life-saving drugs intravenously. “Administering drugs intravenously comes with hospital stays of about R2 700 a day instead of sending people home with medicines. It’s a case of being penny-wise and pound-foolish,” the doctor says. 

“I also have no doubt that we will see HIV patients returning to hospital with meningitis because we are not able to give them Flucanozole, which is an anti-fungal treatment that fights opportunistic diseases in HIV-positive people,” the doctor says. “It’s the same with urine testing – because there are no urine test strips that we use to pick up blood, proteins or infection, doctors have to order expensive blood tests instead. It comes with high costs and delay, so there are infections that are not getting picked up early.” 

Another doctor says that for some conditions there just aren’t alternative medicines and often switching drugs means having to re-stabilise patients on a new drug regime. Some pharmacists are already resorting to dispensing smaller quantities of drugs to patients and asking them to return more frequently in the hope stocks will be replenished by their next visit. Sometimes, like in Tendai’s case, they have nothing at all to give their patients. 

Before South Africa’s Covid-19 Lockdown, patients from Rustenburg Hospital often turned to sourcing medicines at public facilities in Pretoria or Johannesburg. That avenue has been cut off with travel across provincial borders having been restricted. One doctor says that Covid-19 preparations and the procurement of personal protective equipment have come at the expense of pharmacy staff having capacity to maintain stock of items on the EDL in the province. “We know that without the drugs we need in ICU we will not be able to cope if our Covid-19 cases spike,” another doctor says. 

Government response

Polaki Mokatsane, Deputy Director General (DDG) for health in the North West, acknowledges that there are long-standing systemic problems but believes that they are getting things back on track. Mokatsane says with the new financial year having started in April, he expects all debts to suppliers to be settled by the end of this month (May) so contracts and supplies can resume. However, he confirms a huge backlog of having to process individual invoices. “Four staff members were suspended at the end of last year and we did have HR issues. But we now have two staffers who I believe can get us to where we want to be. The problem is that there wasn’t proper forecasting with some of our drugs and that’s why we ran out of stock,” he says. 

He adds that they have focused on improving communication with hospitals, improved buying-out options for emergency supplies and to widen the networks of sourcing medicines across facilities in the province. “If you ask me if we have a crisis with supplies of essential drugs, I will say no, we only have challenges,” says Mokatsane, who was previously CEO at Klerksdorp/ Tshepong Hospital before stepping in the DGG role in September last year. 

He sounds assured, but many physicians in his province are unconvinced that a turnaround is imminent. And for people like Tendai who goes home from the pharmacy empty-handed, his words a difficult to believe. 

*Full name withheld

Note: In this article, four different medical doctors are quoted anonymously. While Spotlight generally avoids making use of unnamed sources, we make exceptions where we consider the fears expressed by the sources to be valid, the information provided to be reliable, and the publication of the information to clearly be in the public interest.

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Ufrieda Ho

Consumers often struggle to achieve self-set life improvement goals, but what if deliberately emulating the successful strategies used by their friends could help them?