South Africa

Maverick Citizen: Coronavirus

450 US health experts send open letter to Vice President Pence on ‘Achieving a Fair and Effective response to Covid-19’

450 US health experts send open letter to Vice President Pence on ‘Achieving a Fair and Effective response to Covid-19’
Passengers arrives from Hong Kong at Cape Town International airport after being screened by health officials following the outbreak of the coronavirus in China. January 29, 2019. (Photo: ESA ALEXANDER/SUNDAY TIMES)

Today, South Africa registered its first confirmed case of the virus that causes Covid-19. What we do in the next few days will be critical. Missteps, panic and poor communication will be fatal.

There are lessons to be learned from the US, where it appears that the Covid-19 virus may soon be entering an exponential phase of transmission. California has declared a state of emergency, a school district has closed in Seattle and a cluster of cases have been identified in New York City. In days ahead, Covid-19 may spread more rapidly and there are concerns that inequalities in the US, particularly in access to affordable healthcare and medical insurance, may facilitate more rapid transmission than in other developed countries.

Predictably, President Donald Trump’s first steps were missteps; initially attempting to deny the scale of the threat and then appointing Vice President Mike Pence to head the response.

On the other hand, the appointment of Dr Debbie Birx, a highly experienced and respected clinician and the hands-on head of the President’s Emergency Fund for AIDS Relief (PEFAR) has given reassurance that at the operations and technical level at least, a dedicated professional is in charge.

Nonetheless, as the response was being scaled up, on Monday, 2 March, a group of more than 450 law and public health experts issued a public letter addressed to Pence and federal, state and local leaders.

The letter is a short, but remarkable distillation of principles based on the collective experience of health experts who have been directly involved in combating epidemics from HIV to Ebola and Zika, as well as the more common genres of influenza that annually sweep across developed countries. It itemises all the essential aspects of what it calls “an effective and fair response”.

We republish it here because although conditions in South Africa and the USA are vastly different, many of its recommendations are highly relevant to what we do here. 

The letter starts by recognising that “one of the greatest challenges ahead is to make sure that the burdens of Covid-19, and our response measures, do not fall unfairly on people in society who are vulnerable because of their economic, social or health status.”

Thereafter, it calls for adequate funding, including a special “major emergency congressional appropriation”, signed by the president. Since the letter was written, Congress has approved $8.3bn in emergency aid.

This too is something the South African government must urgently consider as it is impossible that Covid-19 can be contained within the existing overstretched health budget. It would also make sense that money is made available now, rather than waiting until an epidemic develops and is out of control. 

The letter draws special attention to the need for protecting healthcare workers and patients with a recommendation that:

“Healthcare facilities must be immigration enforcement-free zones so that immigration status does not prevent a person from seeking care.”

This too should be the explicitly stated position of the SA government and communicated urgently to all health workers.

If undocumented migrants feel afraid to access health services, Covid-19 will spread rapidly within communities and could lead to further acts of xenophobia.

This recommendation also applies to the letters’ recognition that “people residing in close living quarters are especially vulnerable and will need special attention both to minimise transmission risk and address their healthcare needs”.

The letter calls for “clear evidence-based communication to manage public fear” (something that has been lacking in SA thus far), and pays close attention to what it terms social distancing measures, voluntary self-isolation and quarantine. It calls for all such measures to be:

“Guided by science, with appropriate protection of the rights of those impacted. Infringements on liberties need to be proportional to the risk presented by those affected, scientifically sound, transparent to the public, least restrictive means to protect public health, and regularly revisited to ensure that they are still needed as the epidemic evolves.”

For example, the experts point out that although quarantine may be essential at the outset, its success will be dependent on “whether individuals can comply, which will be determined by the degree of support provided particularly for low wage workers and other vulnerable communities”. This in turn has ramifications because, as community transmission spreads, “quarantine becomes a less plausible measure”.

The letter closes by advising that: “The Covid-19 outbreak is unprecedented in recent American history, and there is no playbook for an epidemiological event of this scope and magnitude. To mitigate its impact you must act swiftly, appropriately and effectively.”

Although South Africa is only in the earliest stages of this epidemic, what we do in the next few days will have major implications for its impact.

We too need to be swift, appropriate and effective. MC

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