---
title: "Covid-19 in South Africa – perspective is needed"
description: "Covid-19 has caused us to lose perspective on various fronts. One main front is the burden of disease. In a country in which many thousands of people die each year from treatable diseases like TB and Type 2 diabetes, an exclusive focus on the mortal impact of Covid-19, while understandable, is misplaced."
type: "OpinionNewsArticle"
publisher: "Daily Maverick"
site: "https://www.dailymaverick.co.za"
section: "Opinionistas"
author: "Michael Cosser"
author_url: "https://www.dailymaverick.co.za/author/michael-cosser/"
canonical_url: "https://www.dailymaverick.co.za/opinionista/2020-05-25-covid-19-in-south-africa-perspective-is-needed/"
published: "2020-05-25T23:36:08"
lang: "en-ZA"
word_count: 1127
---

# Covid-19 in South Africa – perspective is needed

> Covid-19 has caused us to lose perspective on various fronts. One main front is the burden of disease. In a country in which many thousands of people die each year from treatable diseases like TB and Type 2 diabetes, an exclusive focus on the mortal impact of Covid-19, while understandable, is misplaced.

By Michael Cosser · Published 26 May 2020, 01:36 SAST

## Content

This is not another piece about the epidemiology of Covid-19 by an amateur epidemiologist, but an article about the need to place the pandemic in perspective.

A recently released estimate of possible deaths due to Covid-19 is that[up to 48,000 people in South Africa may die from the pandemic by November 2020](https://www.businesslive.co.za/bd/national/health/2020-05-19-sa-faces-up-to-48000-covid-19-deaths-by-november/) (Kahn & Paton, 2020). At the time of writing (24 May 2020),[340,196 people worldwide have died from Covid-19](https://coronavirus.jhu.edu/) (Johns Hopkins University Coronavirus Resource Center) – 407 in South Africa. This means, in the worst-case scenario (if 48,000 deaths is worst-case), that the country can anticipate a 47,900 percentage point increase in Covid-19-related deaths over a six-month period – an increase of truly epidemic proportions.

But we need to place a scenario of 48,000 possible deaths due to Covid-19 in perspective.[A total of 446,544 people died in South Africa in 2017](http://www.statssa.gov.za/publications/P03093/P030932017.pdf) (Statistics South Africa, 2020) – 395,380 (or 86%) of natural causes. Of these, 28,687 (6.4%) died of Tuberculosis (TB) and 25,336 (5.7%) of Diabetes mellitus. From a numerical perspective, then, more people died from TB and diabetes (54,014) in 2017 than are projected, in the worst-case scenario, to die from Covid-19 in 2020.

**![Image](https://www.dailymaverick.co.za/wp-content/uploads/Opinionista-Cosser-CovStatsTW-graph.png)**

Perhaps more tellingly, more people died in South Africa in 2017 from non-natural causes (51,164) than are projected to die from Covid-19 in 2020.

What are the implications of these statistics for how we view the Covid-19 pandemic? Three present themselves.

First, because of its immediacy and its propensity to crowd out other priorities – or at best to colour our frames of reference – Covid-19 has caused us to lose perspective on various fronts. One main front is the burden of disease. In a country in which many thousands of people die each year from treatable diseases like TB and Type 2 diabetes, an exclusive focus on the mortal impact of Covid-19, while understandable, is misplaced.

A recent World Health Organisation (WHO)[Information Note](https://www.who.int/docs/default-source/documents/tuberculosis/infonote-tb-covid-19.pdf?sfvrsn=b5985459_18) cites modelling that predicts that a global reduction of 25% in expected TB detection for three months, because of a focus on Covid-19 testing would issue in a 13% increase in TB deaths – returning the world to TB mortality levels of five years ago.

“Between 2020 and 2025 an additional 1.4 million TB deaths could be registered as a direct consequence of the Covid-19 pandemic,” according to the Information Note.

Given this play-off,[the WHO](https://www.who.int/docs/default-source/documents/tuberculosis/infonote-tb-covid-19.pdf?sfvrsn=b5985459_18) urges health systems to ensure that TB prevention and care continue without any interruption. As past epidemics like influenza and Ebola have shown, the reassignment of personnel and hospital in-patient facilities for patients with serious respiratory complications that accompanies emergency outbreaks of such diseases has compromised TB care. South Africa is no different: a recent[NICD report](https://www.nicd.ac.za/wp-content/uploads/2020/05/Impact-of-Covid-19-interventions-on-TB-testing-in-South-Africa-10-May-2020.pdf) reveals that there has been a large decline in TB testing since the first lockdown was instituted – from an average of 47,520 TB tests per week before lockdown, to an average of 24,574 tests per week during the lockdown – a 48% reduction.

A total of 21,439 people (Table 1) died from underlying HIV disease in South Africa in 2017 (though the number may be considerably higher, as it is[estimated by scientists](https://journals.lww.com/aidsonline/FullText/2016/03130/HIV_AIDS_in_South_Africa__how_many_people_died.15.aspx) \[South African National Burden of Disease Study team\] that 93% of Aids deaths in the country are misattributed to other causes). But in a country in which HIV and TB intersect (around 301,000 people developed TB in 2019,[nearly 60% of whom were also HIV-infected](https://www.medicalnewstoday.com/articles/comparing-covid-19-with-previous-pandemics) – Newman, 2020), a higher proportion of the population than might otherwise be the case may manifest with severe symptoms if they contract Covid-19.

Second, while comparing Covid-19 with TB is instructive, comparing it with other diseases broadens our perspective even further. Covid-19 has arrived[amidst a “pandemic” we have been living with for some 40 years](https://www.medicalnewstoday.com/articles/comparing-covid-19-with-previous-pandemics) (Newman, 2020 – though the WHO now classifies HIV as an[epidemic](https://www.who.int/gho/hiv/en/)) – at the epicentre of which is South Africa. According to the WHO, more than [32 million](https://www.who.int/news-room/fact-sheets/detail/hiv-aids) people worldwide have died of HIV since the early 1980s, and at the end of 2018 about 37.9 million people were living with HIV – albeit that the majority of them have been kept alive by antiretroviral therapy.

The last 700 years have witnessed[a number of other pandemics](https://www.medicalnewstoday.com/articles/comparing-covid-19-with-previous-pandemics) (Newman, 2020): the Black Death, which in the 14th century killed 75 million to 200 million people – and possibly (according to[Spyrou, Tukhbatova](https://www.sciencedirect.com/science/article/pii/S1931312816302086#!) et al., 2016)[half](https://www.sciencedirect.com/science/article/pii/S1931312816302086) of the entire population of Europe; cholera, which over the past 200 years has reached pandemic proportions seven times and has killed thousands of people; the 1918 Spanish Flu, which infected around 500 million people (about one in three people on earth) and killed around 50 million people worldwide; and severe acute respiratory syndrome (SARS), which infected an estimated [8,000](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329048/)people ([LeDuc](https://www.ncbi.nlm.nih.gov/pubmed/?term=LeDuc%20JW%5BAuthor%5D) & Barry, 2004) in 29 countries and had a mortality rate of about 10% –[at this stage higher than that of Covid-19](https://www.medicalnewstoday.com/articles/comparing-covid-19-with-previous-pandemics) (Newman, 2020).

And third, the sudden arrival and the swift and ubiquitous spread of Covid-19 has not only focused the mind, but has fixated it on the present moment. Covid-19 colours our vision to the point of framing how we see everything, from events on the world stage to – in the context of lockdown – the most banal everyday events at home.

The loss of perspective the pandemic produces is not confined to the sphere of health, therefore. We are locked in a[time warp](https://www.collinsdictionary.com/dictionary/english/time-warp) in which the “[distortion](https://www.collinsdictionary.com/dictionary/english/distortion) of [space-time](https://www.collinsdictionary.com/dictionary/english/space-time)” (Collins English Dictionary) alters our perception of history. While millions have died over the last 700 years from pandemics, millions have also died from – and many more millions have suffered the repercussions of – natural disasters. There is not the space to enumerate these deaths and losses here; but in South Africa, in just short of a 40-year period (1980-2016),[there were 89 declared natural disasters](https://oxfordre.com/naturalhazardscience/view/10.1093/acrefore/9780199389407.001.0001/acrefore-9780199389407-e-246) (Van Niekerk, Wentink & Shoroma, 2018) killing 2,022 people but affecting more than 21 million.

And in the bigger scheme of things – the kind of historical sweep taken by historians Ian Morris in[*Why the West rules – for now*(2010)](https://books.google.co.za/books/about/Why_the_West_Rules_for_Now.html?id=4gFfSyXG2_wC&redir_esc=y) and Yuval Noah Harari in[*Sapiens* (2011)](https://books.google.co.za/books?id=FmyBAwAAQBAJ&dq=sapiens&hl=en&sa=X&ved=0ahUKEwinieqG7cfpAhUYSxUIHcC0CgsQ6AEIMTAB) – Covid-19 is but a moment in time. This is cold comfort for those living in the midst of a pandemic from which many thousands have died and many more have suffered – and the full trajectory and end-point of which we cannot know. But it does appear that, as for Wordsworth (in *[The World is Too Much With Us](https://www.poetryfoundation.org/poems/45564/the-world-is-too-much-with-us)*) lamenting the materialism of his age and the lack of synchronicity with nature which it spawned, “For this, for everything, we are out of tune.”**DM**