Deadly pandemics and epidemics, caused by viruses and bacteria, are part of human history. Spectacular examples include: the Plague of Justinian during 541-542 (30-50 million deaths); Bubonic Plague/Black Death during 1347-1351 (200 million deaths); Smallpox in 1520 (56 million deaths); The Third Plague in 1855 (12 million deaths), and the Spanish Flu in 1918-1919 (40-50 million deaths).
Viruses are the smallest and deadly microorganisms with their unique ability to only live and multiply inside the host cells of living things. The novel (emergent or new) coronavirus (Covid-19), caused by the novel Sars-CoV-2 virus, is a stark reminder of ever-present virulent microbes and a stage for novel solutions. [Sars is a severe acute respiratory syndrome.]
Human-animal interaction and human impact on the environment are said to drive zoonotic (animal to human) infectious disease transmission, caused by bacteria, viruses and parasites through the air, direct or indirect contact with infected animals, contaminated meat or produce, and insect bites. In the case of the Covid-19, bats or pangolins are suspected to be the natural reservoir.
A novel virus is one not seen before, transferred from its natural reservoir (source) as a result of spread to an animal or human host where it has not been identified before. It is either an emergent/new strain or an extant strain never previously identified. Because it is new, it does not encounter immunity from antibodies in the new host to fight the infection, thus overwhelming the host cells before immunity or a vaccine is developed. This results in mutations, destruction or death of the host cells, leading to a local or global crisis.
As Namibia was celebrating her 30th independence anniversary, the annual global pandemic/epidemic fatalities read as follows: TB (1.3 million); HIV (770 000); Seasonal influenza (650 000); Pneumococcal disease (500 000); Malaria (405 000); Rota-Norovirus and Shigella bacteria (200 000), and RS-virus (200 000) [Source: Helsingin Sanomat, 22 March 2020]
On 23 March 2020, as the coronavirus pandemic was accelerating, the World Health Organisation sent out a chilling message: “It took 67 days [2.23 months] from the first reported case to reach 100 000 cases, 11 days [almost 2 weeks] for the second 100 000 cases, and just four days [about half a week] for the third 100 000 cases.” [Source: Tedros Adhnom Ghebreyesus, WHO Director General]. As global cases eclipsed 350 000, deaths soared past 15 000.
In mathematical terms, this is an exponential or explosive growth, typical of pandemics, which gives rise to sickness, death, despair, fear, panic and urgent action and vaccines. However, this deadly virus currently shows that only about 5% of cases have become serious or critical, with mortality under 4% (diving the number of deaths by officially confirmed cases). Mortality is, thus, lower in the total population. Compare this to mortality rates of SARS at 9.6%, Ebola at up to 71% and untreated Rabies at 100%.
Any outbreak of an infectious disease has a ramping-up period, followed by a peak of intensity, then a decline, yielding a bell-shaped curve. Public health is immediately concerned with “flattening the curve”, that is to prevent a sharp peak of cases, thus to spread out the infection over a longer period of time so that the healthcare system will not be overwhelmed. [Source: The Star, Malaysia, 22 March 2020]. In other words, flattening the curve
In Namibia, like in most countries, we have yet to ride out the three phases, and an effective response intervention will quickly ‘flatten the curve’ before a rapid decline. This is critical to direct public health response to better control and prevention of a disease – i.e. managing the pandemic with limited resources for critical patient care, under emergency conditions.
Nevertheless, the danger still lingers in several factors: i) new infections may not reduce significantly overall; ii) the pandemic may last longer; iii) the pandemic may resurge, or iv) mutations – changes in the genome of the virus – may complicate immunity and vaccines. Thus, these conditions must be well managed.
Lately, we have heard more news about cases identified and contained locally (since mid-March 2020) then about public education and directives, and national preparedness. Albeit and regrettably a belated response at the international and national levels, the interim national state of emergency declaration and the associated measures are positive and necessary to flatten the curve as soon as possible.
However, Namibia remains challenged in many ways that pose a threat to an effective response to the pandemic. It seems we are not medically ready to contain the pandemic – in terms of medical insurance/care, medical personnel, medical facilities and resources, etc. In addition to the older population, there are many people suffering from low nutrition and low immunity due to pre-existing conditions, whoa are, thus, more susceptible to infection.
Nevertheless, it is reassuring to know that each pandemic is conquered in unique ways and the overwhelming majority of the people will survive this one with reinforced immunity. In conclusion, this limited narrative on the pandemic serves the purpose of public education and debate. We may say, this too shall pass!
*Dr Tjivikua holds a Ph.D. in Organic Chemistry and 30 years of academic experience. He is the Founding Rector of the Polytechnic of Namibia (est. 1994) and Founding Vice-Chancellor of the Namibia University of Science and Technology (est. 2015).
2020-03-27 08:00:12 | 6 days ago