I am an HIV specialist – not a doctor – who worked internationally through the HIV pandemic 1989-2003.
I learned a lot about pandemics, diverse countries, and various cultures. Covid-19 is of course very different from HIV. HIV stole our youngest and brightest, and today, pre-eminently, South Africa is still carrying the heaviest HIV burden in the world.
Of course, along with it has come TB, which has reached an extremely drug-resistant stage.
The latest data suggests 2.5 million South Africans are living with HIV without antiretroviral drugs. Over 100 000 South Africans die from HIV/Aids or HIV-related illness every year.
Now we are looking at Covid-19. We have been in lockdown in the hope that we can delay the onset of the pandemic in South Africa. It is anticipated that the epidemic will peak here in August or September.
And what will happen between now and then? I do not like to think of it, but my pandemic experience suggests that we are looking forward to an appalling period of death, economic disintegration and profound sorrow.
This virus is coming into a South Africa already struggling with the burden of HIV and TB. We have also been hit by lack of electricity and a drought – too little water throughout the region.
Many people live in overcrowded townships, one-room shack next to one-room shack, and no chance to self-isolate in case of infection.
We have the highest income inequality (measured by the Gini coefficient) in the world.
It was announced the other day that in our population of 52 million, about 12 million people are on the point of starvation, many of them children.
There are 12.4 million children who are now out of school, and who therefore no longer have access to school feeding schemes which, for many, provided their daily meal. This is the platform on which the virus will build its fearful empire.
On April 22, the Minister of Health reported that South Africa has 3 635 Covid-19 cases, with 65 deaths. In an African country of 52 million people?
These are extremely low figures, as are the figures available for other countries in the region – Namibia, Botswana, Zimbabwe, Zambia inter alia. The slow onset of a larger pandemic throughout Africa has puzzled scientists and doctors.
It is probable, however, that, in part at least, because Africa has fewer contacts with the outside world, fewer infections have been brought into countries like Botswana or Zambia, or even South Africa, by travellers and tourists. Second, how widespread and accurate is our testing for infection?
Third, how many of those infected do not show symptoms, are asymptomatic? Once the infection is established, there is nothing to halt its advance except the preparations governments and NGOs have been able to make while they are waiting to meet it.
In Cape Town, we feel as if we are waiting for an atomic blast to hit us. Yes, we have slowed the curve, but as lockdown ends, our infections will start rising in the almost vertical line we all know.
What will happen to the hungry, to the overcrowded, to the schoolchildren and teachers, to the farmers and herders, the shopkeepers, the miners and factory workers?
There is nothing between them and the virus, but there is a lot of HIV, TB and hunger to feed it. It has been suggested that at least 50 000 South Africans will die of this disease. How many of us know this will happen?
We will not escape this plague. It will not pass over Africa. I am sore at heart and bewildered about how each of us can help.
But we must – even if by just staying at home if possible. And we must prepare in our hearts and minds to meet this catastrophe once it is upon us.