Where is the covid-19?

14 04 2020

The message is clear

Officially there have been 3 deaths due to the covid-19 (the causative virus is called SARS-COV-2) in Zimbabwe. Nobody really believes that – testing is sketchy at best but the point remains; the deluge has not arrived and nobody really knows why.

South Africa has a much more robust medical service than Zimbabwe and it’s top medics are also puzzled by the lack of a tsunami of covid-19. Their containment policy has been much more rigorously applied than Zimbabwe’s and testing has been widespread. Nobody is prepared to say that this has worked just yet, and planning for widespread infection goes on regardless.

Meanwhile in Zimbabwe we are taking precautions on a number of levels. I don’t do the shopping even when it’s not restricted but Marianne tells me that all the shops she goes to, which is just the food markets and pharmacists, have hand sterilizer for customers and it’s not always optional to use it. At the doctors’ practice I use it’s prominently displayed (picture above) and although its use wasn’t being enforced I’m pretty sure that someone would have called me out if I’d avoided it. It’s a sensible precaution along with the advice to social distance.

Having left the doctor with a script for my asthma control I went to a local pharmacy. On the way I passed by a noisy crowd outside the side entrance of a local supermarket. They were queuing for mealie meal (maize meal), the local staple food. It was a scrum of pushing and shoving – social distancing was the last thing on a hungry person’s mind!

There’s much we don’t know about this virus. The mode of transmission is assumed to be mainly by droplets and aerosols from infected people coughing or sneezing and to a lesser extent contact with contaminated surfaces. We don’t know if it will follow the seasonal pattern of the common ‘flu – there are indications from outbreaks in the southern hemisphere which is now coming out of summer that it won’t be.  This could be bad news for Zimbabwe or good news. We are just going into our winter which is characteristically cool and dry. We tend to be an outdoor economy and work in well-ventilated office spaces as there is no real need for heating or cooling, so virus transmission by aerosols is likely to be low. Indeed a study in the online journal PLoSCurrents indicates that influenza in the tropics is much more sporadic (not seasonal) in nature and the most usual mode of transmission is by contact not aerosols which are sensitive to temperature and humidity. Not good news for Zimbabweans for whom social distancing is an alien concept.

“There really is nothing else that can prevent this virus from spreading in the population outside of public health interventions like social distancing. It’s the lack of immunity in the population that is making people so susceptible.” (Andrew Pekosz, Professor of Microbiology and Immunology at Johns Hopkins University, USA.)

There is of course the possibility that the lock-down has been effective in preventing the covid-19 from really getting going. I don’t think that really is the case. While the roads are relatively quiet they are not as quiet as in South Africa – I have yet to encounter a road block. A friend in the USA who’s daughter is a doctor working in Liberia has commented that they covid-19 hasn’t really taken hold there either. Whatever the cause I see a real issue here if it doesn’t take hold like expected; the general population will become contemptuous of the warnings and let down their already low guard for the next time.

“Public health measures can only succeed if there is a high degree of social solidarity, which requires trust in public health agencies and their leaders.” (Mark A. Rothstein is the Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine and a Hastings Center Fellow.)

And there will be a next time. It could take the form of another novel virus or a resurgence of the covid-19. The virus that caused the 1918 influenza pandemic that killed around 17 – 50  million people took 3 years to abate, so we should expect the covid-19 to be around for some time and a possible resurgence in the northern hemisphere winter is a real possibility. There’s also a possibility of a resurgence at the end of lock-down – a problem that South Korea may already be experiencing.

The tuberculosis vaccine, BCG, is mandatory for children in Zimbabwe and other African countries. There has been speculation that it could explain apparent anomalies in the spread of the covid-19 as it may confer resistance to other viruses. My friends in the medical profession are sceptical that it will be of much use to my generation as the vaccine is thought to be effective for a maximum of 20 years though that is hugely variable depending on, among other things, geographical location.  Trials are underway though it will be several months before the results emerge.

World UV intensity map

We have plenty of sunshine in Zimbabwe and are heading into the sunniest time of year; winter. It’s long been known that patients exposed to sunshine and fresh air recover quicker. UV light, which is also in abundance here due to our altitude and latitude, is an important sterilant and vitamin D generator which is also important for the immune system.  This all sounds like we should have an easier time of the pandemic, should it arrive, though I think this is far from a certainty. I am not taking chances and as an asthma sufferer I am high risk so will continue to take my medication. And wait.





A state of health

16 03 2020

Lots of hardware holding my neck together

This is my neck. It doesn’t look pretty but with this amount of hardware holding it together it’s pretty strong. Quite how it got to be such a mess is a long and convoluted saga but it’s worth telling if only to warn just how badly wrong surgery can go.

In 1977, just before I was to start my compulsory military service, I went on holiday to South Africa with my sister and friend of hers and the friend’s brother. We met up in Pietermaritzburg where my sister was at university and made our way to the east coast of South Africa to a small town called Uvongo. We found the campsite and quickly pitched camp. I made my way to the beach whilst the others went shopping.

The surf on the South African coast can be big as there are no reefs offshore so it helps to be surf-wise. The tide was out and the body-surfers were making their way out to the bigger waves, diving under the breaking waves and surfacing once they’d passed.

A wave broke and tumbled towards me, I dived as stylishly as I could straight into the sand. My head hit the sand, swiveled to the left and bent backwards and I became a quadriplegic. Coughing seawater I somehow got my head back to the surface and legs and arms started to move again. I staggered a few steps then stumbled back to the shore.

That afternoon I went to see a local doctor. He was in an old cottage in a quiet part of the town and was totally bored. I explained what had happened.

“Squeeze my hands” he told me.

I did.

“Here’s a prescription for some pills that should ease the discomfort in your right shoulder”.

“So I’ve pinched some nerves in my neck?” I asked.

“Yes, something like that” came the reply.

And that was it.

20 years later and whiplashes to the neck in a military parachuting jump, a car accident and a mountain bike accident, I was in trouble. I’d had crippling migraines since leaving university. Now I had electrical like nerve pain in my shoulders to boot. It was time to see a neurosurgeon.

The same surgeon who’d fixed my spine after gunshot injury sustained during military service way back in 1979 put the MRI film of my neck up onto the light box. He’d done a good job then so I had a lot of faith in him.

“That’s giving you headaches” he said, pointing to a very distinct constriction in the spinal cord channel. Even to my untrained eye it didn’t look good.

I mentioned that on a recent trip to Cape Town a local neurosurgeon had fitted me in for a quick consult. He’d said that on the strength of the X-rays that I probably needed surgery although a MRI would be necessary to confirm it (I didn’t have the time for a MRI).

“Why didn’t you get it done in Cape Town?” the Zimbabwean surgeon asked.

“He only fitted me in as a favour” I replied.

I only realised years later that the Zimbabwean didn’t want to do the surgery. By the time the surgery was done some months later I’d discovered the surgeon was 74, certainly not in his prime but he assured me that it was routine. When I walked out of the hospital after 6 days I was convinced the problem was fixed.

After 3 months I had a final consult and all the adverse symptoms were gone.

“Thank goodness” the surgeon said with relief, “I don’t need to see you again”.

We discussed other things for a short while and I went on my way. No follow-up X-ray was mentioned.

By the end of 2009 I was dropping things and my left shoulder had become very weak. I was advised to go to Johannesburg in South Africa. I duly sent a stack of MRIs to the recommended surgeon and the reply was; “You need surgery!”.

Early 2010 found me in Milpark Hospital in central Jo’burg.

“These MRIs are terrible” the surgeon commented. “Do you mind if we do them again?”.

I was not surprised. The machine in Harare was old and the collar for the neck MRI was broken. A plan had to be made Zimbabwe style and the results were indistinct. So I agreed. Fortunately it was covered by my medical insurance.

The next day I was being prepped for sugery when the surgeon came past.

“Those MRIs, it’s a good thing we redid them”

“Why’s that?” I asked.

“Because it’s worse than I thought – it means we are doing the right thing!” came the response.

After 5 hours of surgery I woke up in agony. It went from bad to worse after that.

On the 4th night I woke up in the early hours and couldn’t get my right arm off the bed. My left arm was slightly better and I could just reach the handle on the chain over my bed. The nursing staff were puzzled and insisted it could not be swelling on the operation site as that only happened up to the third night. The surgeon was concerned and redid all the MRIs. He told me that he didn’t see anything he wasn’t expecting to see though the report that got back to the referring doctor in Zimbabwe clearly stated there was swelling, and pressure on the spinal cord, at the operation site. Evidently my body hadn’t read the text books.

The pain eventually subsided but I never got the full function back to my right arm and hand and now have had to become left-handed (with limited success). Weakness to my left shoulder resulted in surgery to it to decompress a pinched ligament but that was not wholly successful and I’ve had to give up swimming as a result.

In early 2014 I was in trouble yet again – falling over my own feet and eventually had to admit I needed two walking sticks instead of the one I’d used for the past 35 years. My GP referred me to Dr. V. He put the images up on the light box and could hardly contain his excitement (beware of surgeons who sense a challenge – they love challenges).

New MRIs were ordered and the news, once again, was bad.

“You need to make a decision soon. This degeneration is moving quickly” Dr. V. cautioned. Unfortunately I’d already booked to go to a bucket list event; a World Horticultural Congress in Brisbane Australia. By the time I got back I was in further trouble so hurried up and booked the surgery.

“This is to stop the rot” Dr. V. said from behind his surgical mask as I was wheeled into the operating theatre. “Anything else you get back will be a bonus”. The procedure went well with no complications and the rot was stopped but there were no bonuses. Dr. V. had been as good as his word.

Recently I went back to Dr. V. for a checkup on the neck and to asses a potential problem with my lower back which is starting to show signs of degradation below the original war injury that I sustained in the Rhodesian military in 1979 (this is accounted in https://gonexc.com/reflections-on-the-first-half-abridged-and-mostly-expurgated/). It was well treated by the standards of the day but now if you look at the X-ray on the left it’s possible to see where one disc has collapsed below the L4 vertebra and I felt that my gait and balance had suffered as a result. Dr. V. wasn’t so sure and sent me off to see a neurologist for nerve function testing.

My lower back. Look for the collapsed disc between the 2nd and 3rd vertebrae from the bottom.

I got chatting to the technician who did the actual tests and discovered that he’d tested my hands back in 2009 in the big government run Parirenyatwa hospital. I was curious to know if it was still running as it had closed in 2019 when all the junior doctors had gone on strike over pay so low that they could not afford to feed themselves and get to work. When the government had stone-walled the doctors the senior doctors had also gone on strike in support and they were fired too. A wealthy entrepreneur had offered to pay the junior doctors a useful wage but they replied that even if they could get to work there was nothing in the hospitals to work with – no bandages, syringes, gloves, medication etc.

“The junior doctors were reinstated – well those that hadn’t emigrated were – but the senior doctors weren’t and now there is no-one to run the departments” said the technician. So the hospital remains dysfunctional. Which applies to many hospitals around the country.

Fortunately for me I can afford the local private healthcare system which is adequate for most things. For the more technical I have an offshore policy that I have used in South Africa. The vast majority of Zimbabweans have no health cover at all and no way to pay for any.

I have been out of Zimbabwe for 10 days now, staying in the USA where my sister is very ill. In that time the unofficial exchange rate for the Zimbabwe dollar to the US dollar has plunged from 30:1 to 40:1. Nobody except the banks and government use the official rate (called the interbank rate) at 18:1. It is illegal to use anything but the interbank rate but even a fuel station chain, part owned by the government, is now openly charging US dollars for fuel. Just before I left Zimbabwe I was in a big hardware store in the industrial sites of Harare buying electrical cable for a borehole pump. The customer next to me asked if he could pay for a car battery in US dollars. The till operator nodded and printed out the relevant invoice. At the end of the counter the man operating the in-store bureau de change was asleep. The electronic notice board for the exchange rates on offer indicated the official interbank rates. Nobody was interested as the store was offering the black market rate. Yet the central Reserve Bank and the finance minister continue to trumpet that the economy is on course to de-dollarize i.e. go back to the Zimbabwe dollar.

I read somewhere that the death toll from the economic impact of the current COVID-19 coronavirus is likely to be higher than the direct death toll from the virus itself. Given the disastrous state of the government health system this is difficult to imagine. Large swaths of the population are malnourished and undernourished. Many are immune compromised with HIV and its effects. Should the virus get to Zimbabwe in any substantial force the impact is going to be massive because those most at risk are the old, infirm, malnourished and immune compromised. It won’t be pretty.