This day, the first of its kind, is aimed at recognising and raising awareness of the invaluable role Field Epidemiologists play.
As health systems face increasingly complex threats, training workers in field epidemiology is even more important.. The NICD, a division of the National Health Laboratory Service, embarked on a joint collaboration more than 15-years ago in establishing the South African Field Epidemiology Training Programme (SAFETP). To date the program has trained 98 epidemiologists with the majority located in the public service in South Africa.
Field Epidemiologists, or ‘disease detectives’ are considered the cornerstone of public health preparedness and response. They undertake arduous, time-consuming tasks that include contact tracing, case investigations, community engagement, data collection and analysis.
One such ‘disease detective’ is Alain Musaka Abera, whose team was deployed to Equateur province in the DRC in response to an outbreak of Ebola virus disease (EVD). “The health zone of Ingende had already reported seven confirmed cases, including two deaths in the community,” said Abera, describing his work. “I had to set up the different pillars of epidemiological surveillance (management of alerts, active research, investigation, follow-up of contacts) and, at the same time, support coordination of the response in the health zone.
“The task was tough; the means of transport insufficient; communication almost non-existent. It was necessary to travel long distances in the forest on motorcycles that sometimes broke down and to cross the river in a canoe to search for and investigate suspects. It took courage, determination, and will to face these constraints.”
The Daily Maverick interviewed Dr Ridhwaan Suliman, a senior researcher at CSIR who has entered the spotlight by posting his concise, easy-to-understand COVID numbers graphs on Twitter.
Trained as a mechanical engineer and with a PhD in applied mathematics, he develops computational tools to model and simulate physical systems and processes. Equations in real-world contexts and how they govern physical systems are the relationships he translates into code. And from the code and modelling he can find solutions to make things work more optimally.
As a boy, he took apart his brothers’ old toys to see how they worked, and he took the same approach with COVID data to make sense of it. He started tracking the data in early 2020, and wanted to contribute in some way amidst all the growing uncertainty.
“When I started seeing the raw numbers that were being fed to us daily I couldn’t quite make sense of it myself because the raw numbers in isolation don’t show what’s happening, actually.”
As he tweeted his analyses, he drew attention for his concise summaries of the situation, and praise for helping people to understand the trends. However, he stresses that this is all unpaid, with nobody else’s agenda and that he is not a medical expert.
“I’m just comfortable with the numbers.” He gratefully turns to the science experts he engages with on Twitter because “there’s so much more to learn”, he says. That, and a lot of background reading, which he readily dives into.
Dr Suliman’s tracking of the data let him identify gaps and to add to the call for open data, better data collection and smarter analysis. This allows for the factoring in of more variables and laying out of better parameters. “Sure, data can be manipulated to fit a certain narrative, but the benefits outweigh the risks,” he says.
Even in the polarising, easily toxic world of Twitter, Dr Suliman’s interactions show a great empathy.
“We’ve all had numerous moments in this pandemic when things have been depressing and that’s probably something that doesn’t come out on Twitter because you’re generally only sharing things when things are hunky-dory, you don’t share when you’re not okay. There have been many times when I’ve just wanted to stop tweeting, but I get drawn back by people who reach out and say ‘you’re helping me’ – and that’s good enough reason to continue.”
Since he first started on Twitter, he has since appeared numerous times on television to explain the data behind COVID numbers.
Despite his newfound fame however, he looks forward to the time when he can travel again. “I’ll trade the followers any day for our lives to go back to some sense of normality,” he says.
An article by the Daily Maverick reveals that a wave of suspensions in the Department of Health are impending as a result of the investigation into the Digital Vibes contract, which prompted the resignation of Dr Zweli Mkhize.
Minister of Health Dr Joe Phaahla said that he received a letter from the Special Investigations Unit (SIU) which he would have to act on.
Dr Phaahla said that “in the next few days and weeks there will unfortunately be some action and that will have some impact also on our capacity as a department”, adding that “when wrong things have happened and investigations have led to findings, then people have to be held answerable”.
However, Dr Phaahla said it was regrettable since “it will have an impact on our capacity, because from what I have seen, a number of people will have to be on suspension, pending charges.” He said it would be difficult for the vaccination programme as management staff were already stretched thin, but “it’s a consequence which must follow”.
Drs Buthelezi and Pillay denied any knowledge of suspension, though the Daily Maverick has found out that referral for disciplinary action have been sent to the presidency.
The details of the SIU’s investigation have not been made public yet, although the Daily Maverick was able to tease out some details from an affidavit to set aside the Digital Vibes contract and to seeks to reclaim up to R150 million that was paid for the contract.
The affidavit further reveals that Dr Mkhize allegedly pressured the previous Director-General, Precious Matsoso, to employ Tahera Mather to be contracted for communication.
Precious Matsotso was replaced after an unblemished ten years by Dr Anban Pillay, who had been Deputy DG. Dr Pillay then became the active facilitator for the Digital Vibes contract, the affidavit suggests — a matter in which the DIU has also referred to the National Prosecuting Authority.
The current DG, Dr Sandile Buthelezi, who replaced Dr Pillay, is also noted as approving payments to Digital Vibes, though the DIU states it is not seeking any relief against him other than setting aside of relevant agreements.
The situation still has a way to run, with disciplinary inquiries, the Special Tribunal hearing and NPA investigations all ongoing.
However, the Daily Maverick warns that it is clear that this critical government department is in “freefall” and will not have the capacity to deal with South Africa’s health challenges in the months and years to come.
After a group of anti-vaxxer demonstrators gathered outside Groote Schuur Hospital (GSH), Western Cape Health authorities have slammed anti-vaxxers for inflaming vaccine hesitancy. Even so, there was a record vaccination turnout on Friday when inoculations were offered to over 18s.
“I just don’t understand why people don’t believe us when we say that the vaccines are safe,” Western Cape Health Department’s Dr Saadiq Kariem said, warning of the damage that misinformation can do.
“There’s no 3G in the vaccine. There’s certainly no conspiracy theory. All we’re trying to do is help by making sure that the population is as protected as possible against coronavirus,” Dr Kariem said, adding that it was even more dangerous when medical professionals were against the shots.
“It just baffles my mind how other medical professionals can, in fact, be anti-vaccination because people will believe professionals, you know, and take their word as they’ve studied this field,” he added. Some of the protesters were carrying signs in support of controversial anti-vaxxer doctors.
IOL reports that one man who was employed by the hospital and chose not to be named, stood alone in the street and faced down the protesters with a sign saying “Covidiots”. He said the pandemic had been happening for 18 months, and that the ignorance of the crowd was disgraceful.
Just before the protests got underway, the University of Cape Town had released a statement in support of GSH. “The Faculty stands in solidarity with the staff (including cleaners, security, admin staff, drivers etc) of GSH. We stand in support of their work and the herculean efforts they have taken across the era of this pandemic under extremely challenging circumstances and often at personal risk. We salute the work of our partners in delivering the best possible care in responding to the world’s greatest human tragedy.”
At age 37, Mary Gordon was fit and healthy but could not explain the fatigue she began experiencing. Shortly before Christmas 2019, she woke up feeling out of sorts. During Christmas shopping, she nearly passed out at one point.
“Everything went blank,” Gordon recalled. “But it was so quick that I questioned if it really happened.”
Gordon put it down to dehydration and tiredness. But over the next week, she nearly passed out three more times, once while driving. Just before flying home, she managed to get a last-minute appointment on New Year’s Eve with her doctor’s physician assistant. By this point, she half expected to be admitted to hospital. The physician assistant performed a test on her heart, which looked normal. But her blood pressure was through the roof. She advised Gordon to cancel her flight and to start wearing a heart monitor so the medical team could gather more information.
Gordon was familiar with the heart monitor because in university, her doctor detected a heart murmur and diagnosed her with mitral valve prolapse: extra tissue caused the mitral valve leaflets to expand into the left atrium when her heart contracted. In the severe cases, it can lead to blood leaking back through the valve, potentially resulting in arrhythmia. However, when the doctor reviewed the data, he told her to not worry about it. And an electrocardiogram years later seemed to confirm the diagnosis.
But now, leaving the visit with the physician assistant, Gordon collapsed near the elevator, in cardiac arrest. Fortunately a receptionist found her. For six minutes, the physician assistant and a doctor performed CPR , and also used an automated external defibrillator. The first thing she remembered was being in the emergency room, with her boyfriend, Matt Costakis, and several doctors at the foot of her bed. She was confused for the first few days.
“My brain was not retaining information,” she said. “It took a few days before things were sinking in. Everything was a blur.”
An implantable cardioverter defibrillator was implanted in her chest, followed by a minimally invasive surgery the week after to repair her mitral valve.
“It wasn’t until the surgery that it was fully recognized she has something that’s particularly rare called mitral annular disjunction,” said Dr. Paula Pinell-Salles, Gordon’s cardiologist at Virginia Heart in Falls Church. “That variant is the most prone to significant prolapse and may be more closely associated with the kind of arrhythmia she presented with.”
Gordon was discharged after a two-week hospital stay. Though fatigued, she eagerly started her cardiac rehab, relishing the supportive environment.
“The thought of raising my heart rate or being able to ever run again was so foreign,” she said. “It was awesome to know there’s a way to slowly ease back into that with the safety of people watching you.”
When COVID ended in-person rehab, she continued to push herself walking long distances but she still feared exercising alone.
“It was a weird transition and very emotional,” she said, pointing to the emergency ID tag she now wears. “But I got to the point where I could go off by myself.”
Eight months after the cardiac arrest, she was running again. And on the one-year anniversary, Gordon and Costakis, along with her dog, hiked her favourite trail to the top of a mountain, where Costakis proposed to her.
Now happily engaged and largely recovered, Gordon promotes CPR training and wants to raise awareness about the difference between heart attacks and cardiac arrest.
As defined by the American Heart Association and the American College of Cardiology, “(sudden) cardiac arrest is the sudden cessation of cardiac activity so that the victim becomes unresponsive, with no normal breathing and no signs of circulation. If corrective measures are not taken rapidly, this condition progresses to sudden death. Cardiac arrest should be used to signify an event as described above, that is reversed, usually by CPR and/or defibrillation or cardioversion, or cardiac pacing. Sudden cardiac death should not be used to describe events that are not fatal.”
“It doesn’t hurt to learn it again, or watch the video and just build your confidence,” she said. “If I can do something to help the next person, that’s all I can ask for.”
The Japanese government, struggling to control its latest and largest COVID outbreak while maintaining the Olympic bubble, is turning to a new tactic — public shaming.
On Monday, Japan’s health ministry released the names of three people who broke COVID rules after returning from overseas. An official statement said that the three people, two returning from South Korea and one from Hawaii, had clearly acted to avoid contact with the authorities.
All three had negative virus tests on arrival at the airport but thereafter neglected to report their health condition and did not respond to location-monitoring apps or video calls from the health authorities.
In May, the Japanese government had said that about 100 people a day were flouting the border control rules, and warned that it would disclose the names of violators soon.
Japanese authorities are struggling to adapt their COVID response as caseloads surge to their highest levels of the pandemic and vaccinations continue to lag behind other wealthy nations. Public fatigue seems to be setting in from the on-and-off emergency measures the government has imposed in various cities.
And in the face of rising cases, the Japanese government failed to speed up its vaccination campaign. It has maintained that hosting the Olympics inside a tightly controlled bubble, with spectators and athletes isolated from the public, did risk exacerbating the outbreak.
While comparatively few infections have occurred inside the Games, totalling about 300 so far, some Japanese people say that seeing the Olympics held in Tokyo has encouraged them to relax against the virus. The first cases were reported on July 17, with two members of the South Africa soccer team testing positive despite having tested negative on their departure.
Yet the outbreak has continued to worsen. On Tuesday, officials said they had recorded more than 8300 daily cases across Japan, slightly down from the weekend’s record high of more than 10 000. A total of 3709 cases were reported in Tokyo, also slightly lower than previous days.
On Monday the government said that it would hospitalise only those with severe cases of COVID, to avoid increasing the strain on hospitals, suggesting that they are already starting to struggle with the influx of cases.
While radon is commonly known as a radioactive gas that sometimes builds up in basements, people in pain travel to Montana in the US to be surrounded by it. The visitors view the radon exposure as low-dose radiation therapy for a long list of health issues.
But the Environmental Protection Agency and the World Health Organization, among others, list the gas as the second-leading cause of lung cancer. Though radiation is used to kill cancer cells, in the US, using low doses for other ailments is disputed – one such debated use is treating respiratory conditions. Clinical trials are testing whether low doses of radiation can help treat COVID patients.
But radon gas is not the same as the targeted radiation in radiotherapy. It can be inhaled, making it particularly dangerous. Sitting in a radon-filled room and radiotherapy are as different as “chalk and cheese,” said Brian Marples, a professor of radiation oncology at the University of Rochester.
“In clinical therapy, we know exactly what the dose is, we know exactly where it’s going,” he said.
Prof Marples said much of the argument for radon’s therapeutic use stems from historical reports, unlike evidence-based research on clinical radiation. However, there is debate as to what level of radon gas exposure is harmful. Another concern is that the radon treatment in the mines is largely unregulated, and bodies like the EPA don’t have the power to mandate limits on radon.
Nonetheless, each year travelers head to western Montana, where four inactive mines with high levels of radon are within 18 kilometres of one another. Radon gas forms from the radioactive decay of naturally occurring uranium in the bedrock and has a short half-life. In the Merry Widow Health Mine, visitors can bathe in radon-contaminated water or simply sit and work on a puzzle.
For owner Chang Kim, 69, his business helps treat chronic medical conditions such as arthritis or diabetes. Adherents claim radon in low doses creates stress on the body, triggering the immune system to readapt and reduce inflammation.
“The people coming to the mines, they’re not stupid,” Mr Kim said. “People’s lives are made better by them.”
He learned about the mines 14 years ago when his wife, Veronica Kim had developed a connective tissue disease which crumpled her hands and feet. Traditional medicine wasn’t working for her. After takim=ng two sessions a year in the mines ever since, Veronica smiles when she shows her hands.
“They’re not deformed anymore,” she said, adding she’s been able to reduce her use of meloxicam for pain and swelling.
Radon users point to European countries such as Germany, where the controversial radon therapy can still be prescribed for various conditions.
In the US, the EPA maintains that no level of radon exposure is risk-free, noting it is responsible for about 21 000 lung cancer deaths every year. The agency recommends that homes with radon levels of 150 Becquerels (radioactive decays per second) per cubic metre or more should have a radon-reduction system. The EPA derived this valuefrom lower values being subject to false negatives, and it being an achievable level with radon-reduction systems. By contrast, the owners of Montana’s oldest radon therapy mine, Free Enterprise Radon Health Mine, said their mine has an average of about 64 000.
The federal guidelines are “a bunch of baloney” according to Monique Mandali, who lives in Helena, about 40 minutes from the mines, and tries to fit in three sessions at Free Enterprise a year – 25 hours of exposure spread out over 10 days for arthritis in her back.
“People say, ‘Well, you know, but you could get lung cancer.’ And I respond, ‘I’m 74. Who cares at this point?'” she said. “I’d rather take my chances with radon in terms of living with arthritis than with other Western medication.”
Antone Brooks, formerly a scientist at the US Department of Energy and who studied low-dose radiation, is one of those who believes the low dose threshold is excessive.
“If you want to go into a radon mine twice a year, I’d say, OK, that’s not too much,” he said. “If you want to live down there, I’d say that’s too much.”
In the early 1900s, before antibiotics were popularised, small doses of radiation were used to treat pneumonia with reports it relieved respiratory symptoms. Since then, fear has largely kept the therapeutic potential of low-dose radiation untapped, said Dr Mohammad Khan, an associate professor with the Winship Cancer Institute at Emory University. But amid the pandemic, health care providers struggling to find treatments as hospital patients lie dying have been giving clinical radiation another look.
Patients who received low doses of radiation to their lungs were weaned off of oxygen and were discharged from hospital sooner than those without the treatment. Dr Khan said more research is necessary, but it could eventually expand clinical radiation’s role for other illnesses.
“Some people think all radiation is the same thing, that all radiation is like the Hiroshima, Nagasaki bombs, but that’s clearly not the case,” Dr Khan explained. “If you put radiation in the hands of the experts and the right people – we use it wisely, we use it carefully – that balances risk and benefits.”
Though it’s not quite as fantastic as Iron Man’s super-powered exoskeleton, a robotic exoskeleton designed by his father’s company helps 16 year old Oscar Constanza to walk. Oscar has a genetic neurological condition that means his nerves do not send enough signals to his legs.
Fastened to his shoulders, chest, waist, knees and feet, the exoskeleton enables Oscar to walk across the room and turn around. The exoskeleton is a voice-operated robot, responding to the user’s verbal commands, rather than other designs which respond to user movements or nerve signals.
“Before, I needed someone to help me walk … this makes me feel independent,” said Oscar.
His father Jean-Louis Constanza is one of the co-founders of the company that makes the exoskeleton, which is called Atalante.
“One day Oscar said to me: ‘dad, you’re a robotic engineer, why don’t you make a robot that would allow us to walk?’” his father recounted “Ten years from now, there will be no, or far fewer, wheelchairs,” he said.
Exoskeletons are being produced around the world, with a wide variety of applications including, the military, industrial work and in healthcare to help nurses move and position patients. During the COVID pandemic, they have even been evaluated for use in the physically taxing task of prone positioning of COVID patients in ICU wards. Some, like Wandercraft’s model, are designed to help people with mobility problems to walk.
Since most are still quite heavy, manufacturers are competing to make them as light and usable as possible.
Wandercraft’s Atalante exoskeleton, which is an outer frame that supports but also simulates the movement of the wearer’s body, has been sold to dozens of hospitals in France, Luxembourg and the United States, with a unit price of about $176 000, said Constanza. The Atalante exoskeleton is currently aimed at use in physical rehabilitation in stroke and spinal cord injury patients.
At the moment, it cannot be bought by private individuals for everyday use – but the Wandercraft engineers are working on this as the design would need to be much lighter.
A study set to be published in the August issue of Social Science & Medicine found that Americans created over 175 000 COVID-related crowdfunding (CCF) campaigns in the first half of 2020, with many receiving no funding at all and campaigns in the most privileged areas receiving the most funding.
During the first year of the COVID crisis, many Americans turned to charitable crowdfunding for help with medical bills, funeral expenses, lost wages, small business support, food assistance, and other needs. CCF increased exponentially after March 2020 on platforms such as GoFundMe. Europe saw CCF focusing largely on support for medical facilities and workers, while the majority of US CCF aimed to support individuals, raising money for food, rent, funerals, and other expenses. In India, which only spends 1.2% of its GDP on healthcare, huge numbers of people are turning to crowdfunding in an attempt to cover costs caused by patchy medical insurance which often does not cover COVID-related illness, nor the significant outpatient costs.
According to GoFundMe CEO Tim Cadogan, the platform saw “unprecedented use,” in the first few months of the COVID pandemic, and crowdfunding “activity has persisted at an alarming rate” since then. Unlike most disasters, which generally have an acute phase of destruction followed by a recovery phase, the economic and health impacts of the pandemic are long-lasting, a trend reflected in the prolonged growth of CCF campaigns. Between March and August of 2020, GoFundMe reported that more than 150 000 CCF campaigns had been started.
Drawing on a large dataset of geo-tagged CCF campaigns started on GoFundMe between January 1 and July 31, 2020, researchers found a number of surprising results in their analysis. They found that the median campaign raised only $65 out of a $5000 goal, with a median of 2 donations. A striking 43.2% of CCFs received zero donations, with more than 90% not reaching their campaign goal. This is worse than reported in prior research; a 2017 study of medical campaigns found only 3.5% had no donations. Medical fundraising made up 18.3% of all CCF campaigns, and those indicating severe medical needs, with terms like “ICU”, received an average of 96 donations, and an average donation size of $197, while campaigns mentioning “rent” or “eviction” received an average of 23 donations, with an average size of $84. Campaigns seeking money for businesses or PPE fell between these extremes.
The researchers also noted that CCF campaigns are created most often in the highest-income areas, not those hardest hit by COVID. Previous research on charitable crowdfunding has shown that it exacerbates social inequities by providing financial relief primarily to privileged recipients. Previous economic and ecological crises have also been used by powerful individuals and institutions to serve their own interests, deepening inequities and health disparities during recovery.
“We find a significant disconnect between COVID- related needs, and the ability to adequately and equitably address them with crowdfunding. CCF campaigns face heightened competition, and steep inequalities between winners and losers,” the authors wrote. “Campaign success increasingly accrues among those with more social and economic capital.”
Journal information: Igra, M., Kenworthy, N., Luchsinger, C. and Jung, J., 2021. Crowdfunding as a response to COVID-19: Increasing inequities at a time of crisis. Social Science & Medicine, 282, p.114105.
Three members of the South African soccer team staying in the Olympic Village have tested positive for COVID just days before the Olympic opening ceremonies. They are also the first Olympic athletes who tested positive in the tightly-monitored athletes’ enclave along a Tokyo waterfront.
The South African team said in a July 17 statement that defender Thabiso Monyane, midfielder Kamohelo Mahlatsi, and Mario Masha, a video analyst on the coaching staff, had tested positive on the weekend. All South African players had tested negative when they departed for Tokyo on July 13. The entire South African football team is now under quarantine, raising doubts whether they’ll be cleared for their July 22 match against Japan.
Since the announcement, South African rugby Sevens coach Neil Powell as well as an unnamed member of the female US gymnastics team have also tested positive. Outside the athlete’s complex, positive results have been reported for South Korean IOC official Ryu Seung, an unnamed member of the Nigerian delegation, and an unnamed athlete.
Despite the country’s best efforts to contain the virus, COVID remains a big concern in Tokyo at the world’s largest sporting event, expected to draw about 11 000 athletes from 200 nations. The Tokyo Olympic Committee has introduced measures such as banning spectators at games, daily COVID screening for athletes, and limiting stays at the Olympic Village to seven days.
With Japan still under a state of emergency and the COVID delta variant spreading rapidly, many continue to appeal to the International Olympic Committee to cancel the games. But some experts said that at this point a cancellation would cost Japan $16.4 billion. It would also run the risk of being sued by the IOC for breach of contract.
Addressing the outbreaks in an effort to rally local support for the events, IOC president Thomas Bach said, “We are well aware of the skepticism a number of people have here in Japan,” he said. “My appeal to the Japanese people is to welcome the athletes for their competitions.”
