In a short space of time, COVID-19 has changed normal life in South Africa. Since the introduction of the lockdown, schools and universities have been empty, vast segments of the economy have been closed and, in many households, there are hushed conversations about our future. Social media is awash with all sorts of quackery regarding prevention and treatment remedies. These are difficult and somewhat scary times. It is during these times that we need to keep rationality and be guided by science rather than by emotion.
There are numerous studies regarding the COVID-19 outbreak that are being published on a daily basis in journals all over the world. All these are almost universally open access at present. Despite this growing data set of COVID-19 infection worldwide, there are no published local clinical data that have studied the impact of different aspects of COVID-19 infection in South Africa. The editorial team of Wits Journal of Clinical Medicine thus decided that it would be an opportune time to review many aspects of this viral pandemic in South Africa and provide information and direction for health-care professionals in South Africa.
As recommended by the World Health Organization, testing for COVID-19 has become a cornerstone of both the short- and long-term management of this pandemic, and this has appropriately been strongly supported by our health authorities. In this COVID-19 issue of the journal, the Cape Town study group has elegantly reviewed the diagnostic strategies that are currently available in South Africa and discuss the sensitivity and specificity of these tests. They also highlight the imminent arrival of the antibody tests for COVID-19 and how South Africa will be ideally poised to do many of these tests due to the wide availability of Gene Expert machines in South Africa.
Currently there is a vast array of opinions with regard to treatment of COVID-19. The Infectious Diseases Department at Wits University discusses in detail the evidence behind the current treatment protocols for COVID-19 infection and provides an elegant treatment algorithm protocol how to manage patients presenting with COVID-19 infection. From the therapeutic perspective, the first report of successful treatment with inflammatory inhibition in a patient with severe COVID-19 infection in South Africa is also presented in the journal.
The vexed issue of the burden of HIV and tuberculosis in South Africa and many parts of Africa is brought up in every discussion on the risks of COVID infection and its impact on this subgroup of patients. In this issue, Feldman dissects the current evidence with regard to the risk of influenza in HIV-positive patients and forecasts the potential risk of COVID-19 in these patients and highlights some interesting preliminary data from Spain regarding HIV and COVID-19 infection.
There were recent reports in the literature, which were hyped immediately by the media that ACE inhibitors and angiotensin II receptor blockers, which are widely used in patients in South Africa with heart disease, hypertension, diabetes and chronic kidney disease, need to be discontinued as they increase the risk of severe COVID-19 infection. The evidence that this recommendation is incorrect is discussed in detail in this issue, and recommendations are made as to how these patients should be managed.
As this pandemic becomes widespread and overwhelming many health structures in the would,many ethical aspects related to the pandemic are being raised. For example, in the setting of severe COVID-19 infection, do you resuscitate because the prospect of recovery is slim and risk to health-care team is very high? Which patients do you admit to already-filled ICUs and who are the decision-makers in this triage process? K Behrens discusses many of these ethical conundrums in his review.
In this country with its vast social disparities, Baldwin-Ragaven presents a sobering overview of the social inequalities that exist in South Africa, on how some of these inequalities may play out during this unique situation in our country and what will be our responsibilities, both clinical and social, as health practitioners during this pandemic.
The concept of herd immunity is highly topical in the current setting of the COVID-19 pandemic. The underpinnings of herd immunity are reviewed by Kalla and Laher, who also present an alternative strategy to the lockdown extension in South Africa and logically support their assertion based on South Africa's age demography.
South Africa has had a few weeks head start in preparing for the pandemic to evolve. Saggers and colleagues highlight how they have prepared the Neonatal unit at a large public hospital in Johannesburg to take care of COVID-19 patients, even in a setting of limited resources.
I finally would like to thank the Editorial team, Wits University Press, the journal's publisher, the authors and all the reviewers for their tremendous effort they have all put in to get this special issue of COVID-19 out in a very short space of time.
Editor in Chief