In the early months of the coronavirus pandemic, the World Health Organization warned that African fitness systems would struggle to cope if the virus began to spread across the continent. This prediction is beginning to come true, as Nature has reported in Guinea, Liberia and Sierra Leone. But more than part of the 780,000 cases reported on the continent are in South Africa.

Initially, a heavy five-week blockade starting On March 27 helped keep the numbers low, but it was economically ruinous as 3 million South Africans lost their jobs. The official death toll is 6,000, but as in other countries, it is most likely being underestimated, according to the South African Medical Research Council.

The government eased restrictions to revive the economy, but closed schools for 4 weeks. Health Minister Zweli Mkhize suggested that citizens warn the circle of family and friends that they do not respect social estrangement, dressed in masks or washing their hands.

Nature spoke with Salim Abdool Karim, epidemiologist and chairman of the Ministry of Health’s clinical advisory committee. A veteran of the AIDS crisis, Karim talks about his hopes and fears and why he believes South Africa’s ubuntu culture (communities care about others) is the key to the country’s response.

We had our first case on March 5. In the first 3 weeks that followed, we had a developing epidemic; instances doubled every other day. We were on the same trajectory as the UK at the time. By pointing to a state of disaster, ending the country’s borders, and implementing the blockade on March 27, we slowed the transmission to a duplication time of 15 days. We didn’t have the initial peak of countries like the UK. If we had not implemented these measures, we would have experienced the scenario in April.

Given that there are communities in South Africa where social remoteness and common hand washing are not possible, basically in casual settlements, I hope that the number of cases will increase significantly, surpassing one million. I think that would happen within two or three months of the first case.

He hoped the epidemic would take off in Gauteng [a small, densely populated province that includes Johannesburg and Pretoria] by the end of April when we ease the closure. Gauteng has so many travelers, so much density: this is the New York of Africa. I was absolutely wrong! Instead, the first primary epidemic occurred in Cape Town. But we thought that when, despite everything, they gave it to Gauteng, it would grow, and that’s what we’re seeing now. The president talks about a “storm”: we see between 5,000 and 6,000 new cases a day in Gauteng. Still, our epidemic is smaller than I imagine now. I think we’d get some serious figures in May.

I never thought Africa was exceptional. But I don’t have the answer. There is no explanation why this epidemic has not spread more rapidly in some countries, such as Nigeria. Some say it’s because those countries aren’t testing enough. But even if you don’t take a test, you’ll still see an increase in hospitalizations and deaths. So that’s not the real explanation for why. At the moment, it’s an enigma. The explanation of why it will work in due course.

Yes, the main goal of South Africa’s reaction to COVID-19 is to delay the spread of infections to allow the fitness formula to prepare and cope better. This would not necessarily amount to fewer infections. Participation was still on the table at first, but there was still a long way to go. We have no idea of that as a realistic option. Of course, we hoped south Africa would end up with a “mojo” that would protect it more than other countries. But South Africa’s truth dictates otherwise. Much of our country does not have the ability to identify social estrangement and for others to wash their hands regularly. So we had to anticipate that we might not get involved, waiting for us to do it. But when I presented the most likely situation to politicians and then to the public at Easter, I explained that we had to face a “difficult truth”: that we probably couldn’t involve the virus and that the spread would likely increase. exponentially as we remove lock restrictions. It was hard to tell that to the whole nation.

There’s more dating between science and politics now, it’s very different. Neither Cyril Ramaphosa [the president of South Africa] nor the other people we deal with like Mkhize have ever denied that this is a serious problem. They sought to hear what we thought, they were encouraged through our experience. But they made their own decisions. We’re consultants and they make calls.

I was hoping that we would be more concerned about the progression of COVID-19 vaccines in South Africa. We have the capacity, built from HIV, of which we are the first. The explanation for why I say that is that when you play such a leading role, you have a seat at the table where decisions about the vaccine and its distribution are made. Unfortunately, because we came by because of the epidemic, it had already passed through China, Europe, North America, we had to play a supporting role in vaccines.

We would have added some other candidate vaccine, and there are already many. So, without a seat at the table, we’ll be at a disadvantage and we’ll have to wait our turn. As things stand, the United States will probably need to take the first two hundred or three hundred million doses and then let the rest of the world divide equally. It is smart to know that the World Health Organization facilitates this process.

‘We build the shipment the way we navigate.’ This virus exposes the flaws of our society. But I think when we get to a point where a sufficient number of other people have a parent, a member of a circle of relatives, or someone in their neighborhood who has been in poor health or died from the virus, Americans must take collective action. so they can join in. Array When the challenge didn’t seem so serious, when the block slowed down the transmission, others questioned restrictions like those of a nanny state. But I think we will soon realize that the most productive coverage we have opposed to this virus is ubuntu, a South African word meaning “I am because you are”. I’m sure because you’re sure. I saw that in HIV, when other people saw the death of their loved ones, it caused a change in behavior. As a country, we rely on the ubuntu precept. We’ll have to rediscover this, otherwise we won’t beat this virus.

Nature 583 and 672 (2020)

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