Chaos and catastrophe – COVID-19’s ‘annus horribilis’

Exactly a year ago, COVID-19 entered our living rooms as news broke of the first case of the dreaded disease striking a member of our community.

Johannesburg businessman Gary Sweidan’s private WhatsApp video started doing the rounds. The post informed his friends about testing positive for the virus following his return from a trip to New York.

Along with alarm and dismay, the virus hit the community barely a week or so after the first few cases were detected in KwaZulu-Natal by locals who had travelled to Italy.

Sweidan, 44, soon became the community’s poster boy for calm in the face of the COVID-19 curse after his post went viral followed by panic, stigma, and terror.

He and communal organisations went into overdrive to foster unity, allay fears, and equip people with what little knowledge was available.

“Last year was chaos,” Sweidan told the SA Jewish Report this week. It still baffles him that his wife never contracted the virus even though she sat next to him on the long-haul flight when he first started to feel symptoms.

“There is so much about this illness that is still unknown. I guess you can say I was lucky in that I didn’t land up in hospital, but I felt horrible make no mistake, and it took me months to get over the fatigue,” he said.

Marking the anniversary, doctors worldwide have taken to reflecting on an incomprehensible year that caught them totally off guard.

“We did suspect that a pandemic such as COVID-19 would ultimately be unleashed on an unprepared human population,” said Professor Barry Schoub, emeritus professor in virology at the University of the Witwatersrand and former director of the National Institute for Communicable Diseases.

“Many of us in the virology community believed it was a matter of time before a widespread pandemic of an animal-sourced virus would cross the species barrier and spread rapidly into a vulnerable human population. But we didn’t foresee how it would actually turn out.”

Also the chairperson of the South African Ministerial Advisory Committee on COVID-19, Schoub said that in retrospect, experts should have been more alert and responsive to certain cues.

“The combination of humans intruding into animal ecosystems, the caging, transporting, and consumption of exotic animal species, together with the globalisation of human movement, have all ensured that an event such as a global pandemic of COVID-19 would be inevitable,” he said.

However, he agreed that no one could have anticipated and have prepared for the explosive pandemic of a respiratory-spread virus which COVID-19 turned out to be.

Specialist physician pulmonologist Dr Carron Zinman of Netcare Linksfield Hospital said the effects of the disease had been “unprecedented and overwhelming from the scale, the severity, the clinical spectrum of this disease, to the effect of this virus on the human body”.

It had behaved in a way that was “completely dissimilar” to the usual seasonal coronavirus influenza infections doctors were used to.

There is the early viral-response phase, which generates symptoms that people are used to by now. If you have mild COVID-19 illness, it means that your immune system has controlled the disease, Zinman said.

“However, a percentage of people go on to a more severe form of COVID-19 with direct involvement of the lungs and every other organ in the body,” she said.

“The lay public have learnt a new vocabulary from this disease which includes the words ‘cytokine storm’, a term we dread as it heralds the onset of the severest form of COVID-19. Another unanticipated element is the hypercoagulable state associated with this infection, causing clotting in small and large blood vessels.”

The pandemic rapidly became a scientific challenge of the utmost urgency, and the global scientific community all become students of this new disease, said Schoub.

“The challenge was met head-on and with incredibly rapid progress and success. Within 10 months of isolating the virus, a protective human vaccine had been developed and rolled out into the human population.”

Doctors and healthcare workers across the spectrum understand the disease better now than they did a year ago.

Said Zinman, “We know how it’s transmitted and know what behaviour is considered safe in terms of preventing infection. We know what the ‘danger signs’ are, and have learnt which medication is effective and which has proven to be of no benefit. We understand immunity better than we did before.”

Sadly, said Schoub, the cost to society of the past year of COVID-19 has been high, as medical science struggled to cope with the new emergency.

“Faced with a menacing and dark threat, societies are wont to respond in three ways,” said Schoub. “First, by taking refuge in conspiracy theories, much of them authored from science fiction. Second, by vainly searching for a miracle drug, often by trying to repurpose medications designed and used for other purposes such as Chloroquine in the first wave and Ivermectin in the second wave. Third, by pushing the blame game, sometimes fuelled by an ever-eager, sensation-driven media.”

While so much has been learnt, doctors agree that there is no “magic cure”.

“There is no pill or injection or anything else that will make it go away,” said Zinman.

But the management of patients has advanced significantly. While there is no anti-COVID-19 drug, there is oxygen therapy, steroids, and anticoagulants. And of course, there are vaccines to lessen the severity, although there is the growing threat of “immune-escape variants”, said Schoub.

“We also know what doesn’t work,” said Zinman, citing antiretrovirals, antibiotics [unless there is a bacterial superinfection], Chloroquine, and convalescent plasma. Ivermectin remains unproven, with preliminary controlled studies showing lack of efficacy.

Zinman said doctors had come to terms with the disease’s “unpredictability”, and the devastating effects on multiple systems in the body.

“We’re better off because we’re comfortable with COVID-19 as a disease. The medication prescribed is very familiar now, and can be written by rote. The bloods we use to monitor our patients with have become standard practice. We recognise the extreme anxiety present in our patients and manage it, trying to make the whole experience more bearable. We’ve surrendered to a completely different way of practicing medicine without compromising standards,” she said.

“We’ve learnt a lot, but there is still a lot to learn.”

The second year of COVID-19 will again see cycles of waves, said Schoub, especially as winter approaches.

Its control will still depend only on human behaviour as the vaccine rollout progresses towards achieving community immunity. He hopes the pandemic will be brought under control in 2022.

“Medical science has learnt a lot over the past year, and we can only hope that the knowledge gained will make the biomedical fraternity better prepared and equipped for the next animal-sourced pandemic.”