Unmasked: conditions that make Covid-19 a killer

As the number of Covid-19 infections creeps closer to 5,000,  health minister Zweli Mkhize has expressed concern about the huge risk group comprising of South Africans suffering from high blood pressure, diabetes and obesity.

This worry, Mkhize said on Tuesday, was born of the fact that these were the most common underlying medical conditions of those who had died of Covid-19 to date.

“Studies have continuously shown that there is a strong association of adverse outcomes – that is serious illness or death – from Covid-19 infection with preexisting comorbidities. Underlying diseases tend to be a big challenge.

“The three that are currently emerging to be the most commonly associated comorbidities are hypertension – that is high blood pressure – and diabetes and obesity,” he said. “In our country we have a very significant burden of all these three diseases.”

Citing a Wits University study, the minister said that “more than one third of South Africans suffer from hypertension” – and it was largely “not well controlled, even with treatment”.

“Over 4.5 million people in SA have diabetes, and almost 70% of women and 40% of men are also overweight or obese.

“These risk factors are important to take into account because they are also serious factors when it comes to the conduct of the Covid-19 infection,” he said.

Mkhize announced that 4,996 Covid-19 cases had been recorded in SA to date, and three newly recorded deaths had taken the total to 93.

The three deaths were all in the Western Cape. One was a 67-year-old male, another a 70-year-old male, and the third a 79-year-old female.

All had "underlying [health] challenges", said Mkhize.

This is the current provincial breakdown:

• Western Cape: 1,870 cases (with 38 deaths);
• Gauteng: 1,377 (8 deaths);
• KwaZulu-Natal: 919 (30 deaths);
• Eastern Cape: 616 (10 deaths);
• Free State: 113 (5 deaths);
• Limpopo: 31 (2 deaths);
• North West: 29;
• Mpumalanga: 24; and
• Northern Cape: 17.

In the digital briefing, Mkhize also raised concern about other comorbidities – which can affect smokers – and also the ages of those who had died to date.

“The other challenges, the other comorbidities, such as lung diseases, asthma, chronic obstructive airway disease, some of which are also seen among smokers, are also very important comorbidities that have been associated.

“Also the age, about age 63. The majority of those who have faced the difficulty of this particular infection [Covid-19] come from that age range,” he said.

Adding to the worry, said the minister, was the “unknown factor” of HIV-Aids and tuberculosis.

“We’ve also seen an unknown factor, which is HIV and Aids and tuberculosis. And, unfortunately, SA has got the largest numbers [in the world] and, therefore, will not be in a position to learn from many other countries because they have less of a challenge than ours,” he said.

But, all in all, Mkhize said he was happy that – at this stage, anyway – the country was on solid footing. And for a very practical reason.

“So, we still feel, of course, quite fortunate that our mortality rate has remained a bit lower, at about 1.9%, which is attributable to the fact that most of the people to date who have acquired Covid-19 infections are healthy, young individuals. And, therefore, that tends to make them recover pretty quickly,” said Mkhize.

He added: “There are many others who actually have not passed away although they’ve got the underlying conditions, and I think it’s important for us to take the opportunity to appreciate all our clinicians, both nursing, medical and other staff, who have played a very significant role in ensuring that we can actually keep the mortality rate as it is at the moment.

“So we remain very vigilant, although we have seen the mortality rates in some of the countries in the Western Europe have gone up to as far as 14%.

“Now, all of these are indications for us that we need to do a lot of work, amongst ourselves, to be able to, you know, make sure that we got an impact, a very strong impact, on the infection.”

What was important, said Mkhize, was that SA had “not seen a rapid explosion of infections”.

He put this down to the effectiveness of the extended national lockdown, which had made a difference in “flattening the curve” of infections, and spreading out the number of cases back. The expected peak in cases has now moved out to September from initial estimates of June or July.

This, he said, had helped the country’s health sector to prepare for the inevitable spread of the virus.

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