Thomas Johnson - Medical Blog

Covid reached a million cases in South Africa over the Christmas weekend and the band plays on. No one seems to have noticed the oddity revealed in President Cyril Ramaphosa's "emotional" address on Monday: members of the military-style command council recalled from their "festive breaks" while a "war" is raging. Like Western Cape health MEC Nomaindia Mbombo who went on holiday to Limpopo while the WC experiences a Covid surge worse than the first. And when these putative leaders return from their breaks they'll bring the virus with them, infecting colleagues and family, ironically, what they're concerned holidaying citizens are doing. It's no wonder the virus is rampant in SA. Like UK and US, its leaders are on holiday, playing golf or - something Ramaphosa shares with Johnson - weak, ineffectual and flip-flopping. And SA's people too are throwing caution to the winds as they always do - capacity shopping malls and beaches and ignoring...

Prof. Devi Devi Sridhar, chair of global public health, University of Edinburgh in The Guardian on December 24:  “The responsibility for this new [Covid-19] variant [in the UK which is similar to SA's] can partly be attributed to those who argued against restrictions, believing that allowing the virus to run rampant in young people while shielding the vulnerable would allow immunity to develop. Such conditions are ripe for variants to emerge. Unless we suppress the virus, it will probably mutate further. This could make our current vaccines ineffective, or lead to reinfections.” The UK is now called “Plague Island”, exacerbated by its Brexit woes. Because of the infectious variant, Boris Johnson, after as usual flip-flopping, “cancelled Christmas”. The British wanted to be isolated but not in the way they thought. Meanwhile, like the UK, the DA and DA-run Western Cape too are heading for their own right-wing isolationist bubble by arguing against restrictions (John Steenhhuisen, ri...

Last month I wrote Western Cape Premier Alan Winde and the DA (leader John Steenhhuisen et al) continue to push back against the even benign level 1 lockdown. This was as Europe, UK and Australia experienced a resurgence of Covid-19 and US numbers continued worsening. But Winde and DA wanted travel restrictions between South African and countries lifted. Winde and the DA oppose lockdowns, even when Covid infections were at their worst mid-year and despite lockdowns being the only way community infections can be slowed. Now Covid is increasing again, as one expected. This week Winde is warning WC residents of a 50% increase in cases , particularly along the Garden Route. This is not surprising as the Eastern Cape is a hotzone. Covid appears to be making its way from the EC to Cape Town. Infection numbers, Winde says, are like May's.  He says another lockdown will "kill all jobs" (sic), but like his DA colleagues doesn't suggest ways to slow it. With inter-provincial m...

This post contains previously posted information. Links provided. It is custom that when a person dies the community, even those who didn’t know the deceased, show empathy and respect to the family. People express sympathy – “sorry for your loss” and “condolences”. The cultural tradition is as old as civilisation. It’s rooted in our humanity and basic decency. Even enemies put aside their rhetoric for a while. The Western attitude to death is influenced by Greek and Latin/Roman cultures and Christianity . The other is Persian which too has ancient roots. Death is an inevitable part of life and is cause for reflection. What happens after is unknowable and so it’s treated with reverence. And to honour the life, achievements and new generation the departed contributed to. The loss is felt closest to the deceased, but the impact ripples to the wider community, more or less, depending on the contact the deceased had with them. My mother died at Groote Schuur Hospital in 2017 aged 91, ...

Public health experts and health minister Dr Zweli Mkhize are concerned about a second wave. He and his wife are recovering from Covid-19.  A number of countries in Europe, and the UK, have implemented lockdowns over the past two weeks. There are concerns the resurgence is going to get out of control - "collapse" was used to describe the state in Spain. On Friday October 23 the US broke the previous record in July with 85 000 cases reported in a day.  South Africans have reason to be worried. But the DA and Western Cape government, who want travel restrictions lifted, are not among them. A pandemic denialist believes it's a hoax, minimises it or rejects universally accepted measures to combat the spread: masks, distancing and lockdowns. From the outset the DA, leader John Steenhuisen and WC government - Premier Alan Winde - insists the lockdown, even the present benign level 1, is exaggerated and unnecessary (they haven't heard about the "prevention paradox...

Is the South African government manipulating Covid-19 data to justify fully reopening the economy? Cases are apparently slowing. But since the start of the pandemic government and experts have been predicting the peak anytime from July to September.  The alleged slowing of infections comes at the time government is about to relax* the lockdown to level 2. At the same time there are reports of more focused testing, i.e. reduced community-wide testing. If that's the case, of course reported infections - not real infections in the community which could be 10 times the official number - will appear to have slowed.  When government moved to level 3 they also announced the peak had been reached. It hadn't. There's nothing about the country's precarious and collapsing health system and socio-economic position - hell, it can't even keep the lights on, struggling with 150 year-old techonology, coal-powered energy - that indicates the pandemic will just go away by itself.  T...

The South African Medical Research Council's finds there are 17 000 more natural deaths , what it calls "excess deaths", than expected. At 400 000 cases and 5 940 official Covid-19 deaths, SA is the fifth highest in the world. The Guardian writes: "South Africa’s initial response to the virus was widely praised. President Cyril Ramaphosa implemented a tough lockdown at the end of March, when South Africa had only 400 recorded cases. But a surge in poverty and unemployment in a country that already had high levels of both spurred the government to lift restrictions well before the outbreak was fully under control. Rates of infection have soared since. "Ramaphosa said this month that scientists had predicted up to 50,000 deaths in South Africa. But confidence in the government’s handling of the crisis has plummeted. There has been widespread criticism of decisions to allow the overcrowded minibus taxis that provide most public transport to function with mi...

Read articles in New York Times, Washington Post, The Guardian, etc about the pandemic in US "epicentre [sic]" - to use South African government's confused term - Arizona, Florida,etc that are experiencing surges. Replace "Arizona" and "Florida" for "South Africa" and the stories could be about SA word for word: lockdown too late, reopen too soon, lack of testing, delays in processing results, lack of a coherent strategy, political confusion, lack of leadership, president in hiding or abdicated responsibilities overwhelmed hospitals, etc. This is not an exaggeration. Ramaphosa, who has no stomach and aptitude for leadership, and his band of cabinet jesters is going to do to the nation what Mbeki failed to do to HIV/AIDS sufferers only: Through incompetence and neglect guarantee a significant section of the population get Covid-19 and die. That's not an exaggeration either. Covid-19 is spreading uncontrollably through the country...

Economically, militarily and diplomatically South Africa is insignificant, unexceptional. It does have Nelson Mandela, game parks and Table Mountain, though. And it excels in negative indices like poverty, unemployment and crime. Now we can add Covid-19. SA now has the fifth highest Covid-19 infections in the world after the US, Brazil, India and Russia. As at Saturday cases were 350 879. Table:  MyBroadband  Since 50 000, infections have been doubling every 14 days. The numbers have gone as I’ve predicted. By the end of July they will be 500 000 and one million by the end of August. There’s still an unconcerned, glib and fatalist attitude from public and government. But will it change because rapidly rising cases, up to 15 000 a day, are not doing it. Now experts say deaths, which were comparatively low and puzzled scientists, are underreported  especially when compared against excess deaths, i.e. more deaths from natural causes than anticipated, fo...

Western Cape premier Alan Winde [said] the province’s peak was likely to be “flatter, later and longer” than previously thought. A few weeks ago he said it was going to be July but it was “hard to predict". Without the curve already flattening there's no way to predict when the peak will be because no one knows the level of community infections. It's like trying to judge the severity of a predicted hurricane by a few drops of rain now. Epidemiologists say they don't know much about the virus so why do idiot politicians pretend they have the answers. Winde, who's the onomatopoeiac,, eponymous windbag, couldn't predict catching the virus himself but talks about predicting something at global level. South Africa has the tenth highest Covid-19 infections in the world and highest cases per 100 000 . Infections have been doubling every 14 days. Now 300 000, I shall reach 500 000 by month end. This is not "scaremongering", as denialists like the eve...

Last week it was clear South Africa's coronavirus cases would breach 200 000 this week . From 50 000, it has been doubling every 14 days. It will reach 500 000 in a month. There are now over new 10 000 cases a day. SA has 40% of African cases and 14th highest in the world. It has among the highest increases over a 14 day period per million people - 1 000 - 2 000 - in the same group as six other countries, US and Sweden included. These are only the tested cases, not total cases. Charts show a surge a month ago after the lockdown was eased. After initially listening to the science, Ramaphosa's government gave in to self-doubt and right-wing denialist fear-mongering and eased restrictions far too soon. They threw the baby out with the bath water and undid the the lockdown's benefits.  Now, after the fact to justify themselves, they say it was to give time to prepare rather than flatten the curve. That's believable if the country is really prepared but it's ...

South Africa's Covid-19 cases have reached 100 000 , doubling from 50 000 in 14 days. But the country is slowly going back to normal! In March, with the lockdown imposed and cases at 1 000, pandemic denialists (see right-wing local media, e.g. BizNews, Politicsweb, Daily Friend, DA and disparate commentators) postulated, with no evidence, SA was presenting more like mild Australia and New Zealand (and, why not, South Korea and Japan), and herd immunity is our saviour. That is, a lockdown is unnecessary, a nefarious ANC plot and there's nothing to worry about Others like "PANDenialists" aka PANDA, who are not medical experts, refuted credible epidemiological models. One retired SA government statistician called the pandemic a hoax. Emeritus Stanford biologist Mike Levitt (not medical doctor) called Australia a 'loser' for implementing a lockdown, and said the crisis is exaggerated. These opinions were headlined "MUST READ" (sic, BN), ie "mus...

Pliny the Elder, around 70BC, said doctors were able to get away with murder, citing Cato the Elder two hundred and fifty years earlier [1] . Later, Galen had complained Greek doctors fled to Roman cities to hide their incompetence. Pliny’s tirade was against Greek doctors who undermined Roman self-reliance. But he was right all the same. Doctors (and chemists) have the technical skill to kill without the cause of death being obvious, or they can be negligent without it raising questions. It’s sometimes the plot of detective stories. But in these, the doctor killer is always discovered. In reality, it’s very hard to prosecute doctors for malpractice or worse despite professional ethics and the law, in South Africa the Health Professions Act and National Health Act, being clear about the highest standards of professional and ethical conduct. Traditionally, doctors are reluctant to testify against colleagues even when the evidence of negligence is evident, although in a...

Last year Auditor-General Kimi Makwetu gave the Western Cape Health Department (WCHD) a clean audit . At best he was generous, at worse, mistaken, particularly regarding them allegedly meeting their performance objectives. In my opinion  he made a mistake  signing off on their 2018/2019 annual report containing their congratulatory self-assessment of all performance objectives when the facts say otherwise.  The AG is preparing for the 2019/2020 annual audit of state departments. This week I wrote asking him to review his decision. He confirmed receipt. This is an edited version of my letter. On November 21, 2019 I sent a report to the then head of health Dr Beth Engelbrecht (she was replaced by her deputy, Dr Keith Cloete from 1 April 2020), Premier Alan Winde and chair of the health committee of WC Legislature Wendy Philander my assessment as a patient of WCHD of its high-level financial position, cost efficiency and performance objectives in terms of ...

Who is PANDA (Pandemic – Data Analysis)? They came out of nowhere with their report “Lockdown is a humanitarian disaster to dwarf COVID-19 ” , which Business Day broke on April 5. Since then they’ve received a lot of media coverage questioning government’s epidemiological models that predict large numbers of coronavirus infections and deaths in South Africa. Little is known about them other than they’re a newly formed ad hoc advocacy group (also called a “consortium") of actuaries Nick Hudson and Peter Castleden and an unnamed medical doctor and economist. PANDA has no website or even a blog. But there are plenty of hits about them.  Credulous media, public, pandemic denialists and conspiracy theorists (BizNews chief among them) have unquestioningly taken their and generally business’ narrative the lockdown, at level 3 since June 1, is unnecessary and its economic consequences shall allegedly cause more deaths than the lockdown itself. Fund manager Allan Gray’s CEO ...