Fears of an imminent COVID-19 catastrophe drove government to put the country under national lockdown for three weeks to curb the spread of the coronavirus. At heart of this decision, was the prevalence of chronic diseases such as tuberculosis and HIV within the population.

In the video below, the Aurum Institute’s Dr Reginah Osih talks about how COVID-19 could possibly impact those living with HIV and TB:

In announcing a State of National Disaster in March, President Cyril Ramaphosa indicated the population’s particular vulnerabilities, which will significantly challenge South Africa in the fight against COVID-19.

“We need to urgently and dramatically escalate our response. The next few days will be critical. Without decisive action, the number of people infected will rapidly increase from a few hundreds to tens of thousands and with a few weeks to hundreds of thousands. This is extremely dangerous for a population like ours with a large number of people with suppressed immunity because of HIV and TB and high levels of poverty and malnutrition.”

With an estimated 7.7 million people living with HIV in 2018, South Africa has the highest rate of the pandemic globally. At a briefing last Friday, the Director at the World Health Organisation’s Department of Global HIV, Hepatitis and STI programme Meg Doherty said not much is known about the co-relation between HIV and the COVID-19 virus with just a few reports coming out of China.

In the video below, South Africa says it has 7.7 million people living with HIV/AIDS, the highest in the world:

“There is a concern that anybody with severe immunodeficiency and/or other common diseases, which we know many people with HIV have, they can have both hypertension, diabetes, pulmonary disease and also tuberculosis and that could put them at increased risk of having a severe COVID-19 course and we also have known that from the SARS time persons who were infected with HIV and having anti-retrovirals were not infected with SARS, leading some to think that about the coronavirus.”

South Africa also has the third highest incidence of tuberculosis worldwide after India and China, with an estimated 1% developing active TB each year. Of those who have TB, about 66% have both HIV and TB.

Head of the Southern Africa Medical Unit of Doctors Without Borders Tom Ellman says it is absolutely important that those with these conditions take their medication during this time.

“The issues specific to HIV, TB are maybe not as different to the issues for elderly populations; the vulnerabilities are the same for everyone. We don’t know enough yet about how HIV relates. Certainly in people with advanced HIV that’s a poor immune system. But not on anti-retrovirals or people who are not taking their anti-retrovirals, they need to get back on to treatment urgently; same with tuberculosis. But people who are stable people, whose viral loads are undetectable; it may be that they don’t have much of a different risk to the rest of the general population.”

In the video below, HIV/AIDS and TB patients not on treatment could be at risk of contracting COVID-19:

Ellman says, despite fears surrounding the country’s weak health systems as well as conditions of poverty affecting millions, South Africa is well-placed to curb the spread of the virus.

“The experience of working with communities, activists, councillors on HIV means that there is more preparation in some way than in Europe. We know the communities; they have been involved in fighting a virus the AIDS virus for 20 years and more. We need to take advantage of the capacity to capitalise on that experience.”

Experts have also cautioned against resources allocated for the treatment of these chronic diseases being swallowed up by the fight against COVID-19. They say ensuring coronavirus infections are kept under control within the country will assist in ensuring that patients with other illnesses can continue to be given attention.