1 00:00:01,720 --> 00:00:07,320 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day one seventy 2 00:00:07,520 --> 00:00:12,720 Speaker 1: since coronavirus was declared a global pandemic. Today's main story. 3 00:00:13,720 --> 00:00:18,239 Speaker 1: South Africa was already dealing with other infectious disease outbreaks 4 00:00:18,640 --> 00:00:23,720 Speaker 1: like HIV. When COVID came along. The country went into 5 00:00:23,800 --> 00:00:27,680 Speaker 1: strict lockdown to try to keep the outbreak from overwhelming 6 00:00:28,040 --> 00:00:34,000 Speaker 1: It's already shaky health system. But first, here's what happened 7 00:00:34,159 --> 00:00:43,720 Speaker 1: in virus News today. The pandemic is speeding up the 8 00:00:43,760 --> 00:00:48,120 Speaker 1: demise of a controversial industry in the Netherlands. The Dutch 9 00:00:48,159 --> 00:00:52,320 Speaker 1: government is forcing all mink farms to close by March 10 00:00:52,400 --> 00:00:56,280 Speaker 1: of next year. According to a report from news agency, 11 00:00:56,600 --> 00:01:01,560 Speaker 1: A and P infected minks were found on forty two farms, 12 00:01:02,040 --> 00:01:05,760 Speaker 1: triggering mass cullings of the furry mammals that are bred 13 00:01:05,959 --> 00:01:10,959 Speaker 1: for their soft pelts. Before the outbreak, the mink industry 14 00:01:10,959 --> 00:01:14,319 Speaker 1: in the Netherlands had been scheduled to close in twenty 15 00:01:14,840 --> 00:01:20,800 Speaker 1: four on animal welfare grounds. Peru has set another grim 16 00:01:20,800 --> 00:01:24,480 Speaker 1: record by reporting the highest number of deaths per capita 17 00:01:24,680 --> 00:01:29,760 Speaker 1: from the coronavirus, with twenty eight thousand, two hundred and 18 00:01:29,800 --> 00:01:34,840 Speaker 1: seventy seven confirmed deaths from COVID nineteen, or just over 19 00:01:34,920 --> 00:01:39,839 Speaker 1: eighty six for every one hundred thousand inhabitants. Peru overtook 20 00:01:39,840 --> 00:01:43,440 Speaker 1: Belgium as the nation where the virus has been deadliest. 21 00:01:44,480 --> 00:01:48,280 Speaker 1: That's according to data compiled by Johns Hopkins University, the 22 00:01:48,360 --> 00:01:52,600 Speaker 1: I m F and Bloomberg. Peru has one of the 23 00:01:52,640 --> 00:01:57,919 Speaker 1: world's worst outbreaks by other measures too. Over the past 24 00:01:58,160 --> 00:02:02,960 Speaker 1: seven days, no country in the world has posted more cases. 25 00:02:04,640 --> 00:02:07,360 Speaker 1: The outbreak has been so bad that as much as 26 00:02:07,400 --> 00:02:10,400 Speaker 1: a quarter of the twelve million people currently living in 27 00:02:10,480 --> 00:02:14,360 Speaker 1: Lima may have already had the virus. According to a 28 00:02:14,440 --> 00:02:19,399 Speaker 1: government study published last month, Officials war in the country's 29 00:02:19,680 --> 00:02:25,880 Speaker 1: real death toll may be close to double the official figure. Finally, 30 00:02:26,280 --> 00:02:29,880 Speaker 1: a UK study has suggested all the children who have 31 00:02:30,040 --> 00:02:34,760 Speaker 1: died from COVID nineteen in the country had quote profound 32 00:02:35,320 --> 00:02:40,880 Speaker 1: underlying medical conditions. The report suggests that healthy school age 33 00:02:40,880 --> 00:02:45,359 Speaker 1: patients are at very limited risk of severe disease outcomes. 34 00:02:46,240 --> 00:02:50,560 Speaker 1: The report adds to previous indications that youthful patients suffer 35 00:02:50,720 --> 00:02:54,399 Speaker 1: less from the disease than older people, but it did 36 00:02:54,440 --> 00:02:58,000 Speaker 1: show that black or obese children are at a marginally 37 00:02:58,320 --> 00:03:08,480 Speaker 1: higher risk and now for today's main story. The coronavirus 38 00:03:08,600 --> 00:03:12,560 Speaker 1: has swept through South Africa, but the country was already 39 00:03:12,639 --> 00:03:17,799 Speaker 1: carrying a heavy burden of chronic and infectious diseases. Its 40 00:03:17,800 --> 00:03:22,400 Speaker 1: health care system is fragile. So what happened when the 41 00:03:22,400 --> 00:03:26,000 Speaker 1: country went into a strict lockdown to prevent the spread 42 00:03:26,000 --> 00:03:33,360 Speaker 1: of COVID nineteen from overwhelming its medical facilities. Johannesburg based 43 00:03:33,440 --> 00:03:43,240 Speaker 1: reporter Janice Q explains. In the early hours of July thirty, 44 00:03:43,680 --> 00:03:46,960 Speaker 1: protests from a heavy green countryside in South Africa's northeast 45 00:03:47,360 --> 00:03:49,600 Speaker 1: set fire to some parts of the hundred and seventy 46 00:03:49,600 --> 00:03:53,720 Speaker 1: bed Katherine Booth Hospital. Their complaints they didn't want COVID 47 00:03:53,800 --> 00:03:56,960 Speaker 1: nineteen patients at the facility. It was the second protest 48 00:03:57,000 --> 00:03:59,360 Speaker 1: in as many months after the local government Sate had 49 00:03:59,400 --> 00:04:03,480 Speaker 1: wanted it to become the region's COVID hospital. Katherine Booth 50 00:04:03,520 --> 00:04:07,440 Speaker 1: is already dealing with many high risk patients. Our hospital 51 00:04:07,640 --> 00:04:11,800 Speaker 1: has a lot of people suffering from hypertension, diabetes, HIV 52 00:04:11,960 --> 00:04:17,000 Speaker 1: and TV. In fact, we our hospital that initiates medication 53 00:04:17,120 --> 00:04:21,120 Speaker 1: for certain people who are resistant to certain drugs for TV, 54 00:04:21,800 --> 00:04:26,200 Speaker 1: so that is a speciality. This is Dr Martinez Duplusy 55 00:04:26,240 --> 00:04:28,680 Speaker 1: one of nine doctors who work at Katherine Booth. He 56 00:04:28,800 --> 00:04:32,000 Speaker 1: joined the hospital in July twenty nine and usually works 57 00:04:32,000 --> 00:04:35,200 Speaker 1: in the outpatients department and in the emergency room. When 58 00:04:35,200 --> 00:04:38,440 Speaker 1: South Africa started its initial strict lockdown in March, he 59 00:04:38,520 --> 00:04:41,919 Speaker 1: largely became the de factor coronavirus doctor, doing most of 60 00:04:41,960 --> 00:04:44,040 Speaker 1: the unside testing and making many of the calls on 61 00:04:44,080 --> 00:04:47,799 Speaker 1: who should be admitted. While frequent slewness in getting COVID 62 00:04:47,880 --> 00:04:51,359 Speaker 1: nineteen test results has made his job challenging, he's grateful 63 00:04:51,520 --> 00:04:54,200 Speaker 1: that other than gowns, there haven't been any real shortages 64 00:04:54,240 --> 00:04:58,080 Speaker 1: in protective clothing. What is more concerned about is the tuberculosis, 65 00:04:58,120 --> 00:05:01,359 Speaker 1: diabetic and hypertension patients that he hasn't seen in the 66 00:05:01,360 --> 00:05:05,359 Speaker 1: past five months. After a few months, you realize that 67 00:05:06,080 --> 00:05:09,760 Speaker 1: a lot of the familiar faces aren't they anymore. And 68 00:05:10,240 --> 00:05:15,120 Speaker 1: coupled of that, people that present acutely in the hospital 69 00:05:15,400 --> 00:05:19,240 Speaker 1: that has a chronic illness, so let's say hy pretensive 70 00:05:19,320 --> 00:05:25,440 Speaker 1: crisis or diabetic crisis. Um, you make the assumption and 71 00:05:25,640 --> 00:05:29,440 Speaker 1: realization that a lot of these people passes away at 72 00:05:29,480 --> 00:05:33,160 Speaker 1: home because they never yeah, they never make it to hospital. 73 00:05:37,640 --> 00:05:40,760 Speaker 1: As South Africa entered its lockdown. Nurses had gone into 74 00:05:40,760 --> 00:05:43,360 Speaker 1: the community to ask people a series of questions as 75 00:05:43,360 --> 00:05:46,359 Speaker 1: a way of screening them for the coronavirus. At the 76 00:05:46,400 --> 00:05:48,839 Speaker 1: same time, they told people to please only go to 77 00:05:48,920 --> 00:05:52,480 Speaker 1: hospital for an emergency. The idea was to reduce the 78 00:05:52,560 --> 00:05:54,640 Speaker 1: number of people coming in so as to prepare for 79 00:05:54,680 --> 00:05:58,600 Speaker 1: the expected influx of COVID nineteen patients, but the hospital 80 00:05:58,640 --> 00:06:02,159 Speaker 1: mostly just emptied out, with occupancy dropping to less than half. 81 00:06:03,120 --> 00:06:06,560 Speaker 1: The diversion of resources from HIV and TB programs to 82 00:06:06,600 --> 00:06:10,799 Speaker 1: tackle the coronavirus outbreak is one of South Africa's significant losses. 83 00:06:11,520 --> 00:06:14,240 Speaker 1: Together with the reluctance of people to visit health facilities 84 00:06:14,279 --> 00:06:17,080 Speaker 1: for fear of contracting the disease, this has led to 85 00:06:17,120 --> 00:06:21,320 Speaker 1: collateral deaths. No one told them that they still need 86 00:06:21,400 --> 00:06:28,280 Speaker 1: to follow up every month to collect their medication. South 87 00:06:28,279 --> 00:06:30,839 Speaker 1: Africa has one of the world's biggest number of people 88 00:06:30,880 --> 00:06:33,640 Speaker 1: infected with HIV and one of the world's largest number 89 00:06:33,680 --> 00:06:38,240 Speaker 1: of tuberculoser sufferers. Together with extreme poverty, which exacerbates high 90 00:06:38,240 --> 00:06:41,360 Speaker 1: obesity levels that have boosted the number of diabetes patients, 91 00:06:41,880 --> 00:06:44,920 Speaker 1: it's understandable that the Health Minister took steps to mitigate 92 00:06:44,960 --> 00:06:48,359 Speaker 1: the chances of hospitals being in indebted. But still the 93 00:06:48,360 --> 00:06:52,919 Speaker 1: strict and prolonged lockdown has a diet economic consequences. You know, 94 00:06:53,040 --> 00:06:56,520 Speaker 1: if your need is really to put food on the table, 95 00:06:57,160 --> 00:07:00,520 Speaker 1: that trump's you know, thinking about your diabetes teas care 96 00:07:00,520 --> 00:07:02,280 Speaker 1: and the impact that that food may have on your 97 00:07:02,320 --> 00:07:05,839 Speaker 1: blood sugars and those diets tend to be very high 98 00:07:06,000 --> 00:07:11,200 Speaker 1: in carbohydrates, which then obviously impact significantly on on on 99 00:07:11,280 --> 00:07:14,600 Speaker 1: poor glucose control. This is Dr za and Stevens, a 100 00:07:14,600 --> 00:07:18,400 Speaker 1: specialist position an India chronologist at the Christian Barnard Memorial 101 00:07:18,440 --> 00:07:22,240 Speaker 1: Hospital in Cape Town. It's a private hospital named after 102 00:07:22,240 --> 00:07:25,040 Speaker 1: the famous South African surgeon who conducted the world's first 103 00:07:25,280 --> 00:07:28,840 Speaker 1: human heart transplant. It's also a stock reminder of South 104 00:07:28,920 --> 00:07:33,400 Speaker 1: Africa's high inequality for country that boasted this groundbreaking surgery 105 00:07:33,480 --> 00:07:38,240 Speaker 1: in nine. South Africa's history of four racial segregation during 106 00:07:38,240 --> 00:07:41,960 Speaker 1: the Partet regime set its healthcare system on a destructive path. 107 00:07:42,480 --> 00:07:45,280 Speaker 1: We've got this two tiered health system in South Africa 108 00:07:45,320 --> 00:07:48,400 Speaker 1: where we have a small group of people, probably about 109 00:07:48,400 --> 00:07:51,560 Speaker 1: twenty of the population, who are cared for with in 110 00:07:51,600 --> 00:07:55,680 Speaker 1: the funded healthcare sector, and then the overwhelming majority of 111 00:07:55,680 --> 00:07:59,080 Speaker 1: the population being cared for by the state healthcare sector. 112 00:08:00,040 --> 00:08:02,800 Speaker 1: Katherine Booth has a TV war that is good for isolation, 113 00:08:02,880 --> 00:08:05,080 Speaker 1: so the idea of using it as a COVID facility 114 00:08:05,160 --> 00:08:08,040 Speaker 1: makes some sense still for the community of about three 115 00:08:08,360 --> 00:08:11,160 Speaker 1: and fifty thousand people that it serves, many who have 116 00:08:11,240 --> 00:08:14,640 Speaker 1: little disposable income. Having to find money to travel further 117 00:08:14,680 --> 00:08:17,760 Speaker 1: to a different facility as a problem. So they're protesting 118 00:08:17,800 --> 00:08:21,240 Speaker 1: for their own health, which makes sense. Everyone has a 119 00:08:21,400 --> 00:08:24,480 Speaker 1: right to get medical care, and to take that away 120 00:08:24,520 --> 00:08:27,200 Speaker 1: by telling it in to a COVID hospital and telling 121 00:08:27,200 --> 00:08:29,320 Speaker 1: you to drive an hour and a half or two 122 00:08:29,360 --> 00:08:33,040 Speaker 1: hours to a different hospital, it's not feasible for the 123 00:08:33,080 --> 00:08:36,360 Speaker 1: people in my communities. Even so, in late August, the 124 00:08:36,400 --> 00:08:39,480 Speaker 1: local health authorities decided that Catherine Booth would be converted 125 00:08:39,480 --> 00:08:42,400 Speaker 1: to a COVID hospital. That means besides those heading for 126 00:08:42,440 --> 00:08:45,600 Speaker 1: the maternity ward, no new patients can be admitted unless 127 00:08:45,640 --> 00:08:49,560 Speaker 1: there are COVID patient. It's very time consuming to transfer 128 00:08:49,679 --> 00:08:53,800 Speaker 1: sick people and our closest hospital is mar b and 129 00:08:54,600 --> 00:08:57,920 Speaker 1: ha We which together with the dirt road, it takes 130 00:08:57,920 --> 00:09:00,160 Speaker 1: about an hour hour and a half to get the 131 00:09:00,200 --> 00:09:02,480 Speaker 1: patient there, But then you still need to book an 132 00:09:02,520 --> 00:09:06,520 Speaker 1: ambulance and discuss the patient, so it takes about four 133 00:09:06,559 --> 00:09:09,360 Speaker 1: to five hours for patients to get to the hospital. 134 00:09:10,080 --> 00:09:15,040 Speaker 1: So it's very frustrating, as frustrating for us as frustrating 135 00:09:15,080 --> 00:09:18,280 Speaker 1: for the patients. We still actually not sure how to 136 00:09:18,960 --> 00:09:21,400 Speaker 1: cope with all of this. It's not that the doctors 137 00:09:21,400 --> 00:09:23,480 Speaker 1: and Katherine Bruth are being left all alone to figure 138 00:09:23,520 --> 00:09:26,360 Speaker 1: it out. Through a research program, some doctors from the 139 00:09:26,360 --> 00:09:29,120 Speaker 1: bigger hospitals are coming to help them manage the COVID patients. 140 00:09:29,559 --> 00:09:33,200 Speaker 1: There are also more resources being provided. The Department of 141 00:09:33,240 --> 00:09:37,080 Speaker 1: Health has started its biggest ever medical intern allocation program 142 00:09:37,120 --> 00:09:42,120 Speaker 1: with almost recruits at Katherine Ruth. Construction to build new 143 00:09:42,120 --> 00:09:45,200 Speaker 1: wards have been fast tracked and since April, South Africa 144 00:09:45,240 --> 00:09:48,080 Speaker 1: has a cured fleet of new mobile coronavirus screening and 145 00:09:48,160 --> 00:09:53,040 Speaker 1: testing fans. The mobile testing like clinics, I think is 146 00:09:53,080 --> 00:09:57,319 Speaker 1: a great idea. Some of the units even will say 147 00:09:57,400 --> 00:10:02,319 Speaker 1: chronic mediation and then give own patients day chronic treatment. 148 00:10:02,960 --> 00:10:05,720 Speaker 1: Across the country. There's also be incorporation between the public 149 00:10:05,800 --> 00:10:08,320 Speaker 1: and private health sectors to an extent not seen before. 150 00:10:09,040 --> 00:10:11,520 Speaker 1: And here's with South Africa make it it's most significant 151 00:10:11,520 --> 00:10:14,800 Speaker 1: COVID related when the virus is breaking down walls that 152 00:10:14,880 --> 00:10:26,839 Speaker 1: could expedite the expansion of care. That was Janice Q. 153 00:10:27,559 --> 00:10:30,200 Speaker 1: And that's it for our show today. For coverage of 154 00:10:30,240 --> 00:10:33,840 Speaker 1: the outbreak from one twenty bureaus around the world, visit 155 00:10:33,880 --> 00:10:38,720 Speaker 1: bloomberg dot com slash coronavirus and if you like the show, 156 00:10:39,120 --> 00:10:41,920 Speaker 1: please leave us a review and a rating on Apple 157 00:10:41,960 --> 00:10:45,520 Speaker 1: Podcasts or Spotify. It's the best way to help more 158 00:10:45,600 --> 00:10:50,400 Speaker 1: listeners find our global reporting. The Prognosis Daily edition is 159 00:10:50,400 --> 00:10:55,360 Speaker 1: produced by topor foreheads Jordan gas Pure, Magnus Hendrickson, and 160 00:10:55,480 --> 00:10:59,880 Speaker 1: me Laura Carlson. Today's main story was reported by ja 161 00:11:00,120 --> 00:11:04,920 Speaker 1: This Cube. Original music by Leo Sidrian. Our editors are 162 00:11:05,040 --> 00:11:09,839 Speaker 1: Rick Shine and Francesca Levi. Francesca Levi is Bloomberg's head 163 00:11:09,880 --> 00:11:22,120 Speaker 1: of podcasts. Thanks for listening. H