The recent outbreak of novel coronavirus (COVID-19) has, understandably, created a lot of anxiety, especially among those whose immune systems may be weak. That, however, says Shrikant Peters, is no excuse for discrimination, human rights violations, or any other form of harmful stereotyping. All people are created in God’s image and deserve respect and, should they contract the illness, access to dignified and adequate healthcare.
Although it has captured the imagination and invoked fear in global audiences only recently, coronaviruses have existed for many years.
The coronavirus is one of the causes (although not commonly) of the common cold. This fact is sure to escape many members of the public within the current hysteria. In reality, coronaviruses can kill (just like the flu virus can kill), and recent international outbreaks of other coronaviruses such as the Middle Eastern Respiratory Syndrome outbreak (MERS) of 2012 and the Severe Acute Respiratory Syndrome outbreak (SARS) of 2003.
This current outbreak is a new strain of coronavirus, hence it has only recently been recognised, first as a cluster of cases of initially unexplained pneumonia, in Wuhan, Hubei Province, China. Japan, Italy, the USA, the Philippines and Thailand have also reported nCov-2019 cases and deaths. The disease can present (although not always) as a fever, cough and shortness of breath.
These symptoms are similar to those caused by many other respiratory viruses and bacteria. Therefore, healthcare workers will typically inquire about the patient’s travel history, especial to Wuhan city in China, or whether they have had contact with any infected persons within the 14 days preceding their symptoms, as part of their diagnosis.
The virus is assumed to have crossed the species barrier in China from animals to humans. Although the first cases were due to inter-species transfer, the virus is now able to spread person-to-person, obviously aided by international travel, which is evident in the disease’s ability to travel rapidly in a short space of time. Currently, treatment is supportive and there is no cure or vaccine for the disease. Antibiotics have no effect on viral illnesses, although they may be used if a bacterial infection is also suspected.
A public health emergency of international concern?
The word “outbreak” takes me back to the year 2014. I was on duty as a fully qualified medical officer, in a dirty hovel of a clinic in inner-city Johannesburg. The air was rife with the stench of urine and sweat. The world was in fear at the threat of a far more vicious virus – Ebola; a viral haemorrhagic fever, which had recently reared its head again in West Africa.
With Johannesburg being a major port of entry to foreigners from the rest of Africa, clinics had been placed on high alert. Posters were up in each casualty department regarding the personal protective equipment and screening techniques to be used in the event of suspected cases. Unfortunately, we didn’t have any of this equipment. Asking whether South Africa is ready to deal with an outbreak of novel coronavirus is then a fair question indeed!
Ebola is rightfully feared for its transmissibility and high case fatality rate; around 50% (but up to 90% in certain outbreaks). Luckily, unlike Ebola, the case fatality rate of novel coronavirus is actually quite low; as such only 1 in 5 patients will experience severe symptoms, and by the end of January, although almost 8 000 cases had been identified, this had resulted in fewer than 200 (ie <2.5%) deaths.
This does not mean that one should not take the necessary precautions, however, especially when travelling internationally, or using healthcare facilities. To prevent the spread of coronavirus, the World Health Organization (WHO) has recommended adhering to basic hygiene practices, including covering one’s coughs and sneezes, handwashing with soap and water or alcohol-based rubs, cleaning and disinfecting frequently touched surfaces and objects in public spaces, avoidance of contact with symptomatic people, and avoidance of animal markets.
The WHO has also advised against non-essential travel to Hubei Province, China; movement restrictions have been placed on both travellers and locals there. Currently, South Africa’s international airports are screening travellers for fever, and have facilities for testing and isolation of people with suspected illness. Swabs and samples of sputa would then be sent off to the National Health Laboratory Service. Certain hospitals in the country have been designated as treatment facilities, and all cases would be followed up to ensure that further spread of disease is prevented.
As the symptom of fever is extremely non-specific, this is not an absolute indicator of novel coronavirus. Due to the 14-day incubation period, the absence of a fever also does not exclude a diagnosis of coronavirus. High-risk contacts of persons with the illness have thus been advised to avoid travel for 14 days after exposure.
Safeguarding human rights and dignity
After a period of aversion, the Secretary-General of the WHO, Dr Tedros Ghebreyesus, declared a Public Health Emergency of International Concern (PHEIC), noting that cases were being transmitted person-to-person. In raising this alarm, the WHO was also quick to ask for calm and point out the need for human, financial and scientific solidarity in combating the disease.
VIEW – Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE // John Hopkins University
Due to the paranoia and fear associated with a poorly understood global scale disease, it has become commonplace for social media to be awash with rumours, myths, memes and jokes that may seem harmless, but can serve to propagate stereotypes, unhelpful misinformation and racism. Accurate and up to date information should be sought and obtained from official sources, such as the World Health Organization and the South African National Institute for Communicable Diseases, both of which regularly publish situational reports detailing the developing outbreak.
With greater ability to control the flow of information, goods, services and people, it is important for nations to still respect, protect and fulfil the precepts of the Universal Declaration of Human Rights. In countries that recognise them, human rights are inalienable (cannot be removed), they are indivisible (have the same importance), and inter-dependent (rely upon each other).
Interestingly, China is not a signatory to the two documents, which codified human rights into international law. Therefore, its government is not obliged to provide rationale for any limitations it may place upon the freedoms of movement, expression and opinion during this outbreak. This enables a lockdown of geographic areas, but can also serve to silence important information.
Dr Li Wenliang, a healthcare worker in Wuhan province, was silenced when he tried to alert authorities to the developing outbreak and has since succumbed to the illness himself.
The failure of international human rights laws in the face of political and economic power makes the case for personal morality, generosity of spirit and scientific rationality even greater.
Many nations across the globe have implemented either travel bans from China, or a system of two-week quarantine at major airports for all travellers coming from mainland China. There is thus no need for avoidance of contact with Chinese people, goods and food. External shocks to our health systems and communities serve only to demonstrate their innate resilience (or lack thereof) to handle external threats in a fair and effective manner.
The international health regulations (IHR)
The declaration of a PHEIC can have far-reaching consequences, hence the caution with regard to declaring one. It is an international legal instrument that is designed to protect all states from the international spread of disease. The purpose of the IHR is thus to prevent, protect, control and respond to international diseases which are a public health risk.
Coronavirus fulfils the definition of a PHEIC as there is risk of person-to-person spread, it is unusual and unexpected in both the number and speed with which cases have developed, and it has resulted in international trade and travel restrictions (and is hence an economic risk as well). PHEICs are declared to ensure that there is coordinated control of persons, goods, food, animals, vectors and the environment to prevent further morbidity and mortality. This should always be balanced by the need to respect human rights and dignity, inclusive of the freedom of movement and the right to the highest attainable level of health.Republish