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WHAT IS COVID-19?
COVID-19 is the name for the global pandemic caused by a coronavirus.1a This disease was first reported on 31 December 2019 by the World Health Organisation (WHO) following a cluster of pneumonia cases in Wuhan City, China.1b On the 7th January 2020, the causative pathogen was identified as a novel coronavirus (SARS-CoV-2).1b,2a
Who should get tested?
Any person presenting with symptoms of respiratory illness or other clinical illness compatible with COVID-19:1
- sore throat
- shortness of breath
- loss of sense of smell
- alteration of the sense of taste
- aches and pains
An asymptomatic person who is a close contact of a confirmed case may be tested in certain circumstances.1
Only patients meeting the criteria for a suspected case of COVID-19 or essential workers eligible for testing as per guidelines, will be tested. Guidelines for testing may change over time.1
Where do you get tested?
If you think you might have contracted the virus, you can call the NICD helpline (0800 029 999) and you will be advised on possible testing facilities.5
Public sector testing is free of charge. Private laboratories such as Lancet, Ampath and Pathcare can also test for SARS-CoV-2.5
What tests are being used in South Africa?
A single swab taken from the nose/throat area is the preferred sample type.1
The laboratory tests your sample for genetic material from the SARS-CoV-2 virus using a method called a PCR test (PCR stands for polymerase chain reaction). Testing is performed in laboratories by staff trained in the relevant technical and safety procedures.1
If your test was reported to be positive, then genetic material from the coronavirus was found in your sample and you have confirmed coronavirus disease.2 A single positive PCR test is sufficient proof of COVID-19 infection.1 Repeat confirmatory PCR testing is not indicated, as PCR-based tests have excellent specificity.1
What about antibody testing?
In order to improve testing worldwide, many rapid diagnostic tests are in development or being used. The World Health Organisation does not currently recommend the use of antigen or antibody rapid diagnostic tests (RDTs) for diagnosis testing as they are not sufficiently sensitive early in the disease course. This means many COVID-19 infected patients may be missed by such tests depending on when they were tested (the majority of patients develop an antibody response only in the second week after onset of symptoms). Currently, South Africa guidelines do not recommend using antibody-based tests for the diagnosis of COVID-19, but the development of these tests may be useful to support the development of vaccines and disease surveillance.6,7
Standard COVID-19 drug-regimen prescribed for positive cases
Treatment of COVID-19 will differ based on individual preferences from the HCP and symptoms shown by each patient.
Patients who are asymptomatic or have mild disease can be managed at home provided they can safely self-isolate.7c
RECOVERING FROM MILD ILLNESS FROM HOME
|What can you take?||What does it help for?|
|Paracetamol or NSAIDs7c,e||Symptomatic relief of fever or pain|
Some patients initially assessed as having mild disease may continue to worsen over the course of a week or more and subsequently require hospitalisation. Any deterioration in the ability to perform activities of daily living at home as a result of shortness of breath should prompt re-evaluation at a healthcare facility. Patients managed at home need to be given the contact details of their doctor or healthcare facility in case of any clinical worsening.7d
|PATIENTS HOSPITALISED WITH COVID-19|
|Oxygen||Oxygen therapy remains the mainstay of therapy for most hospitalised patients.7f|
|Fluids||Intravenous fluids may be needed due to prolonged fever.7g|
|Ventilation||Patients with respiratory failure may require intubation and mechanical ventilatory support.7h|
|Dexamethasone||Potent corticosteroid drug with an anti-inflammatory action that assists and inhibits the immune system’s overreaction to damaging lungs in COVID-198a|
|Anticoagulants||Helps prevents the development of blood clots.7i|
It is important to note that each individual will be treated according to their needs and co-existing conditions, the decision to treat is under the supervision of the prescribing doctor.
DRUGS THAT ARE CONSIDERED UNSAFE OR ARE NOT ADVISED TO BE TAKEN WITH COVID-19
Hydroxychloroquine & chloroquine
Hydroxychloroquine or chloroquine are drugs used for the treatment of malaria and auto-immune disorders like rheumatoid arthritis and lupus. Current evidence shows that this drug does not reduce deaths related to COVID-19 and does not help with moderate disease. Its use in COVID-19 is not recommended.9a
Remdesivir is an antiviral drug approved in the United states for hospitalised COVID-19 patients.8b However, due to the high cost and marginal benefit, it is not routinely recommended in South Africa.7j
Ivermectin is used as an antiparasitic drug in humans and animals but is not registered for human use in South Africa.10a The immense burden of the second COVID-19 wave and the limited availability of evidence-based options for the prevention and treatment of the virus, lead to widespread and unregulated use of ivermectin with the consequence that the quality and content of the ivermectin being prescribed, cannot be guaranteed.14a,b Due to the absence of approved guidance for ivermectin use in humans, there is no standardisation for dosage or indications for its use.14c
In order to restrain uncontrolled use of the drug, SAPHRA is exploring controlled and monitored access to reliable quality ivermectin through Section 21 application from health care professionals or prescribers to treat COVID-19.14e,f The responsibility for monitoring adverse events and therapy outcomes lies solely with the applicant and they (usually prescribers) are required to provide feedback on this to SAPHRA.14f Despite the fact the use of this repurposed medicine is being heavily promoted via social media, to date, there is insufficient robust evidence for or against the use of Ivermectin in the prevention or treatment of COVID-19.14d
SAPHRA will continue to update its position as needed, after appraisal of any new data that becomes available.
COVID-19 vaccines in South Africa
South Africa officially received 1 million doses of the AstraZeneca/Oxford COVID-19 vaccine at the beginning of February 2021.13c However, the rollout of the AstraZeneca vaccine has been placed on hold by the South African Government due to efficacy concerns against the new COVID-19 variant (501Y.V2) .15 New data shows the vaccine offers minimal protection against mild-to-moderate illness in patients infected with the new variant that is currently dominant in the country.15
The pharmaceutical company Johnson and Johnson (J&J), applied for emergency authorisation at the beginning of February from SAPHRA 15a, as recent studies have proven that their single dose vaccine provides 85% efficacy 16 against the new COVID strain. The first batch of 80 000 J&J vaccines arrived in South Africa on 16 February 2021.17,18 To date, this vaccine is the only single dose vaccination available, an advantage given how complex a logistical exercise the mass vaccination campaign will be.19a
Because the J&J vaccine is being studied in the South African population, an extension on the study was approved and early access granted to South African research sites 18b by SAPHRA, making South Africa the first country to administer the J&J vaccine before it is officially licensed. 20
The vaccination programme with the J&J vaccine started on 17 February 202117 and will continuously follow a mass three-phase roll-out approach, beginning with frontline healthcare workers in the private and public sector.14d Phase two will see the vaccination of other frontline workers, people older than 18 years with comorbidities and over 60 years. Everyone aged 18 years and older who has not been vaccinated will get the shot during phase three18c with a target to vaccinate 40 million people (67 % of the population) by the end of 2021 to ultimately achieve population immunity.13, 17
Another 200 000 J&J vaccines are to arrive shortly after the inoculation of the first batch of vaccines are concluded.19 An additional 500,000 vaccine doses are expected over the next four weeks, supplemented by 20 million doses of the Pfizer vaccine that are expected to be received at the end of March.18
For more on Vaccines click here
Recovering from COVID-19
The isolation period is 10 days after your illness began or 10 days after a positive test if you were asymptomatic.2
After a 10-day home isolation period, you are considered to no longer be infectious – you are very unlikely to transmit infection to others. No follow-up laboratory tests will be done during or at the end of your home isolation period.2
Close contacts: You can end your home quarantine 10 days after your last contact with a person with COVID-19. No laboratory tests will be done at any time during your home quarantine period unless you develop symptoms.3
For more information on the difference between self-isolation and quarantine, click here.
Can you get re-infected with the new variant strain of COVID-19?
It was initially thought that patients who already tested positive for COVID-19, could not get re-infected with SARS-CoV-2 due to the development of antibodies that remain in the blood for an estimated five to six months. Recent studies suggest that protection of immunity against the new strain of COVID-19 cannot be guaranteed.4
Adhering to protocols is essential for the public, including those who were already infected with an older variant of COVID-19.4
For more on Recovery click here
Information on the COVID-19 Vaccine
A vaccine is intended to provide immunity against COVID-19.13a Vaccines do not give you the virus, rather it teaches your immune system to recognise and fight the infection and may be the only way to stamp out this disease.13b
The WHO currently acknowledges three COVID-19 vaccines currently authorised for use, with many more in development. WHO is working with partners around the world to help coordinate key steps in this development process, including to facilitate equitable access to safe and effective COVID-19 vaccines for the billions of people who will need them.12a
Safety of the COVID-19 vaccine
Before administration, vaccines must be proven safe and effective in large clinical trials (which includes people with a high risk for contracting COVID-19). COVID-19 vaccines go through meticulous, multi-stage testing processes formulated to identify the side-effect profile of the vaccine and other safety concerns. Once the COVID-19 vaccine is declared safe and effective, independent reviewers discuss the efficacy and safety evidence required, including regulatory review and approval boards in each manufacturing country.12a
COVID-19 is a rapidly emerging disease – treatment and prevention protocols may change as and when we know more about this disease. Always ask your healthcare professional for advice on specific treatment and continue to practice safe public health measures to help limit the spread of COVID-19.
- National Institute for Communicable Diseases (NICD). Coronavirus disease 2019 (COVID-19) caused by a Novel coronavirus (SARS-CoV-2). Guidelines for case-finding, diagnosis, and public health response in South Africa. Updated 25 June 2020. Version 3.0. Available at https://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-guidelines/ Last accessed 22 January 2021.
- National Institute for Communicable Diseases (NICD). COVID-19. What to do if i test positive for coronavirus disease and i am asked to home isolate? Available at: https://www.nicd.ac.za/diseases-a-z-index/covid-19/advice-for-the-public/ Last accessed 22 January 2021.
- National Institute for Communicable Diseases (NICD). COVID-19. Frequently asked questions. Available at: https://www.nicd.ac.za/diseases-a-z-index/covid-19/frequently-asked-questions/ Last accessed 22 January 2021.
- National Institute for Communicable Diseases (NICD). Can you be re-infected with the new variant if you have already had COVID-19 from one of the older variants? Available at: https://www.nicd.ac.za/can-i-be-re-infected-with-the-new-variant-if-ive-had-covid-19/ Last accessed 22 January 2021.
- National Department of Health (NDoH). COVID-19 Corona Virus South African Resource Portal. Frequently Asked Questions (FAQ’s). Available at: https://sacoronavirus.co.za/faqs/ Last accessed 22 January 2021.
- World Health Organization (WHO). Advice on the use of point-of-care immunodiagnostic tests for COVID-19: Scientific brief. Available at: https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19 Last accessed: 22 January 2021.
- National Institute for Communicable Diseases (NICD) and National Department of Health. Clinical management of suspected or confirmed COVID-19 disease. Version 5 [24 August 2020]. Available at: https://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-guidelines/clinical-management-of-suspected-or-confirmed-covid-19-disease/ Last accessed 22 January 2021.
- Harvard Health Publishing. Harvard Medical School. Treatments for COVID-19. What helps, what doesn’t, and what’s in the pipeline. Available at: https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19 Last accessed 22 January 2021.
- World Health Organization (WHO). Coronavirus disease (COVID-19) advice for the public: Mythbusters. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Last Accessed: 22 January 2021.
- National Department of Health. Internal Memo. Ivermectin for the treatment of COVID-19. [07 January 2021].
- Moore N, Carleton B, Blin P, et al. Does Ibuprofen Worsen COVID-19? Drug Saf 2020; 43(7):611-614.
- World Health Organisation. COVID-19 vaccines. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines Last accessed: 22 January 2021.
- National Department of Health (NDoH). COVID-19 Corona Virus South African Resource Portal. Vaccine News, Updates & Information Portal. Available at: https://sacoronavirus.co.za/vaccine-updates/ Last accessed 10 February 2021.
- South African Health Products Regulatory Authority (SAPHRA). Update on the use of ivermectin in the prevention or treatment of COVID-19, 28 February 2021. https://www.sahpra.org.za/wp-content/uploads/2021/01/Statement-from-SAHPRA-on-Ivermectin-use-for-treatment-of-COVID-19_28-JAN-2021.pdf Last accessed 10 February 2021
- South African Broadcasting Corporation (SABC) News. J&J applies for COVID-19 vaccine emergency authorisation from SA . Available at: https://www.sabcnews.com/sabcnews/jj-applies-for-covid-19-vaccine-emergency-authorisation-from-sa/ Last accessed: 10 February 2021.
SAPHRA – South African Health Products Regulatory Authority; J&J – Johnson and Johnson, SII – Serum Institute of India
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