Corona Conversations #FactsNotFear

(Please note: this email was sent on March 14th 2020, before a national state of disaster was declared. Also see the official COVID-19 Corona Virus South African Resource Portal here)

Dear friends,

Many of you have been in touch with questions — so I thought it might be helpful to consolidate these conversations and share with everyone here. People seem to either be anxiety balls of panic, or totally complacent. Neither is helpful at this point. There is a lot we don’t know (this is always the case during a pandemic of this nature) — but we have to make the best decisions we can with the information we have available to us. My view is that we do need to be taking this seriously — we need to be focusing on #FactsNotFear and how to support each other.

Now, I am not a Corona expert. But as many of you know, I am a public health person and doctor with experience from working as part of the response during the Ebola outbreak in Sierra Leone (2014–2015) so hoping it will be helpful for me to share some thoughts. It can be quite overwhelming trying to understand what’s going on — and I’m guessing it’s a bit easier for me to digest all the Corona information than it is for those of you without a public health background? Anyway — here goes!

Current situation in South Africa

As of yesterday (Friday March 13th) South Africa had 24 cases of coronavirus disease 2019 (COVID-19). There are a number of additional possible cases (see the NICD tweet) and these details will be released once they have been confirmed. We are lucky to have an excellent National Institute of Communicable Diseases here in Mzansi (check out the NICD website) but managing this outbreak is up to all of us, we all need to get involved.

Although we currently only have a handful of cases, many epidemiologists think that broader community spread is inevitable, and I agree. But, there is still time to shift the epidemic curve. Wondering what that means? Then keep reading!

While community spread in South Africa is quite likely, this does not mean that a widespread COVID-19 outbreak and health system collapse is inevitable — there is still time to shift the epidemic curve. In other words, we know that the outbreak will spread, but we can slow down how fast it spreads. Slowing it down in important because it will help to avoid a total collapse of our health system. Check out Graph 1 below. The orange shows us what could happen if we do nothing and just carry on as usual. The blue shows us what could happen if we act now. We will probably still have an outbreak, but if we can keep it below the health system capacity threshold line, then we could avoid a situation like what is currently happening in Italy. South Korea was in a similar position last week, and managed to shift the course significantly with widespread testing and preventative social distancing measures. (they are testing nearly 20 000 people per day, and even have drive through testing centres!)

Image for post
Image for post

Graph 1: Flattening the Curve (source here adapted from here)

We need to flatten our epidemic curve, and we can. But, we have to take action now. Why? Because although we only have 24 known cases, we probably already have many more unknown cases. Check out the timeline of events in Hubei in Graph 2 below: it shows us that there is a significant lag time between when the number of true cases (the grey bars) starts to rise, and when the official cases (the yellow bars) are confirmed. This is mostly because it takes a while from when people get infected and start developing symptoms, to when they get tested. So, what does this mean? Basically, that there are probably more cases than we know about, and we have to act NOW to control the spread.

Image for post
Image for post

Graph 2: Timeline of events in Hubei (source here)

What do we know about the Coronavirus Disease, and how does it spread?

The Coronavirus disease (COVID-19) is caused by a virus called SARS-CoV-2 (previously referred to as 2019-n-Cov) from the Coronavirdae family (there is a great podcast here if you want more information).

What do we know about how it spreads? Current evidence tells us that person-to-person spread of COVID-19 is via respiratory droplets. This means that tiny virus particles are released into respiratorty secretions when an infected person coughs, sneezes or talks and can infect another person if these viral particles makes contact with mucous memranes — like your your lips, mouth and eyes. (this is why you mustn’t touch your face!) But this does not explain all cases, and fomite spread is also likely. This means the virus can live on surfaces, and that you can be infected by touching things like handrails, elevator buttons or ATM machines etc. But only if you then touch your mouth or eyes. This is why it’s so important to wash your hands regularly and touch your face as little as possible. Hand-sanitiser is great while you are out and about, but first prize is to wash your hands with ordinary soap and warm water. Lather for as long as it takes to sing happy birthday twice (now people — please sing this in your head, or sing the Stevie Wonder version — we don’t need an outbreak of bad birthday song singing and coronavirus disease!). How long can it live outsdie the body? The short answer is we don’t know. Some have suggested that the virus can live on plastic and stainless steel surfaces for 2–3 days, and cardboard for one day — but it really is too soon to tell. (this study still needs to be peer reviewed) Best is to wash your hands, disinfect surfaces where you can, and don’t touch your face.

Most people who get COVID-19 will have a mild illness. 81% will have a mild flu like illness and can safely recover at home, 14% of people will need to be hosptialised and 5% will be critically ill and need ICU. If you are healthy and under 60, then you will probably have a mild illness but if you are older, or have any chronic illnesses then you will probably need to go to hospital (you can read more about this here).

At the moment, the World Health Organisation estimates that 3,4% of people wo get COVID-19 will die, but this varies from country to country (6,2% in Italy and 0,9% in South Korea for example). You can see what’s happening across the world here. One reason for this variation is health system functioning, which is why it is so important to flatten the curve (as discussed above) so that people don’t die unnecessarily simply because the hospitals are treating too many people at once. So, in summary: the fact that you will likely get a mild case doesn’t mean you shouldn’t worry if you are young and healthy. It means you should do everything you can not to get infected, and if you do get sick — you should make sure you stay away from others who may get more severe case of COVID-19. So, even if you’ll probably be fine — your granny, or your neighbours mother might not be so we should all do everything we can not to spread the virus. COVID-19 reminds us that we are all in this together, and we should look after each other!

So, what can you do?

It’s important not to panic — there is a lot we can all do. Here are the 10 most important things you can do. And remember: #FactsNotFear

  1. Wash your hands, often and don’t touch your face: all the evidence suggests that this remains the key to reducing spread of the virus. Use hand-sanitizer where possible if you can’t wash your hands.
  2. Social distancing: try to keep about one meter from people where possible, do this at all times, but especially if one of you are sick. If you have to care for a loved one, then try to wear gloves and a mask (but remember these are single use, and you have to throw them away after you use them) so try to have as little contact a possible with people who are sick.
  3. If you have visitors to your home — avoid hugging, kissing, and shaking hands, and ask everyone to wash their hands when they enter.
  4. Do your best to stay healthy: eat well, sleep well, exercise, and look after your mental health.
  5. Clean and disinfect surfaces regularly — and especially surfaces people touch a lot. You can read more about that here.
  6. Avoid mass gatherings of people where possible, and if you are in a leadership position in your community or organization then think carefully about the meetings you call, and the meetings you cancel. You can read more about that here.
  7. Avoid unnecessary travel to any countries with confirmed cases.
  8. Stay up to date with what is happening, and start thinking about plans in your neighborhood in case we do get a widespread outbreak.
  9. If you aren’t feeling well, do your best to stay at home. If you are coughing, make sure you cover your mouth (and/or wear a mask)
  10. Call the national hotline on 0800 029 999 if you have any flu like symptoms.

COVID-19 myth busters

So, #fakenews risks going more viral than COVID-19 so make sure you talk #FactsNotFear with everyone you know, and correct mis-information.

  1. The flu kills more people that COVID-19. Nope, that is simply not true. COVID-19 is both more contagious and more severe than flu. The mortality rate for COVID-19 is estimated at 3,4% compared to 0,1% for flu.
  2. COVID-19 doesn’t survive in hot weather. Nope, there is no evidence to support this! Qatar’s temperatures at the moment are about the same as South Africa’s and their rate of new infections is currently doubling every two days.
  3. COVID-19 doesn’t like melanin and the darker your skin, the more protected you are. Nope — there is no evidence to support this.
  4. Normal soap doesn’t kill COVID-19 Nope, soap is good! The virus has a fatty outer layer, which is destroyed by any household soap. You don’t need to buy anything special or expensive. Just WASH YOUR HANDS.
  5. I should buy a mask to protect myself. Well, a normal surgeons mask works to prevent germs escaping from the person wearing the mask, so it might help you protect those around you if you are infected (in which case you should not be in public) but it will not protect you from becoming infected.


There are many options: The official COVID-19 Corona Virus
South African Resource Portal
or the NICD website or the NICD twitter account the Western Cape Government website. There is also a WhatsApp broadcast channel that you can join here or you can also just save the number +27600123456 and send ‘hi’ to receive updates.

Hope this is helpful!

Till soon

Written by

Public health activist, researcher, and doctor

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store