Tag: covid

Categories : COVID ExerciseTags :

Lower COVID Risk in Men Physically Fit When Young

On By ModernMedia

Many Swedish men who were physically fit when they did their military service were able to avoid being hospitalised when they became infected with COVID up to 50 years later. 

The results of the study by University of Gothenburg researchers are now available in the BMJ Open.

Sweden has a system of military conscription for its citizens, which it reinstated in 2017 and expanded to include women. The study drew on the Swedish Conscription Register, which contains data on over 1.5 million young Swedish men who began their military service in the years 1969–2005. Nearly all of these men then underwent both a bicycle test and a strength test. In spring 2020, some 2500 of the men included in the Conscription Register were hospitalised with COVID.

The men were divided into three groups based on their results in the fitness and strength tests, and their data were merged with three other Swedish registers: the National Inpatient Register (IPR, also known as the Hospital Discharge Register), Intensive Care Register, and Cause of Death Register. Analysis showed a clear link between fitness and strength in youth and the risk COVID hospitalisation 15–50 years after conscription.

Lead author Agnes af Geijerstam, PhD Student, University of Gothenburg’s Sahlgrenska Academy said, “At the population level, we can see that both good fitness and good muscle strength in the late teens are protective factors for severe COVID. For those with good fitness at the time of conscription, the risk of dying in spring 2020 was half as high as for the least fit. For those whose strength was good back then, too, we see a similar protective effect.”

However, since the oldest men in the study had not reached age 70, COVID deaths were uncommon in the study.

“Previous studies have shown that obesity is a risk factor for severe COVID. But we see that good fitness and strength are protective factors for everyone, including men with overweight or obesity,” said Professor Lauren Lissner, senior coauthor of the study.

Moreover, the study showed a link between the men’s height to the risk of COVID-19 infection.

“The taller the men were, the greater their risk of needing advanced care when they had gotten COVID; but per centimeter this increase in risk is very small. Also, unlike fitness and strength, there is no way to influence our height” af Geijerstam says.

Many studies have already demonstrated the protective effect of good physical fitness in numerous medical conditions, including infections. It has been established that physical activity strengthens the immune system and reduces inflammation propensity. Fitness during adolescence is also likely to be associated with active and otherwise healthy lifestyles throughout adult life.

“It’s interesting to see that the high fitness and strength levels those men had so many years ago can be linked to protection against severe COVID. Today, young people are becoming ever more sedentary, and that means there’s a risk of major problems arising in the long term — including a reduced resistance to future viral pandemics. Children and adolescents must get ample scope to move around,” af Geijerstam said.

Source: University of Gothenburg

Journal information: af Geijerstam, A., et al. (2021) Fitness, strength and severity of COVID-19: a prospective register study of 1 559 187 Swedish conscripts. BMJ Open. doi.org/10.1136/bmjopen-2021-051316.

Categories : COVID HospitalsTags :

As Gauteng Weathers Third Wave, Western Cape Readies its Defences

On By ModernMedia
Image by Quicknews

While COVID infection rates in Gauteng remain high, Western Cape is now firmly in a third wave, with an average of 1969 new cases a day. The healthcare system there has been monitoring the situation and preparing for the expected surge in cases.

“We are in a steep third wave, driven by the Delta variant and urge everyone to adhere strictly to protective behaviours, as a key drive to contain it. We anticipate that the third wave could be as high as the second wave. We await revised modelling from the SACMC to re-calibrate our response,” said head of health Dr Keith Cloete. Data on cases, healthcare capacity and details of the Western Cape’s responses were made available on the SA Coronavirus Portal.

In the Western Cape, the reproductive number has been over one for the past two months and is currently sitting at approximately 1.2, meaning an acceleration of new cases. The test positivity rate is at about 32%.

The public and private sector are using around two-thirds of the oxygen production capacity of Afrox’s plant. The level 4 restrictions with their accompanying alcohol ban saw a significant drop in week-on-week trauma presentations (~25%) and weekend trauma burden (~33% drop). This comes even with the context typical end of month increase as well as expected remaining alcohol stock, demonstrating the ban’s effectiveness.

The modelling referred to by Dr Cloete currently shows a high of ~500 daily admissions by 17 July, however an updated model is awaited. Public sector COVID bed capacity is being increased by converting beds and opening field hospitals, with a planned capacity of 2300 beds.

About 48.5% and 10.4% of the Western Cape population aged 60+ and 50-59 respectively have been vaccinated so far. Meanwhile, in a media briefing on Friday, Acting Health Minister Mmamoloko Kubayi-Ngubane announced that COVID vaccine registration for South Africans between the ages of 35-49 will open on July 15, with vaccinations for this age group planned to commence on August 1.

Categories : COVID Ethics and LawTags :

Why the ‘Lab Leak’ Scenario Was Shouted Down

On By ModernMedia
SARS-CoV-2 virus. Source: Fusion Medical Animation on Unsplash

For most of 2020, the notion that SARS-CoV-2 may have originated in a lab in Wuhan, China, was regarded as a debunked conspiracy theory, only embraced by some conservative media supportive of President Donald Trump. But in early 2021 that all changed, and today most outlets across the political spectrum agree that the ‘lab leak’ scenario deserves serious investigation.

An investigation by The BMJ uncovered a concerted campaign by researchers with funding on pandemic-potential virus research to label ‘lab leak’ scenarios as a conspiracy, effectively stifling journalism and investigation into the topic for over a year. One of the leaders of this was Peter Daszak, president of EcoHealth Alliance, a non-profit organisation which received millions in grants for pandemic preparedness research. EcoHealth Alliance subsequently subcontracted work out to the Wuhan laboratories.

Almost from the outset of the pandemic, a February 2020 statement in the Lancet coauthored by Daszak effectively ended the debate. “We stand together to strongly condemn conspiracy theories suggesting that covid-19 does not have a natural origin.” 

“It’s become a label you pin on something you don’t agree with,” said Nicholas Wade, a science writer who has worked at Nature, Science, and the New York Times. “It’s ridiculous, because the lab escape scenario invokes an accident, which is the opposite of a conspiracy.” 

But hostility to the scenario continued to grow. Filippa Lentzos, codirector of the Centre for Science and Security Studies at King’s College, London, told the Wall Street Journal, “Some of the scientists in this area very quickly closed ranks.” She added, “There were people that did not talk about this, because they feared for their careers. They feared for their grants.”

Daszak wrote an essay for the Guardian in June 2020 attacking the former head of MI6 for saying that the pandemic could have “started as an accident,” and continued to receive support from coauthors of the letter. 
But Daszak’s role in drawing up the statement in the Lancet was revealed in November 2020 in emails obtained through freedom of information requests.

“Please note that this statement will not have EcoHealth Alliance logo on it and will not be identifiable as coming from any one organization or person,” wrote Daszak in a February email, while sending around a draft of the statement for signatories. He also considered omitting his name from the statement to reduce potential negative exposure. A number of the 27 co-signatories omitted reporting their ties to EcoHealth Alliance.

Richard Ebright, professor of molecular biology at Rutgers University in New Jersey and a biosafety expert, considered scientific journal to be complicit in helping to clamp down on talk of a lab leak. “That means Nature, Science, and the Lancet,” he said. Along with dozens of other academics, he has been pushing back against the conspiracy theory labelling of the lab leak scenario.

“It’s very clear at this time that the term ‘conspiracy theory’ is a useful term for defaming an idea you disagree with,” said Ebright, referring to journalists and scientists making use of the term to attack others. “They have been successful until recently in selling that narrative to many in the media.”

Daszak enjoyed more support after then-President Trump cancelled EcoHealth Alliance’s National Institutes of Health funding, and the lab leak scenario remained buried for most of the year. It only resurfaced when a January 2021 New York magazine published an article detailing a possible lab leak scenario, in the face of stiff criticism. The tide began to turn when the World Health Organization investigation (which included Daszak) produced a report which attracted criticism for effectively ruling out the lab leak scenario in the face of almost a complete lack of evidence, such only being allowed a few hours’ worth of supervised access to the Wuhan labs. When Donald Trump lost the Presidential office, the criticism suddenly lost its greatest means for shutting down challenges — its mere association with its most widely-known and disliked proponent. 

Citing an intelligence report, the Wall Street Journal, recently reported that three Wuhan Institute of Virology researchers were admitted to hospital in November 2019. When President Joe Biden ordered an investigation into the scenario, it marked a slow turn-around in media coverage. Many outlets started backtracking their previously publicised viewpoints or adding qualifying statements, justifying them as simply a matter of tracking a “scientific consensus” which, they say, has now changed. Vox posted an erratum noting, “Since this piece was originally published in March 2020, scientific consensus has shifted.”

In recent weeks, a number of high profile scientists who once denigrated the idea that the virus could have come from a lab have made small steps into demanding an open investigation of the pandemic’s origin.

In a recent interview, NIH director Francis Collins said, “The Chinese government should be on notice that we have to have answers to questions that have not been answered about those people who got sick in November who worked in the lab and about those lab notebooks that have not been examined.” He added, “If they really want to be exonerated from this claim of culpability, then they have got to be transparent.”

It is worth noting that searches with phrases like “conspiracy theory”, “lab leak” and “Wuhan” do not turn up any relevant hits on The BMJ website, other than articles published this year which discuss the lab leak scenario seriously and credibly, or an article which discusses the more outlandish viral disinformation typical of the COVID pandemic typically seen in social media. Nor are there any articles with “Daszak” as an author.

Source: The BMJ

Categories : COVID GenderTags :

A Possible Explanation for Greater COVID Severity in Males

On By ModernMedia
SARS-CoV-2 viruses (yellow) on an infected cell. Source: NIAID

Researchers studying COVID patients have uncovered a metabolic pathway linked to immune responses only in male patients, a group known to be more likely to suffer severe cases and die of the disease.

Male COVID patients were more likely than female patients or healthy control subjects to have elevated levels of kynurenic acid, a product of amino acid metabolism, according to the study. High levels of kynurenic acid have been linked to several diseases, such as schizophrenia and HIV-related diseases.

They found that male patients with severe COVID cases were also more likely to have a high ratio of kynurenic acid to kynurenine, a byproduct of the amino acid L-tryptophan which is used to create the nutrient niacin.

“We know that men are at higher risk than women of contracting severe cases of COVID and that sex differences in the body’s immune responses present a compelling explanation for this phenomenon,” said Caroline Johnson, an assistant professor of epidemiology at Yale School of Public Health and senior author of the study. “We also know that immune responses are regulated in part by metabolites, and so these new findings offer a key window into the mechanisms underlying how this disease affects female and male patients differently.”

The team studied blood samples drawn from 22 female and 17 male patients at Yale New Haven Hospital after confirmation of COVID infection. They then compared these samples with samples from 20 uninfected health care workers.

The researchers positively identified 75 metabolites, which are molecular products of digestion and cellular processes. After adjusting for  age, body-mass index, sex, and other factors, the researchers identified 17 metabolites that were associated with COVID infection. Further analysis showed the strong relationship between high levels of kynurenic acid as well as high ratios of kynurenic acid to kynurenine in the male immune response and worse patient outcomes.

“Such sex-specific pathways provide major clues about how this disease infects and sickens individuals,” Prof Johnson said. “We can use this knowledge to create more effective treatments for this terrible disease and similar diseases.”

Source: Yale University

Categories : COVID General InterestTags :

Month-long COVID Coma Left Ambulance Worker ‘Scarred’

On By ModernMedia
Photo by Ian Taylor on Unsplash

A UK ambulance worker who contracted COVID and was in an induced coma for over a month says his family is psychologically scarred by what happened.

Paul Clements, 59, had major organ failure as well as several infections, leaving him in intensive care at Bristol Royal Infirmary. Doctors told him he was lucky to survive the 33-day induced coma. Speaking to the BBC, Mr Clements said that the time passed “in the blink of an eye”.

“The last thing I remember is being handed a cup of tea by my daughter,” said Mr Clements. He was agitated, complaining that the tea tasted awful, prompting concern from his family.

“I put it down, and then I blinked. I then found myself lying on a bed looking at a nurse,” he recalled. “I told her that I’d put my tea down somewhere.”

He said the nurse laughed in response, and then explained to him that he “had been unconscious for 33 days.”

On 19 March 2020, Mr Celements began to have COVID symptoms. Five days later, he was rushed into hospital.

“They tried three times to wake me up. The doctors told me I had pneumonia, a chest infection, an abdominal infection, kidney failure and liver failure – all wrapped up in COVID.” Up to a third of hospitalised COVID patients in the UK’s first wave had ‘do not resuscitate’ orders, recorded on or just before their admission.

He says that “Trying to get my head around that was almost impossible. Even now they have no idea why I survived.”

At the time, his family weren’t allowed to visit the Bristol Royal Infirmary where he was due to COVID restrictions.

“It was hell, absolute hell,” said Paul’s wife, Kerri. “Every time the phone rings you’re on edge thinking this is a call we don’t want. Listening out for his breathing every night, if he coughs I’m on edge, if he says he doesn’t feel well we’re back on edge.”

Mr Clements spent a total of three months in hospital before being leaving the ward to applause by the staff.

He returned to his work as an emergency care assistant six months later, with South Western Ambulance Service where has been for the past 38 years. He acknowledges the close call he had. “Unfortunately in my job I’ve put people in body bags and taken them to the mortuary,” he said.

“I spent some time in hospital trying to get my head around it and realised that could’ve been me, and the reality of it is so scary.”

Source: BBC News

Categories : COVIDTags :

Male and High BMI not Linked to COVID ICU Mortality

On By ModernMedia
Photo by Mufid Majnun on Unsplash

A new meta-analysis shows that, contrary to some previous research, being male and increasing body mass index (BMI) are not associated with increased mortality in COVID patients in intensive care units (ICU).

However, the study by Dr Bruce Biccard (Groote Schuur Hospital and University of Cape Town) and colleagues found that there were a wide range of factors linked to death from COVID in ICU. An August 2020 study of ICU COVID patients in Europe showed an association for age but not male sex.

The meta-analysis, which includes 58 studies and 44 305 patients published in the journal Anaesthesia, showed that, compared to patients without these risk factors, ICU COVID patients had a 40% greater mortality risk with smoking history, 54% higher with hypertension, 41% higher with diabetes, 75% higher with respiratory disease, around twice as high with cardiovascular disease or cancer, and 2.4 times higher with kidney disease. Other factors associated with an increased risk of death were the severity of organ failure, needing mechanical ventilation (a factor of 2.5 over non-ICU), as well as increased white blood cell counts and other inflammation markers.

The authors believe that age may effectively represent frailty in COVID patients which impacts on a person’s physiological reserve to overcome a critical illness. Hypertension, smoking and respiratory disease may be linked by their association with angiotensin-converting enzyme (ACE) receptors in the body, since there is increased expression of ACE-2 receptors amongst smokers and patients with chronic obstructive pulmonary disease. The link between hypertension and cardiovascular disease and increased mortality may be associated with the risk of cardiac injury which occurs with the systemic inflammatory response to COVID infection.

The authors said: “The findings confirm the association between diabetes, cardiovascular and respiratory comorbidities with mortality in COVID patients. However, the reported associations between male sex and increasing BMI worsening outcomes are not supported by this meta-analysis of patients admitted to ICU. This meta-analysis provides a large sample size with respect to these risk factors and is a robust estimate of risk associated with male sex and BMI.”

Source: EurekAlert!

Journal information: Anaesthesia, doi.org/10.1111/anae.15532

Categories : COVID Injury & TraumaTags :

Trauma Patients with COVID at Great Risk

On By ModernMedia
Photo by Nate Isaac on Unsplash

The COVID pandemic has placed a great strain on healthcare resources, with a number of indirect impacts ranging from increased incidence of heart attacks to decreased cancer screenings, but also increased the risk of complications and death among trauma patients with COVID. 

The study revealed that the risk of death for COVID-positive patients in trauma centres across the US state of Pennsylvania was six times higher than non-COVID-negative patients with similar injuries. Complication risk in COVID-positive patients was doubled for venous thromboembolism, renal failure, need for intubation, and unplanned ICU admission, and was five times greater for pulmonary complications. In patients over age 65, the risks were even higher. The findings were recently published in The Journal of Trauma and Acute Surgery.  

“COVID had the largest impact on patients whose injuries were relatively minor, and who we would have otherwise expected to do well,” said lead author Elinore Kaufman, MD, MSHP, an assistant professor in the Division of Trauma, Surgical Critical Care and Emergency Surgery at Penn Medicine. “Our findings underscore how important it is for hospitals to consistently test admitted patients, so that providers can be aware of this additional risk and treat patients with extra care and vigilance.”

Researchers conducted a retrospective study of 15 550 patients admitted to Pennsylvania trauma centers from March 21, 2020, (when non-essential businesses statewide were ordered close) to July 31, 2020. Of the 15 550 patients, 8170 were tested for the virus, and 219 tested positive. During this period, the researchers evaluated length of stay, complications, and overall outcomes for patients who tested positive for COVID, compared to patients who did not have the virus. They found that rates of testing increased over time, from 34% in April 2020 to 56% in July. Centres had a great variability in testing, a median of 56.2% of the time with a range of 0 to 96.4%.

“First, we need to investigate how to best care for these high-risk patients, and establish standard protocols to minimise risks,” said senior author Niels D Martin, MD, chief of Surgical Critical Care and an associate professor in the division of Trauma, Surgical Critical Care and Emergency Surgery. “Second, we need more data on the risks associated with patients who present symptoms of COVID, versus those who are asymptomatic, so we can administer proven treatments appropriately and increase the likelihood of survival with minimal complications.”

Source: University of Pennsylvania

Categories : COVIDTags :

Lockdown Level 4; Third Wave Driven by Delta Variant

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In response to the third wave driven by the delta variant, President Cyril Ramaphosa instituted a two-week Level 4 lockdown during a ‘family meeting’ address to the nation.

He warned that the healthcare system was facing a dire situation. “Our health facilities are stretched to the limit… ICU beds are in short supply,” he said. 

In a press briefing on Friday, the head of the World Health Organization said the COVID Delta variant, first seen in India, is “the most transmissible of the variants identified so far,” and warned it is now spreading in at least 85 countries.

“We are in the exponential phase of the pandemic with the numbers just growing very, very, extremely fast and (they) will keep growing in the next weeks,” said Tulio de Oliveira, a leading virologist in the country.

The Delta variant first seen in India now appears to be “dominating infections in South Africa,” de Oliveira of the Network for Genomic Surveillance in South Africa told a virtual briefing.

The Delta variant has emerged as dominant in South Africa. Source: Department of Science & Technology

Koleka Mlisana, the head of a government ministerial advisory committee on COVID, told the same briefing that there is “evidence that the Delta variant may actually be taking over”.

Acting Minister of Health, Mmamoloko Kubayi-Ngubane said that due to the prevalence of the Delta variant, infection numbers “are likely to surpass the second wave peak” in January.

Only about 2.4 million people have been immunised since February. Thousands of EFF activists rallied in Pretoria on Friday to demand a faster coronavirus vaccination rollout, including expedited approvals for the Sinovac vaccine from China and Russia’s Sputnik V.

Source: Medical Xpress

Categories : COVIDTags :

The Origin Mystery of SARS-CoV-2 Deepens

On By ModernMedia
SARS-CoV-2 viruses emerging from a human cell. Credit: NIAID

Australian researchers studying SARS-CoV-2 have discovered that the virus is most ideally adapted to infect human cells — instead of bat or pangolin cells, prompting renewed questions about its origin.

The scientists, from Flinders University and La Trobe University, described how they used high-performance computer modelling of SARS-CoV-2’s structure at the beginning of the pandemic to predict its ability to infect humans and a range of 12 domestic and exotic animals.

They were hoping to identify an intermediate animal vector that may have played a role in transmitting a bat virus to humans, and to understand any risk posed by the susceptibilities of pets and livestock.

Using genomic data from 12 animal species, the researchers painstakingly built computer models of the key ACE2 protein receptors for each species. These models were then used to calculate how strongly the SARS-CoV-2 spike protein bound to each species’ ACE2 receptor.

Surprisingly, the results showed that SARS-CoV-2 bound to ACE2 on human cells more tightly than any of the tested animal species, including bats and pangolins. If one of the animal species tested was the origin, it would normally be expected to show the highest binding to the virus.

“Humans showed the strongest spike binding, consistent with the high susceptibility to the virus, but very surprising if an animal was the initial source of the infection in humans,” said Professor David Winkler at La Trobe University.

The findings, originally released on the ArXiv preprint server, have now been peer reviewed and published in Scientific Reports.

“The computer modelling found the virus’s ability to bind to the bat ACE2 protein was poor relative to its ability to bind human cells. This argues against the virus being transmitted directly from bats to humans. Hence, if the virus has a natural source, it could only have come to humans via an intermediary species which has yet to be found,” says Flinders affiliated Professor Nikolai Petrovsky.

The team’s computer modelling also showed fairly strong binding of SARS-CoV-2 to ACE2 from pangolins, which are occasionally used as food or in traditional medicines. Professor Winkler noted that pangolins displayed the highest spike binding energy of all the animals in the study – significantly higher than bats, monkeys and snakes.

“While it was incorrectly suggested early in the pandemic by some scientists that they had found SARS-CoV-2 in pangolins, this was due to a misunderstanding and this claim was rapidly retracted as the pangolin coronavirus they described had less than 90% genetic similarity to SARS-CoV-2 and hence could not be its ancestor,” Prof Petrovsky said.

Similarity in spike proteins

As shown in this and other studies, the specific part of the pangolin coronavirus spike protein that binds to ACE2 was almost identical to its SARS-CoV-2 counterpart.

“This sharing of the almost identical spike protein almost certainly explains why SARS-CoV-2 binds so well to pangolin ACE2. Pangolin and SARS-CoV-2 spike proteins may have evolved similarities through a process of convergent evolution, genetic recombination between viruses, or through genetic engineering, with no current way to distinguish between these possibilities,” Prof Petrovsky said.

“Overall, putting aside the intriguing pangolin ACE2 results, our study showed that the COVID-19 virus was very well adapted to infect humans.”

“We also deduced that some domesticated animals like cats, dogs and cows are likely to be susceptible to SARS-CoV-2 infection too,” Prof Winkler added.

The question of how the virus came to infect humans currently has two main explanations. The virus may have jumped to humans from bats through an intermediary animal which remains to be identified. The other explanation making headlines in the media is an accidental release from a virology lab, where it perhaps was created in ‘gain of function‘ tests, which are carried out around the world to better understand pathogens. A number of organisations and governments, including the World Health Organization and the United States have urged further investigation to find out which of these is correct — though a definitive answer may take years.
How and where the SARS-CoV-2 virus adapted to become such an effective human pathogen remains a mystery, the researchers concluded, adding that finding the origins of the disease will help efforts to protect humanity against future coronavirus pandemics.

Source: EurekAlert!

Journal information: Sakshi Piplani et al, In silico comparison of SARS-CoV-2 spike protein-ACE2 binding affinities across species and implications for virus origin, Scientific Reports (2021). DOI: 10.1038/s41598-021-92388-5

Categories : COVIDTags :

Positivity Rate at 25% as Lockdown Upgrades Expected

On By ModernMedia

President Cyril Ramaphosa is expected to meet with the National Coronavirus Command Council (NCCC) to discuss the government’s response to the third COVID wave, which includes the possibility of new restrictions. 

Several bodies have strongly urged upgrading to a harder lockdown, including the South African Medical Association, the Gauteng Provincial Government, medical professionals, and now the Ministerial Advisory Committee on Covid-19.

Earlier this week Ramaphosa indicated that the government will have to increase its COVID containmant measure – especially in Gauteng province. He noted that the country’s first hard lockdown in March 2020, one of the strictest in the world, did help cut infection rates at the start of the pandemic.

South Africa recorded 17 493 new cases, a new daily high for the third wave, of which 10 806 were in Gauteng. Case positivity rate increased to 24.92%. A report released on Wednesday by the South African Medical Research Council showed that 1349 excess deaths in Gauteng for the week ending 13 June, of which 431 were due to COVID/

Warnings and failure to act

In an interview with The Money Show with Bruce Whitfield this Monday, Netcare CEO Richard Friedland had warned that the numbers of Covid-19 patients “are overwhelming facilities at the moment”.

Since Wednesday last week, Gauteng’s hospitals had been battling with a “mass casualty situation” , not unlike the aftermath of a train accident, or the collapse of a sports stadium, with “injuries on a massive scale”. But, with COVID, he said, the crisis is not over in a couple of hours, but remains ongoing.

With no evidence of a peak in case numbers, Friedland said that, “I’m afraid that these numbers are demonstrating that [without] a Level 5 lockdown in Gauteng, we may not see the end of this surge for some time.”

Professor Koleka Mlisana, co-chairperson of the Ministerial Advisory Committee on Covid-19, says that tighter restrictions are likely needed to help curb infections.

Prof Mlisana said that the other major crisis is making sure that there are sufficient hospital beds in Gauteng. This includes additional facilities, staffing members and beds to ensure the system is not overwhelmed, she said.

Prof Mlisana said that this was down to a lack of preparation by the government, despite warnings from the advisory committees. 

Source: BusinessTech