COVID-19 and our crowning glory

Abstract

The inaugural issue of The South African General Practitioner (SAGP) is published in an unprecedented time of uncertainty, fear and a 21-day nationwide lockdown. The country is rallying to limit the spread of the spiky, single stranded RNA, severe acute respiratory syndrome coronavirus, SARS-CoV-2. It is hoped that isolation, quarantine, social and physical distancing as well as stringent hygiene measures will flatten the curve to decrease the potentially overwhelming burden of coronavirus disease (COVID-19),1 a burden that our country can ill-afford. Global figures of this closely watched pandemic that are being recorded in real time on various interactive web based casetracker maps, reveal that there are 1.4 million confirmed cases of this infectious disease to date, a figure that is on the rise. Approximately 20% have a severe (15%) or critical (5%) illness, characterised by pneumonia with biochemical evidence of an exaggerated immune response,2 and acute respiratory distress. Treatment is supportive. There is no vaccine (yet),3 and no proven pharmacotherapy for COVID-19, although some drugs, notably intravenous remdesivir, chloroquine or hydroxychloroquine, and the protease inhibitor combination, lopinavir/ritonavir, with or without beta interferon, are being repurposed and assessed in he WHO’s global SOLIDARITY clinical trial.4 Convalescent plasma is also being tested. The majority of patients appear to seroconvert within 2–3 weeks of illness onset, and are theoretically able to donate a rich source of IgM and IgG antibodies to the seriously ill.