/ 6 December 2023

Covid and Aids denial: Have we learnt anything?

Mbekihivgettyimages 673376
The government’s Aids policies sparked protests like the one pictured in 2001 in Cape Town. (Per-Anders Pettersson / Getty Images)

The 30th of November was World Aids Day. Since the Aids pandemic, we have had one more devastating pandemic, Covid-19. Have we learnt anything since the disastrous Mbeki years, when Aids denial cost over 300 000 lives?

A key feature of Aids denial was a toxic mix of genuine health-policy concerns and science denial. The genuine concerns fuelled science denial, rather than fuelling rational policy that would deal with those concerns.

Has anything changed?

A big thing that has changed since Thabo Mbeki left office on 24 September 2008 is the rise of social media. While Facebook existed back then, it only had around 100 million users worldwide and the internet was not widely accessible in South Africa, with less than 10% of the population having access. Twitter, the real powerhouse of disinformation, did not exist until 2006. Today, over 70% of the population of South Africa has access to the internet and low-data media such asTwitter have a wide reach.

The toxic mix of genuine issues and science denial is still with us and threatens to be even more harmful. What is in play is not just optimal management of one pandemic but the future management of other pandemics, attacks on vaccines — one of the most effective tools for preventing severe illness and death — and science-based health policy in general.

So let’s unpack the issues.

Covid denial is gaining momentum — as if the deaths and severe illness did not happen. I read a poignant Facebook post recently, which I quote (without naming the author):

“During the spring of 2020 in New York City, I witnessed an innumerable number of people die from Covid-19. Many of these people were previously healthy and many ended up dying anonymously because the volume of incoming patients was too high for us to manage. In fact, the rate of death was so high that we had to line the deceased people in the hallways or place them in corners because we could not transport them to the makeshift morgues quickly enough. These people died alone. 

“Many patients used their last breaths to beg to share their final words with their loved ones. It was heart-breaking to witness this constantly. Our resources were stretched far beyond their limits and we could not honour what was expected from us. We were put into situations I never thought I would have to deal with as a medical professional, particularly in the USA. 

“I had to repeat to myself, ‘This is just a movie. This is not real life,’ so many times in order to cope and carry out my duties. The memories of fear in the eyes of people before they died and the haunting screams of families hearing that their loved ones suddenly passed away are seared into my memory. 

“Death and despair weren’t sporadic throughout this time period, and instead, they were constant. I poured my heart and soul into doing everything I could to deliver the best care that I possibly could give, and it broke my soul knowing that doing everything I could was still not enough. My heart aches for all those lost and how much pain and suffering the pandemic caused.

“I never thought I’d witness such atrocities in my lifetime and was relieved when the infection rate decreased and I could finally process what I had endured. I saw so many bodies. The screaming was haunting. The worst was when a child would answer the phone and they would begin screaming when they found out that their parents had died. It was equally heart breaking informing the parents when their child had died. I felt powerless watching people die in front me, despite doing everything I could to try to save them, and not being able to change the final outcome.

“I was quite stunned afterwards. I had spent months immersed in a hospital filled with death and despair, and had forgotten what life was like outside of the hospital. I did not have time to watch the news, and would only go home to sleep. When I re-emerged into the general public, I wrongly assumed people would be understanding of what our healthcare system underwent. To my dismay, the public had a different agenda. Many people told me Covid-19 was a hoax, they said we were lying that people died from Covid-19 in order to get more money because they died from comorbidities instead, or that it was ‘just the common cold’. Instead of sympathy, our hospital received death threats …”

Covid is not just a cold. It is not flu. It is a dangerous disease that kills and debilitates and is extremely contagious. Fortunately, with the combination of vaccines, community exposure, better treatments and less virulent strains, it is no longer as bad as it was at the start.

But let’s look at one of the earlier tales of denial.

On 28 May 2020, an article titled “To lockdown, or not to lockdown — viewpoint from the number-crunchers” appeared on the BizNews site, not a bastion of journalistic integrity. One of the most-quoted claims by a group of actuaries styling themselves as PANDA is, “…why anybody in their right minds would be talking up a story that involves anything more than 10 000 deaths for South Africa, with or without lockdown”.

A key paragraph in the article goes like this:

“Underscoring the panic, [Peter] Castleden cited an announcement by Imperial College’s Covid-19 response team that their SEIR model (susceptible-exposed-infected-recovered) predicted the UK would suffer 500 000 deaths if stringent control measures were not undertaken. ‘Our conservative maximum had seen the UK at a level not higher than 70 000 and that’s when we realised that many people had missed the boat,’ he says.”

Why does anyone take these people who knew nothing about epidemiology at the start — and know less now — seriously?

Let’s look at actual figures. The UK’s official figure for Covid deaths is over 230 000. This is less than half the figure that Castleden attacked but that estimate was based on inaction. Had the UK taken his advice and done nothing, there is no doubt that the number of deaths would have been considerably higher — and not the 70 000 his group estimated.

South Africa’s official death toll is over 100 000 — 10 times the figure the PANDA group claimed — but far less than excess deaths, a more accurate indicator in South Africa as test access was limited, particularly for the rural poor. Excess deaths show that the true Covid toll should be about three times as many as lab-confirmed deaths.

What is to be done?

Social media has become the battleground of a new form of warfare — information war.

What is desperately needed is research on how best to counter disinformation and blatant falsehood.

But we also need to start addressing a real concern about health — the monetisation of health far beyond what is necessary to cure, provide care and to prevent illness. Suspicions of Big Pharma are not without foundation but that is not a reason to dismiss all science.

Curing cancer, finding vaccines for the most difficult pathogens, such as malaria and HIV and so, on are tough challenges. Solving these problems will not be much use if the solutions are unaffordable to those who need them most — nor will these solutions be of much use unless the information war challenge is also addressed.

The author is an emeritus associate professor at Rhodes University in South Africa and is a long-term civil activist.