COVID-19 research

Title
Rapid reviews of the effects of cloth and medical masks for preventing transmission of SARS-CoV-2 in community and household settings

PIs: Nandi Siegfried, Terusha Chetty and Vundli Ramokolo

Overview
There are now more than 14 million confirmed COVID-19 cases globally. South Africa currently has the highest number of cases on the African continent, which recently passed 350 000 cases and is rapidly rising. Although the transmission dynamics of this virus are still under study, current evidence suggests that SARS-CoV-2 virus is spread from person-to-person predominantly through respiratory droplets and contact with contaminated surfaces. Transmission risk may be mitigated through non-therapeutic interventions, including personal protective equipment (PPE) such as face masks. The pandemic has led to global PPE shortages, including masks and respirators, which are critical to protecting both the healthcare workers and patients in healthcare settings. Masks have also been widely promoted for preventing transmission in community settings. This is particularly relevant for SARS-CoV-2 since pre-symptomatic transmission may be important.

Global guidance on the use of masks varies. At the time of the current review in early April 2020, guidance on the use of cloth and medical masks in the South African general population and households (community settings) was urgently needed to enable decision-makers to ensure evidence-informed policies about preventing community transmission without depleting essential PPE stocks for health care workers.  Since that time, face-coverings have been mandated for use in public, however, the need for a strong evidence base for population prevention measures remains.

We conducted two rapid reviews of the evidence to quantify the effectiveness of cloth and medical masks in reducing the risk SARS-CoV-2 in community settings to inform evidence-based recommendations produced by the College of Public Health Medicine of South Africa. Our review showed that there were no studies of cloth masks in community settings. An RCT in a hospital setting provided indirect evidence that cloth masks increased viral infection risk compared to medical masks. Review of medical masks versus no masks provided low certainty evidence of infection risk reduction.  Given that direct supportive evidence for the efficacy and effectiveness of cloth and medical masks is lacking, we argue that decisions about their use may be based on consideration of other factors such as feasibility, absence of harms and transmission factors for SARS-CoV-2.  Well-designed comparative effectiveness studies between different types of mask are required to better inform policy for community settings and future pandemic preparedness. Furthermore, given that aerosolized SARS-CoV-2 can remain stable in the air for several hours, further research is required on the effectiveness of masks in protecting the wearer from acquiring the virus.

Aims
This study aims to assess the effects of cloth and medical masks for preventing SARS-CoV-2 transmission in community settings.

Collaboration
Cochrane South Africa, College of Public Health Medicine South Africa

Project status
The review has been completed, a report compiled for the College of Public Health Medicine South Africa and a manuscript submitted to S Afr Med J for consideration. The two products can be found here.  

• Should cloth masks be used by the general public for preventing transmission of SARS-CoV-2?
• Should medical masks be used by the general public for preventing transmission of SARS-CoV-2?

Contact person
Dr. Terusha Chetty (terusha.chetty@mrc.ac.za) and Dr. Vundli Ramokolo (vundli.ramokolo@mrc.ac.za)

Title
A rapid review of the effectiveness of screening practices at airports, borders and ports to reduce the transmission of respiratory infectious diseases such as COVID-19

PIs: Dr Terusha Chetty, Dr. Brodie Daniels, Dr. Nobubelo Ngandu, Prof Ameena Goga

Overview
There are now more than 14 million confirmed COVID-19 cases globally. South Africa currently has the highest number of cases on the African continent, which recently passed 350 000 cases and is rapidly rising. Airport screening, with subsequent isolation of suspected cases and quarantine of their contacts, is often implemented to delay or prevent the entry of infected persons to a country/area, thus limiting global spread. Whilst such screening looks politically correct, reassuring, and may deter sick infectious individuals from travelling, it is exceedingly rare for screeners to detect infected passengers. There is concern that even if an occasional case is detected this has almost no impact on the course of an epidemic. Most available publications included modelling data and entry screening measures at airports. Little evidence is available about the implementation and effectiveness of entry and exit screening measure at ports and ground crossings. While the studies included in this rapid review found insufficient evidence to support entry and exit screening measures at points of entry, the included studies reported that over half of the infected cases may be detected at the point of entry.  The effect of partially blocking imported cases could be considered in the South African context with its high HIV and TB prevalence and limited resources to deal with a pandemic of this nature. However, it is unlikely that airport screening will affect the course of an epidemic if local transmission has already taken root. As COVID-19 is a novel emerging infectious disease, more data is required to fully evaluate this question. 

These results were submitted as a report to the South African Ministry of Health to inform health policy-makers of the evidence regarding travel screening and effectiveness of this intervention.

Aims
The study aim was to conduct a rapid review on entry and exit screening for travellers at airports, borders and ports to reduce transmission of infectious diseases, in particular COVID-19.

Collaboration
N/A

Project status
The review has been completed, a report compiled for the Ministry of Health and a manuscript submitted to S Afr Med J for consideration. The review can be found here.

• A rapid review of the effectiveness of screening practices at airports, borders and ports to reduce the transmission of infectious diseases

Contact person
Dr Terusha Chetty (terusha.chetty@mrc.ac.za)

Title
Is dilute sodium hypochlorite (bleach) solution for hand-washing safe and effective for reducing transmission of SARS-CoV-2 compared to alcohol hand sanitizer or soap and water hand-washing?

PIs: Nandi Siegfried, Jim Te Water Naude; SAMRC Cochrane South Africa: Joy Oliver; SAMRC Health Systems Research Unit: Witness Chirinda.

Overview

COVID-19 is caused by the transmission from person to person of the enveloped RNA virus, SARS-CoV-2, either via respiratory droplet spread or via contaminated surfaces.  UNICEF states that the virus envelope (covering) can be disrupted through regularly and thoroughly cleaning your hands by washing them with soap or water or using an alcohol-based hand rub. Dilute sodium hypochlorite at a concentration of 1:1000ppm (0.1%) is recommended by the National Institute of Communicable Disease as an effective disinfectant to wipe (not spray) surfaces to decontaminate where virus may be present. A more dilute solution (usually 0.05%) has been used for hand-washing in the context of other viral epidemic contexts such as for Ebola Virus (Wolfe et al 2017). A 2014 WHO rapid advice guideline, based on a systematic review, recommended that bleach/chlorine solutions currently in use for hand hygiene and glove disinfection for filoviruses (such as Ebola) may be used in the interim period in emergency situations until alcohol-based handrubs or soap and water become available. This was noted to be based on low quality evidence and was intended to be an interim measure. Current World Health Organization interim guidance (1^st April 2020) - specifically for prevention of transmission of SARS-CoV-2 - recommends against chlorine hand washing solutions because of potential harm to users and those making the solutions, as well as degradation of chlorine exposed to sunlight or heat. The guidance recommends handwashing with soap and water a hand rubbing with an alcohol-based hand rub and notes that soap is generally cheap and easy to find, and liquid soap solutions can also be used.

In South Africa, NICD guidelines stipulate that the percentage of alcohol in a sanitizer should not be less than 70% alcohol. Where water is in short supply, such as in rural schools, the use of alcohol sanitizers are advised as a substitute to soap and water hand-washing. The high cost of alcohol sanitizers has raised concerns about the longer-term sustainability of the use of these. Some communities have expressed concerns regarding the use of alcohol based on religious or cultural grounds. UNICEF notes that while alcohol-based hand sanitizer kills the coronavirus, it does not kill all kinds of bacteria and viruses, such as the norovirus and rotavirus. This rapid review aimed to evaluate the use of dilute bleach solution for hand-washing as an alternative to handwashing with soap and water and rubbing with alcohol sanitizer.

Objectives

To assess the safety and effectiveness of sodium chlorite solution for handwashing compared to handwashing with soap and water or alcohol-based sanitiser for preventing transmission of SARS-CoV-2 to inform College of Public Health Medicine guidance.

Methods

We conducted a rapid review of the evidence. We formulated the research question using the PICO format:

Population: Any human populations             

Intervention: Handwashing with dilute sodium chlorite solution

Comparators: Handwashing with soap and water or alcohol-based sanitizer (at least 60% alcohol)

Outcomes:
Skin and respiratory irritation and conditions
Viral decontamination

Study designs: Systematic Reviews
Randomized Controlled Trials (RCTs)

Collaboration
Cochrane South Africa, College of Public Health Medicine South Africa

SAMRC Health Systems Research Unit

Project status
The review has been completed and the report is available.

• Brief Report of Rapid Reiew: Is dilute sodium hypochlorite (bleach) solution for handwashing safe and effective for reducing transmission of SARS-CoV-2 compared to alcohol hand sanitizer or soap and water handwashing?

Contact person

Dr Nandi Siegfried (nandi.siegfried@gmail.com)

Dr. Witness Chirinda (witchirinda@gmail.com)

Title
Understanding SARS-CoV-2 (COVID-19)

Author: Dr Nobubelo Ngandu

A rapid literature review was conducted in March 2020 to give an early overview of SARS-CoV-2, its origins, phylogenetics, epidemiology, immune response and examples of early therapeutics and vaccine research. The overview was presented within the Health Systems Research Unit and the HIV Prevention Research Unit. The link to the slides can be found here.

• Understanding SARS-CoV-2 (COVID-19)

Contact person: Nobubelo.Ngandu@mrc.ac.za

Title:
What is the evidence for transmission of COVID-19 by children in schools? Living systematic review.

PI: Professor Evropi Theodoratou. University of Edinburgh

Co-investigators: Dr Nandi Siegfried, Dr Catherine Mathews

Overview
COVID-19 is the disease caused by SARS-CoV-2, a novel coronavirus, which is spread primarily by respiratory droplets. COVID-19 was declared a pandemic by the World Health Organization in March 2020. Although most individuals do not require hospitalisation for the disease, approximately 20% will have severe disease, and 5% will require hospitalisation of which a proportion thought to be < 1% overall will die. Children usually have a mild disease and many are asymptomatic. At the outset of the epidemic, schools were closed in many countries as schools were considered high-transmission environments. New data suggests that children do not transmit the virus as much as adults and schools may not be high-transmission environments.

Overall aim
We will review studies to answer the following questions:

• What is the evidence for transmission of SARS-CoV-2 by children in schools?
• Do children transmit SARS-CoV-2 in the school environment?
• What is the rate of transmission of SARS-CoV-2 in the school environment from children to other children and from children to adults?

The studies that will be included are tracing studies, viral Genotyping studies, modelling studies, sero-surveillance studies, and community prevalence studies before and after schools opening (controlled before after study)

Collaboration
University of Edinburgh

Project status
Review is ongoing.

Contact person
Dr. Catherine Mathews (catherine.mathews@mrc.ac.za); Dr Nandi Siegfried (nandi.siegfried@mrc.ac.za)

Title
Prevalence, clinical characteristics, immunologic responses and outcomes of children with suspected or confirmed COVID-19 disease

PIs:

• Ameena Goga, South African Medical Research Council and Department of Paediatrics and Paediatric Pulmonology Steve Biko Hospital and University of Pretoria
• Robin Green, Department of Paediatrics and Head of Paediatric Pulmonology Steve Biko Hospital; Head of Clinical Medicine University of Pretoria
• Jeane Cloete, Paediatric Infectious diseases, Steve Biko Hospital and University of Pretoria

Overview: To describe the epidemiology, clinical progression, immunologic responses and outcome of pediatric Covid-19 disease amongst paediatric patients with respiratory disease admitted to Steve Biko Academic and Tshwane District hospital in South Africa

Methods:

• A retrospective review of all patients tested for COVID 19 at Steve Biko Academic Hospital and Tshwane District Hospital will be conducted between 16th March 2020 until Ethics approval
• A prospective cohort study will be conducted once ethics approval has been obtained and systems are set up at hospitals to gather the data.

Outcome:

The Clinical course, immunological responses and outcomes of COVID 19 will be described as the characteristics of children with COVID-19 disease has not yet been described in African settings

Intended Feedback of the study:

Results will be published in peer reviewed journals, and reported to paediatric and public health communities in South Africa and internationally

Project status: Recruitment in progress

Contact person: Ameena Goga: Ameena.Goga@mrc.ac.za
 

Title
Yomelela Community Phone Survey

PIs: Dr Catherine Mathews; Prof Seth Kalichman

Overview
The Yomelela Study is a three-armed RCT that will test a theory-based mobile-phone delivered counselling intervention designed to address HIV-stigma concerns in order to improve HIV treatment retention and adherence in South Africa.  The Yomelela Community Phone Survey is being conducted during the RCT preparation phase.  

Overall aim
The aim is to investigate the impact of the COVID-19 epidemic and lockdown on mental health and wellbeing, COVID-related stigma, and access to HIV and TB treatment among people living with HIV or TB in Gugulethu and surrounding suburbs.  We will recruit potential participants through invitations on flyers distributed in the one Cape Town clinic waiting area and by clinic staff members, as well as through other community organisations providing HIV and TB health services, We will enrol 400 men and women in the phone survey. 

Collaboration
University of Connecticut

Project status
Data collection will start in August 2020.

Contact person
Dr. Catherine Mathews (catherine.mathews@mrc.ac.za); Ms Ellen Banas (ellen.banas@mrc.ac.za)

Title
PHANGISA COVID Study: Evaluating the effect of COVID-19 pandemic on HIV clinical health and uptake of routine HIV care and immunizations among PMTCT clients in a rural district.

PI: Dr Nobubelo Ngandu

Overview

The PHANGISA study was initiated in 2019, to measure risk factors for HIV transmission from mother to child in a rural district, Ehlanzeni district in Mpumalanga province.  The 2019 baseline cross-sectional study enrolled 687 HIV-positive pregnant women and HIV-positive postnatal mothers paired with their babies aged 0-24 months.  Data analyses is currently underway. In addition to high unemployment and poverty rates and undisclosed sexual partner’s HIV status, early findings indicate challenges in routine management of antiretroviral treatment to keep maternal viral load suppressed. Understanding how the needed uptake of healthcare visits to monitor HIV health and the health of the HIV-exposed child in this high-risk population with existing socio-economic challenges, is being affected by the COVID-19 pandemic and the lockdown restrictions, is important.

Aims

We aim to ask the over-arching question: “Has the COVID-19 pandemic and national lockdown resulted in increased poor HIV clinical outcomes and lower uptake of routine HIV care and childhood immunizations amongst HIV-positive postnatal mothers and their infants in a rural South African district?”

Methods

A before-and-after study design will be conducted. HIV-positive women and their babies, who took part in the baseline PHANGISA study in Ehlanzeni district during September to December 2019 will be invited to participate in this study. Quantitative data collection will be done using (i) telephonic interviews and (ii) data extraction of routine viral load testing and HIV testing episodes of study participants from the routine national health information systems. Measurement of outcomes post-COVID-19 lockdown will be compared to baseline and pre-COVID-19 lockdown outcomes.

Collaboration

National Institute of Communicable diseases, Stellenbosch University

Funded by: National Department of Health

Project status

Approved by SAMRC ethics in July 2020. Data collection will begin in September 2020.

Contact person

Dr Nobubelo Ngandu: Nobubelo.Ngandu@mrc.ac.za

Title
Exploring the experiences of CSG recipients and non-recipients regarding coping, access to social protection, food security, income security, and safety in the time of Covid-19

PI: Dr Wanga Zembe-Mkabile, Dr Vundli Ramokolo, Prof Tanya Doherty

Overview
The advent of the Covid-19 pandemic in South Africa and across the globe, with associated national lockdowns, poses special challenges and implications for household food security, and child health and wellbeing among poor households. It is important to assess how Child Support Grant-eligible but non-recipient, and recipient households are experiencing and coping with the threat of Covid-19 and the accompanying restrictions on movement, as well as potential loss and or reduction of income.

Study Aim

To explore the experiences of Covid-19 among recipients and non-recipients of the CSG in Langa Township, Western Cape

For this qualitative study we are conducting twenty  telephonic qualitative interviews over two time points with participants (mother-child pairs) that we have been following up for two years in a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security. For this additional piece of research we are exploring  participants’ experiences of accessing social grants in the time of Covid-19; their experiences of securing food for their children and households, experiences of restrictions to movement, loss of earnings due to not working and social distancing while living in informal settlements and or small housing structures with small or no yard space; experiences with safety; perspectives and concerns they might have for themselves and their children and families at this time; and what they see as the role of social grants and the CSG in particular in providing support to impoverished and vulnerable households and communities in the time of Covid-19.

The study will provide learnings and lessons on how poor households reliant on small social grants cope during pandemics such as Covid-19 and the ways in which the social security system in South Africa can better respond to and support children and families from poor households.

Collaboration
SAMRC

Project status
Qualitative interviews are in progress. As part of this study we have published an Op-Ed in the Daily Maverick which communicates emerging results and the implications thereof for policy and practice. Link to the article: https://www.dailymaverick.co.za/article/2020-05-26-covid-19-and-social-grants-relief-measures-welcome-but-not-enough/#gsc.tab=0

Contact person
Dr. Wanga Zembe-Mkabile: wanga.zembe@mrc.ac.za

Title
Opportunities from a new disease for an old threat: extending COVID-19 efforts to address Tuberculosis in South Africa

PI: Dr. Marian Loveday

Overview

The COVID-19 pandemic and phased nationwide lockdown have impacted negatively on routine TB services, as activities to address this new pandemic have been prioritised across all sectors. Within the health system, the health workforce and resources have been redirected away from routine services towards the new disease priority. The lockdown has resulted in additional barriers to accessing TB care with early reports of a decline in TB diagnostic tests. Fewer TB diagnoses; less attention to adherence and support during TB treatment; poorer treatment outcomes; and consequent increased transmission, will increase the TB burden and TB-related mortality. People with TB or a history of TB are likely to be vulnerable to COVID-19.

Aims

Through a literature review and the perspective of members of a national TB Think Tank task team we aim to:

• Describe the impact of the pandemic and lockdown on TB patients and services as well as the potential long-term setback to TB control in South Africa.
• Explore strategies to mitigate risk and impact together with opportunities to leverage synergies from both diseases to the benefit of the National TB Programme.
• Suggest modifications to current treatment practices to reduce visits of patients with TB and RR-TB to health facilities to minimize the risks of COVID-19 exposure.

Collaboration

The South African TB Think Tank “Optimising Treatment Outcomes” task team

Contact person
Marian Loveday: marian.loveday@mrc.ac.za

Title
Patient experiences of the burden of TB in the context of syndemic interaction and social protection, before and during the COVID-19 crisis

PI: Lieve Vanleeuw & Dr Wanga Zembe

Overview

Amid the COVID-19 crisis TB patients face increased vulnerability due to the consequences of the COVID-19 response such as loss of income, challenges to access healthcare services and anti-TB medication, increased stigma, and a loss of social support structures. Many of them are already poor, and many depend on informal work or have lost their jobs. The COVID-19 social and economic response in South Africa, however, might also offer some alleviation to TB patients’ burden by accessing the Covid-19 Social Relief of Distress Grant (SRDG) designed for unemployed working age adults who are destitute because of the virus. Our study will explore how the COVID-19 epidemic and response have affected the social, economic, and health situation of TB patients, as well as how COVID-19 measures to alleviate the social and economic effects of the COVID-19 epidemic and response such as the Social Relief of Distress Grant have affected TB patients’ vulnerability.

Aims

1. Explore how the COVID-19 epidemic and response, such as the lockdown measures, have affected the health, social and economic burden of TB patients in Cape Town, South Africa.
2. Explore how COVID-19 measures to alleviate the social and economic effects of the COVID-19 epidemic and response such as the Social Relief of Distress Grant have affected TB patients’ vulnerability.
3. Explore perceptions of healthcare workers working with TB patients of two primary healthcare clinics in Cape Town on how the COVID-19 crisis has affected TB patients in Cape Town, South Africa.
4. Explore perceptions of SASSA officials on the Social Relief of Distress grant and other forms of assistance for TB patients in Cape Town, South Africa.

Collaboration

Tampere University Finland

Tampere TB Foundation Finland

Project status

Protocol under review by SAMRC Ethics Committee

Contact person

Lieve Vanleeuw: Lieve.vanLeeuw@mrc.ac.za

Title
Exploring the impact of COVID-19 on healthcare service utilization for patients with communicable and non-communicable diseases in eThekwini Metro, South Africa: A qualitative study

PI: Dr. Marian Loveday

Overview:

The COVID-19 pandemic and phased nationwide lockdown have impacted negatively on routine services for communicable diseases (CDs) and non- communicable diseases (NCDs).  Not only has the health workforce and resources been redirected away from routine services towards the new disease priority, but the lockdown increased barriers to accessing routine primary health care, and there are early reports of declines in the pick-up of chronic medication, fewer immunisations and fewer TB diagnostic tests.

Aim:

The study has four specific objectives:

• To explore health care provider perceptions and experiences of the COVID-19 pandemic and the health service prioritization of COVID-19 activities.
• To explore the perceptions and experiences of non-governmental organisations (NGOs) of the COVID-19 pandemic and the health service prioritization of COVID-19 activities
• To explore the understanding of COVID-19 among people living with CDs and NCDs.
• To explore the impact of the COVID-19 pandemic on healthcare access among people living with CDs and NCDs.

Collaboration:

KwaZulu-Natal Department of Health, Interactive Research and Development (IRD) and Advance Access and Delivery (AA&D)

Title
An evaluation of the Mphatlalatsane Initiative

PI: Prof. Ameena Goga, Dr Terusha Chetty and Prof. Helen Schneider

Overview

The National Department of Health (NDoH) is implementing an integrated sexual, reproductive, maternal and newborn health (SRMNH) initiative to improve sexual, reproductive, maternal and neonatal health outcomes in South Africa.  This initiative called “Mphatlalatsane” (meaning “the last star before the dawn”) seeks to reduce unplanned pregnancies, maternal and neonatal mortality, and stillbirths, by testing a potentially replicable quality improvement (QI) model for national scale-up through government adoption and funding. The Mphatlalatsane Initiative embraces QI interventions to make small facility-based changes that the system can absorb and sustain if they work.  The SAMRC, in partnership with the SAMRC Health Services to Systems Research Unit, School of Public Health, University of the Western Cape, is responsible for evaluating the impact and implementation processes of the Mphatlalatsane Initiative in the QI-intensive sites. The evaluation will only focus on the maternal and newborn components.

On 30 January 2020, the World Health Organization (WHO) declared COVID-19 a public health emergency of international concern (PHEIC).  As of 22 July 2020, more than 15 million confirmed cases across 118 countries and over 617 000 deaths have been reported; South Africa reported over 382 000 confirmed COVID-19 cases with 5 173 deaths.

In March 2020, the South African government declared a state of disaster and implemented several measures to prevent the spread of the disease, restricting face-to-face interactions and allowing only essential activities.  The effect that COVID-19 has had/will have on the uptake, continuity and quality of maternal and neonatal healthcare services is still uncertain; much depends on whether South Africa’s efforts to prevent further spread of the virus are effective. Generating research evidence on the impact of COVID-19 on SRMNH services is of utmost importance as it will inform policies and practises on how to mitigate some of that impact. The evaluation of Mphatlalatsane offers an ideal opportunity to add specific COVID-19 research questions.

Aims
The overall evaluation aim is to determine whether a system-level, complex, patient-centred QI intervention reduces institutional maternal mortality ratio, stillbirth rate and neonatal mortality rate by 50% in five years.

The study objectives are as follows:

• To assess the effect of the COVID-19 pandemic on the service utilization and quality of routine non-COVID-19-related SRMNH services in the public sector;
• To assess the effect of the COVID-19 pandemic on the Mphatlalatsane Initiative intervention delivery;
• To assess the contextual and implementation process factors that shape the effectiveness of the Mphatlalatsane Initiative, which will include a specific focus on how COVID-19 affects the delivery of SRMNH services, and health workers’ and managers’, who respectively deliver and manage these services, experiences and perceptions of COVID-19.

Collaboration
The NDoH, in collaboration with the South African Medical Research Council, Clinton Health Access Initiative (CHAI), the SAMRC-University of Pretoria Maternal and Infant Health Strategies Unit (SAMRC-UP), the University of Limpopo Trust-Limpopo Initiative for New-born Care, and the University of Western Cape.

Project status
The study is funded by ELMA Philanthropies. We received ethical approval from the University of the Western Cape to commence with assessing contextual and implementation processes and has produced a report on the first round of interviews we conducted with the collaboration partners. A revised proposal (necessitated by COVID-19 restrictions) is currently under Scientific Review and will be submitted to the SAMRC Ethics Committee at the next sitting.

Contact person
Dr Terusha Chetty (terusha.chetty@mrc.ac.za)

Title
COVID-19: Cost effectiveness of purchasing critical care beds from the private sector

PI:  MOSAIC 

Mosaic Members

Donela Besada, Susan Cleary, Emmanuelle Daviaud, Sumaiyah Docrat, Geetesh Solanki, Cynthia Tamandjou Tchuem, Tommy Wilkinson

Aim

The objective of this study was to examine the cost-effectiveness of purchasing critical bed capacity from the private sector during the COVID-19 pandemic.

Methods

The cost effectiveness assessment model which makes use of simple state transition modelling framework with a single cycle was built to carry out analysis.

Collaboration:  University of Cape Town

Project status: Project completed.

Publications:

Open Source Model: *Cleary, Susan; Wilkinson, Tommy; Tamandjou Tchuem, Cynthia; Docrat, Sumaiyah; Besada, Donela; Daviaud, Emmanuelle; et al. (2020): MOSAIC: A model to assess the cost-effectiveness of ICU strategies for the South African COVID-19 response. University of Cape Town. Dataset. https://doi.org/10.25375/uct.12382706

Op Ed: Covid-19 surge: Investing heavily in ICU capacity is not the only option. https://www.samrc.ac.za/news/covid-19-surge-investing-heavily-icu-capacity-not-only-option

Contact person: Geetesh Solanki(Geetesh.Solanki@mrc.ac.za)

Title
COVID-19: Cost effectiveness of dexamethasone

PI:  MOSAIC 

Mosaic Members

Donela Besada, Susan Cleary, Emmanuelle Daviaud, Sumaiyah Docrat, Geetesh Solanki, Cynthia Tamandjou Tchuem, Tommy Wilkinson

Aim

The objective of this study was to examine the cost-effectiveness of dexamethasone in the treatment of COVID-19 and its impact on the cost effectiveness of ICU care.

Methods

The cost effectiveness assessment model which makes use of simple state transition modelling framework with a single cycle was built to carry out analysis.

Collaboration:  University of Cape Town

Project status: Project completed.

Publication:

Open Source Model: https://doi.org/10.25375/uct.12563381

Op Ed: Wilkinson T, Cleary S. Tchuem CT, Docrat S, Daviaud E, Solanki G. Dexamethasone is not the Covid-19 ‘silver bullet’ we are looking for.  Daily Maverick. 2020-07-9. https://www.dailymaverick.co.za/article/2020-07-09-dexamethasone-is-not-the-covid-19-silver-bullet-we-are-looking-for/#gsc.tab=0

Contact person: Geetesh Solanki(Geetesh.Solanki@mrc.ac.za)

Title
COVID-19: Economic burden of alcohol-related injuries in South Africa

PI:  MOSAIC 

Mosaic Members

Donela Besada, Susan Cleary, Emmanuelle Daviaud, Sumaiyah Docrat, Geetesh Solanki, Cynthia Tamandjou Tchuem, Tommy Wilkinson

Aim

The purpose of the study was to assesses the potential economic burden of alcohol-related trauma events as provides an estimate of potentially foregone opportunities to manage COVID patients

Methods

The number of outpatient visits, general ward inpatient days and ICU days needed per event were modeled to estimate provider costs for each injury and total costs across all injury types

Collaboration:  University of Cape Town, Burden of Alcohol Unit SAMRC

Project status: Project completed.

Publication:

Open Source Model: https://zivahub.uct.ac.za/articles/MOSAIC_A_model_to_assess_the_economic_burden_of_alcohol-related_injuries_in_South_Africa/12645929/1

Contact person: Donela Besada(Donnela.Besada@mrc.ac.za)

PI:  Leonard Gentle

Co-PI:  Geetesh Solanki, Tanya Doherty,

Collaboration:  Various – depending on work.

Aim: The aim of the project is to support the “translation” of the COVID-19 related research within the SAMRC with a view to ensuring that the research is accessible, relevant and meaningful to stakeholders – including government, policy makers, health officials and civil society - so that evidence-based health research may impact on public policy and thereby have virtuous health outcomes.

Methods

1. Facilitated discussion and workshopped presentations with the intra-mural units on the political economy of the pandemic, how it impacts their research, and what research they would like to have “translated”.
2. Work with and develop capacity of the units to translate their research and engage broader public opinion on the research to be carried out and the research being carried out. 3. Forge relations with social movements, NGOs and other civil society organisations. 4.Assist in responding to vested interests which may question the relevance of the SAMRC research.

Collaboration:  Various

Project status: On-going

Publications:  Op Eds

• Geetesh Solanki, Tommy Wilkinson, Cynthia Tamandjou Tchuem, Sumaiyah Docrat and Susan Cleary. Covid-19 surge: Investing heavily in ICU capacity is not the only option. https://www.samrc.ac.za/news/covid-19-surge-investing-heavily-icu-capacity-not-only-option
• Wilkinson T, Cleary S. Tchuem CT, Docrat S, Daviaud E, Solanki G. Dexamethasone is not the Covid-19 ‘silver bullet’ we are looking for.  Daily Maverick. 2020-07-9. https://www.dailymaverick.co.za/article/2020-07-09-dexamethasone-is-not-the-covid-19-silver-bullet-we-are-looking-for/#gsc.tab=0
• Solanki G, Morar R,  Myburgh N, van Zyl J. Urgent need for payment deal on non-medical aid Covid-19 patients in private health facilities. Daily Maverick. 2020-05-18. https://www.dailymaverick.co.za/article/2020-05-18-urgent-need-for-payment-deal-on-non-medical-aid-covid-19-patients-in-private-health-facilities/
• Solanki G, Morar R, Reynolds L, Myburgh N, Gentle L.  Outbreak provides valuable insights needed to implement National Health Insurance. Daily Maverick. 2020-04-06. https://www.dailymaverick.co.za/article/2020-04-06-outbreak-provides-valuable-insights-needed-to-implement-national-health-insurance/
• Solanki G, Morar R, Reynolds L, Myburgh N, Gentle L.  Covid-19: We urgently need a national plan for the looming shortage crisis in critical healthcare. Daily Maverick. 2020-04-01. https://www.dailymaverick.co.za/article/2020-04-01-covid-19-we-urgently-need-a-national-plan-for-the-looming-shortage-crisis-in-critical-healthcare/
• Wanga Zembe-Mkabile, Vundli Ramokolo and Tanya Doherty: COVID-19 and the lived experience of Social Grants: relief measures welcomed but insufficient https://www.dailymaverick.co.za/article/2020-05-26-covid-19-and-social-grants-relief-measures-welcome-but-not-enough/#gsc.tab=0
• Leonard Gentle: Covid 19: Health Scientists caught between a rock and a hard place as government abandons the poor majority. https://www.dailymaverick.co.za/opinionista/2020-06-24-covid-19-health-scientists-caught-between-a-rock-and-a-hard-place-as-government-abandons-the-poor-majority/#gsc.tab=0

Interviews: Cape Talk; Radio 786 May 2020: N. Myburgh, Leonard Gentle

Contact person: Leonard Gentle: Leonard.Gentle@mrc.ac.za