It is now almost 7 months since the first case of COVID-19 was diagnosed in South Africa. The pandemic has caused enormous damage to our economy, job security and health outcomes. To date South Africa has recorded in excess of 700,000 infections and over 18,000 deaths. Despite the many concerns that our health systems would not cope with the pandemic, our health infrastructure has coped remarkably. The coordinated response to the pandemic by health administrators and health-care workers both in the public and private health sectors has quelled the initial criticisms of our preparedness. As South Africans we have risen to the challenge and I believe we will continue the great strides made in managing the health-related issues of the pandemic. Where I practice, biweekly online meetings were held between the administrators and physicians to address the many challenges we faced during the height of the pandemic. I’m convinced that a similar process was in effect in most health facilities across the country.
We have certainly learnt how to manage the COVID-19 infected patients better in hospitals. In Gauteng, based on managing severe respiratory infections in the past, steroid therapy formed the basis of treatment from the onset of the pandemic. The RECOVERY trial confirmed that this practice was the correct one.(1) We have learnt how to manage the oxygen requirements of patients hospitalized with COVID-19. Whether our treatment protocols from the beginning of the pandemic contributed to the lower death rates as compared to many countries is up for debate but my belief is that it played a role.
Wits J Clin Med continues to focus on publication of many health-related aspects of COVID-19 in Africa. In this issue of the journal, Boima and Adu present a narrative on how the pandemic has presented in various regions in Africa as well as Africa's preparedness to counter the pandemic. Diana and co-workers present the largest series to date in South Africa of COVID-19 patients in Johannesburg and Cape Town and highlight the problem of acute kidney injury (AKI) in patients admitted to hospital. They present interesting insights into the prevalence of AKI and COVID-19 and its effect on outcome. Mohamed et al. present the first data in South Africa of the effect of diabetes and hyperglycaemia in hospitalised patients with COVID-19. Based on initial studies from China, diabetes mellitus has been thought to be a risk factor for not only developing COVID-19 but that it has also been associated with worse outcomes. While there is debate as to the risk of developing COVID-19 infection in diabetics, Mohammed et al. clearly highlight the problem of hyperglycaemia in hospitalized patients with COVID-19 and its relation to adverse outcome.
There have been a plethora of manuscripts detailing the cardiovascular (CVS) effects of COVID-19 infection. McCutcheon et al. present an elegant state of the art review of the myriad of cardiovascular presentations and outcomes in COVID-19 infected patients and present strategies on how to manage adverse CVS events in these patients.
COVID-19 pandemic has had a profound effect on education. Although education at school level has been severely impacted, medical education has also borne the brunt of the pandemic. The editorial team has thus decided to host an education forum. In this issue of the journal, authors within the university discuss the impact of COVID-19 on tertiary education and provide their vision of the future of tertiary and medical education. A survey of South African medical students’ perspectives on clinical training during the pandemic is also highlighted in this issue.
The editorial team has also decided to introduce a human touch to the COVID-19 experience, and this issue features reflections of individuals regarding their experiences with the COVID-19 pandemic. Furthermore, we have decided to introduce a commentary section in this issue of Wits J Clin Med, and physicians around the country who have been in the front line of managing COVID-19 patients detail brief insights into what they have learnt about the presentation, science, management and experiences around the COVID-19 pandemic.
I thank the editorial team and Wits University Press for publishing this unique issue with original research as well as introducing many of its new features.
Pravin Manga
Editor-in-Chief
Wits Journal of Clinical Medicine
University of Witwatersrand