Research in the times of COVID-19: Moherndran Archary

The first case of COVID-19 in South Africa was diagnosed in a traveller from Europe to South Africa on the 5th of March 2020. The initial imported infections fuelled the first wave of the pandemic 3 months later, while further mutations of the circulating wild- type virus fuelled the more severe second wave 7 months thereafter. The South African government responded by implementing, several mitigating strategies including lockdowns, social distancing, use of face masks in public and school closures to slow and control community transmission. These control measures had variable success in controlling transmission but also exposed the social disparities in South Africa, with the most vulnerable members of society being heavily affected by the impact on the economy and disruptions to healthcare, education and employment opportunities.

In KwaZulu-Natal, where almost half the population is below the age of 19 years, acute COVID-19 infection in children and adolescents have thankfully been largely asymptomatic or mildly symptomatic. The major impact of COVID-19 in children has been the disruption of health services (especially in prevention of mother-to-child transmission of HIV, immunization and growth monitoring) and the impact of economic hardships on food security, health seeking behaviour and education of children.

As an infectious diseases unit based at King Edward VIII Hospital, which is a university referral hospital, much of our initial activity centred around the public health response (including contact tracing, isolation and management of patients with COVID-19), Infection Prevention and Control (IPC) activities and preparing health facilities for screening, testing and cohorting of inpatients. A large component of our initial activities focused on the development of a national guideline for the management of COVID-19, getting back to school and risk mitigating strategies. As the pandemic progressed, we shifted our attention to the management of children with COVID-19 and Multi-Inflammatory Syndrome in Children (MIS-C).

Conducting research during the COVID-19 pandemic has been challenging, requiring innovative strategies to maintain the safety of both study participants and research staff. This was of extreme importance as many of our studies included children on antiretroviral treatment and needed an ongoing supply of these essential medications. Implementation of risk mitigating strategies at a site level, remote visits and delivery of medications to participants home had allowed us to continue research activities even during the peak of the pandemic.

COVID-19 has been extremely challenging, equitable access to effective COVID-19 vaccines in low-middle income countries remains a major threat to global health and needs urgent action. Our health sector, being poorly resourced, struggled to deal with the ever changing demands of the pandemic and responding to challenges required learning lessons quickly and adapting fast. Fortunately, having access to the expertise and community of infectious diseases specialists within Penta was extremely helpful as we and the rest of the world were learning about this new disease.