​The Covid-19 pandemic has been a stern reminder of the serious need to address the underlying vulnerabilities within South African society that are responsible for an inequitable distribution of diseases.

This was the view put forward by Professor Hassan Mahomed, a public health specialist working in the Western Cape Government, who is also affiliated with the Department of Global Health at Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS).

Speaking at the FMHS's recent Annual Academic Day in a session entitled: The Western Cape Covid-19 outbreak – a reflection on the public health response, Mahomed said there is a clear duty to address the vulnerabilities of South Africa's poorest communities.

The areas that were worst affected by Covid-19 in South Africa were the same areas that were worst affected by TB, HIV, diarrhoea, pneumonia and other infectious diseases – as well as by non-communicable diseases and violence, Mahomed continued.

This, he said, is a powerful reminder of the fact that certain poorer communities in South Africa are vulnerable and that whatever health issue comes along, they will be worst affected.

Mahomed, who played a key role in co-ordinating the province's response to Covid-19, said the strong focus on Covid-19 in South Africa had led to a neglect of other normal health services.

"This includes our immunisation services, our management of TB and HIV clients and our management of mothers and children. These need to be brought back. Of course, we must be cognisant of how they are done in the context of Covid-19 and limit the risks of gatherings and crowds.

"We need to think differently in how we run these services. But they should not be neglected."

Mahomed stressed that there are many lessons to learn from the pandemic, including the need to address the fundamental societal inequities which underlie the way the outbreak spread, particularly in South Africa.

Mahomed gave a background of the origins of the pandemic both globally and in South Africa, saying that Africa had lagged behind in numbers compared to other countries globally – but that the epidemic is still in progress and the numbers might still change.

While South Africa has the unfortunate distinction of having the fifth highest number of cases globally, he said all the provinces are now on a downward trend which is a positive development "but these are trends that we have to watch very carefully".

Reflecting on why the Western Cape peaked in terms of case numbers before other provinces, he said this was, more than likely due to a higher initial "dose" of the virus or "multiple seedings" due to the higher tourism traffic from Europe and the USA to the Western Cape.

The Western Cape saw more than 100 000 cases since the first case detected here on March 11, and had at least 15 000 hospitalisations and 3 573 deaths by 16 August.

"Tourism data shows that the Western Cape gets much higher tourism from Europe and USA where they had much larger epidemics in that early period.

"In addition, there were multiple super-spreader events where there were large gatherings, such as weddings, funerals and music festivals, where a number of cases were detected, including international visitors, which infected large numbers of people. Also we had a number of cluster outbreaks … which contributed to the huge number of cases we have seen."

Better reporting and better testing in the Western Cape might also have contributed to the higher numbers registered in the province.

Mahomed highlighted the "massive willingness" which had emerged during the pandemic by a whole range of organisations and individuals willing to support containment and mitigation efforts without specific additional remuneration.

"This is something we can be proud of … and is a resource potential we can draw on in future."

He said while Covid-19 has had a major negative impact globally, nationally and provincially on South African society, the pandemic had also revealed many "positives" in terms of solidarity and technological advancements.

"This will not be the last global pandemic and we are not out of the woods yet, but we can be better prepared as we move forward."