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Death, Denial And Fear: What Listeriosis Cost South Africa

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December 25, 2017, was the worst Christmas for the Warmback family.

The festivities began two days before with the arrival of Keith and Glenda Warmback’s children from the US. There was food and celebration as the couple saw their one-year-old granddaughter for the first time.

“That evening, we went out and my wife had a chicken salad [from one of the fast food restaurants]. The following day my wife Glenda started having a tummy ache. She went to lie down for a while. She fell asleep and I woke her up around 5PM and she said she couldn’t get out of bed because she wasn’t feeling well and had a running tummy,” says Keith.

Keith says he was woken up by barking dogs, in their room where Glenda was asleep, at about midnight.

“I went to see what was going on and I found Glenda on the floor. She said she thought she had a stroke,” he recalls.

He bundled her up and rushed her to the nearest private hospital.

“The staff was disastrous… They were disinterested in my wife’s condition and three others who were there with similar symptoms,” says Keith.

According to Keith, it was just the beginning of a series of mistakes. Eventually, Glenda’s lungs collapsed and she died at 2AM on Christmas day. She was 61 years old; they had been married for 41 of those.

“The painful thing is the incompetence at the hospital,” says Keith.

Keith Warmback lost his wife Glenda to Listeriosis on the Christmas day of 2017. Photo by Motlabana Monnakgotla.

Doctors sited natural causes as a cause of death. The problem is, just 20 days before, the health minister had announced a foodborne outbreak called listeriosis. According to Keith, Glenda had all the symptoms and blood tests indicated she had it but she was never treated for it.

READ MORE: The Rat Race Against The silent Killer

At the time of going to press, Glenda was one of 183 South Africans who had died from this disease since January 2017; 978 had been infected. It is the world’s worst outbreak of listeriosis, according to the World Health Organization (WHO).

“Listeriosis is the name of a disease that people develop when they eat food that is contaminated with the bacterium called listeria,” says Dr Juno Thomas, head of the Centre for Enteric Diseases at the National Institute for Communicable Diseases (NICD).

According to Thomas, this bacterium is found worldwide. It can be in soil, water and even faeces in many animals.

“Once in the environment, it is very difficult to get rid of because it attaches to things very easily. Once it attaches itself in an environment, it produces a layer of a sticky sugary slime that sticks onto the surfaces and makes it difficult to remove and resistant to disinfectants,” says Thomas.

According to Health Minister Aaron Motsoaledi, South African hospitals saw and treated an average of 60 to 80 patients affected by listeria between 2013 and 2016 with no problems.

Then, in July last year, doctors started seeing more cases of newborn babies born with listeria.

Keith looks at an image of his wife (right), Glenda Warmback. Photo by Motlabana Monnakgotla.

It was a cause for concern. They informed the NICD. A search, led by Thomas, began. On November 29, they found that at the time, 557 people had been infected.

“A team from the NIDC interviewed 109 patients to obtain details about foods they had eaten in the month before falling ill. Eighty five percent of the people reported eating ready-to-eat (RTE) processed meat products, of which polony was the most common, followed by viennas/sausages and then other ‘cold meats’,” says Motsoaledi.

Sixty percent of cases were reported in Gauteng, 13% in the Western Cape and 7% in KwaZulu-Natal.

“We think it affected Gauteng the most because of consumer behavior. Things like sausages, polony and viennas are staple street and household foods in Gauteng because they are affordable and quick to prepare. The economy of Gauteng also plays a factor. There are many more people who can afford to buy these items than other provinces,” says Thomas.

Even armed with this information, the source of the outbreak remained unknown.

Symptoms of Listeriosis:

  • Fever
  • Diarrhoea
  • Vomiting

“When you have an outbreak like this you have no idea where it comes from. We also had not seen many cases of listeriosis in the country, meaning it wasn’t a big health priority compared to all the other issues we have to deal with. For example, we saw 30,000 cases of malaria last year, rabies is a big concern, TB and many others were more severe,” says Thomas.

With hard work and vigilance, the outbreak was traced from Soweto.

Nine crèche kids under the age of five got ill and were admitted to the Chris Hani Baragwanath Hospital. Tests revealed that they had been infected. A team went to the crèche the very day and found kids had eaten polony manufactured by Enterprise Foods, owned by Tiger Brands.

“We then visited the Enterprise Foods factory in Polokwane that makes this brand. We took over 28 samples and they tested positive for the outbreak strain. The conclusion from this is that the source of the present outbreak can be confirmed to be the Enterprise Food production facility in Polokwane,” she says.

On Sunday March 4, Motsoaledi ordered a safety recall of all products from Tiger Brands.

READ MORE: A Deadly $75-Billion Business

After Motsoaledi’s announcement, Tiger Brands shares fell more than 10% when the market opened on Monday.

“It is devastating for me that our business is linked to this outbreak… we detected low levels of listeria in our products on the 14th of February. We took immediate precautionary measures which included immediately halting production of the affected product, quarantining all affected product within our distribution center and withdrawing all affected products manufactured on that day,” says Tiger Brand CEO Lawrence MacDougall at a press briefing the next day.

MacDougall, however, controversially denied any responsibility for the deaths.

“There is no direct link with the deaths to our products that we are aware of at this point. Nothing… All of our tests and results indicate that we kept a very high standard of quality protocols within those sites. The expectations going forward is that those standards are significantly increased if there is going to be a zero detection of listeria going forward,” he says.

Motsoaledi argues that there is proof the ST6 strain was found at their facilities.

“The fact remains that we have had an outbreak of listeria, we informed them [Tiger Brands], in terms of fair administrative justice, that we got the results and we were going public with them. I don’t think they did enough to make sure their produce is safe for consumption by the public. I believe the best way is for this to be a civil case rather than a government case,” says Motsoaledi.

Renowned corruption buster and private forensic investigator Paul O’Sullivan agrees. He is filing criminal charges against the board of Tiger Brands and has called upon them to step aside pending the outcome of the investigations.

O’Sullivan has teamed up with human rights lawyer Richard Spoor to bring charges.

“What is particularly shocking is that Tiger Brands, in its most recent annual report, placed product quality as number nine on the list of risks facing the company, when it should have been be at number one. We cannot think of a greater risk to the sustainability of any food company, than that of killing off your customers through recklessness or gross negligence. We are 100% certain that it will rank top of the list in next year’s annual report.”

What O’Sullivan finds completely unacceptable is that Tiger Brands is still in denial.

“On the one hand they close and deep-clean all the affected facilities, on the other hand they deny culpability and say they will meet each civil claim on its own merits, thereby indicating they will make it a long-haul for the litigants,” he says.

Gareth Lloyd-Jones, Chief Commercial Officer at hygiene and sanitation service provider Ecowize, however says government is to blame. He argues there should be a surveillance system that protects consumers.

“This type of rigorous investigation has been going on for the past couple of months, which is admirable, relevant and necessary and should have been part of a more robust routine surveillance and monitoring process in terms of food safety and legislation requirements,” he says.

According to retail analyst Syd Vianello, this can tarnish a brand that has spent decades trying to live up to high standards.

“How long is it going to take [Enterprise Foods] to convince consumers that the Enterprise brand is good for purchase again? We are talking about the value of the brand and the protection of the brand equity, insurance won’t even cover you for those kinds of losses. These can carry on for a very long time,” he says.

There is also a rub-off effect.

Ronald Dube, a manager at a supermarket in Johannesburg, says people have been returning all cold meats regardless of brand.

“People are afraid and have been returning all sorts of meat. We have also noted that sales of processed foods have gone down, no matter the brand,” he says.

Many people have also thrown away their cold meats but, according to Dr Johan Schoonraad, waste expert and group tactical specialist at EnviroServ Waste Management, there are only two options for disposing of listeria infected food waste – incineration or treatment and landfill disposal.

“The scale of the problem is too big for the incineration industry to deal with in any sort of reasonable timeframe, which leaves waste management companies with the option to do treatment and disposal to landfill,” he says.

Schoonraad says treatment can take many routes. You could sterilize the food waste, heating it and ensuring the material internally gets to 100 degrees which would kill the bacteria.

“If this was done, we could then landfill it without further treatment being required before disposal,” he says.

The other option is to chemically treat it prior to disposal.

According to Schoonraad, the problem is municipal landfills often have poor access control. The risk here, he says, is that the informal sector could enter and scavenge food material, which is then sold or eaten and could spread the disease.

“However, licensed hazardous waste sites have strict access control with no scavenging allowed at these facilities,” he says.

Nevertheless, South Africa remains in fear of this deadly disease.

Who is mostly at risk:

  • Pregnant women
  • Neonates (first 28 days of life)
  • Very young infants
  • Elderly persons >65 years of age
  • Anyone with a weakened immune system (due to HIV infection, cancer, diabetes, kidney disease, liver disease, people with transplants and those on immunosuppressive therapy such as oral corticosteroids, chemotherapy, or antiTNF therapy for auto-immune disease)

Health

[IN NUMBERS] Coronavirus Update: COVID-19 In Africa

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While most cases of the COVID-19 coronavirus have been reported in the U.S. , Europe, and China, the virus is spreading rapidly across the African continent.

The confirmed worldwide cases for the virus have surpassed 11 million with the current figure being at 11,586,780.

The increase in new reported cases around the world has led the World Health Organization (WHO) to declare the coronavirus a global pandemic.

The death toll continues to rise globally. It is currently at 537,372.

The U.S. leads with 131,485 deaths. Brazil is second with 61,990. The U.K is third with 43,995. Italy is fourth with 34,818, and France is fifth with 29,875.

China, where the virus originated from, maintains that the country’s death toll is at 4,634.

The figure of the global recoveries stands at 6,171,905.

The African continent has 480,518 cases of Covid-19, while the death toll stands at 11,403. The continent has made 230,202 recoveries.

Here are the numbers in Africa:

Country Confirmed Cases Confirmed DeathsConfirmed Recoveries
Algeria14,65792810,342
Angola140661
Benin2707228
Botswana60124
Burkina Faso89453804
Burundi85145
Cameroon12,59231310,100
Cabo Verde (Cape Verde)7506301
Central African Republic (CAR)2,2227369
Chad85073720
Comoros1762114
Congo72824221
Cote d’Ivoire (Ivory Coast)9,702684,381
Democratic Republic of the Congo (DRC)7,1891762,317
Djibouti4,704554,550
Egypt71,2993,12019,288
Equatorial Guinea1,30612200
Eritrea9639
Eswatini (formerly Swaziland)4904249
Ethiopia5,8461032,430
Gabon5,513422,508
Gambia28124
Ghana18,13411713,550
Guinea5,404334,346
Guinea-Bissau1,46015153
Kenya6,6731492,089
Lesotho42
Liberia45832219
Libya4541063
Madagascar1,29010384
Malawi547669
Mali1,8091041,088
Mauritania4,4721291,677
Mauritius33710325
Mayotte2,298191,790
Morocco13,2152309,158
Mozambique5833151
Namibia3217
Niger98066885
Nigeria27,11061610,801
Reunion4951460
Rwanda5822332
Sao Tome and Principe66112177
Senegal7,0541214,599
Seychelles1111
Sierra Leone1,16951680
Somalia2,61888577
South Africa168,0612,84481,999
South Sudan1,6932749
Sudan9,5736024,606
Tanzania50921183
Togo53113299
Tunisia1,09649998
Uganda705299
Western Sahara918
Zambia1,358111,122
Zimbabwe383454

Note: The numbers will be updated as new information is available.

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Empty Roads, Occupied Minds

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With a deadly virus still lurking in the streets and tougher times ahead, traders in South Africa’s colorful townships desperately look to resuscitate their businesses with creative offerings online. 

It’s almost two months into lockdown in South Africa and the country’s townships, once bustling hubs of trade, are slowly bracing themselves, with every ounce of willpower left in them, for the unprecedented reality that is ‘the new normal’.

For many, the national shutdown and closed shutters have meant lost jobs, stalled incomes and empty pockets, not to mention a deadly virus stalking them in every street and alley. The small entrepreneurs here – the lifeblood of any economy – now on their last pennies, are still hopeful their re-evaluated strategies and revamped resilience will see them through this fearful nightmare, as the restrictions ease and the townships will slowly crawl back to life again.

Behind the respectful veneer of the lockdown, some of the smaller traders hustle on illegally, under the radar, dodging police patrols and armed surveillance. They have no choice but to stick to their street-smart ways, to survive and feed their families. 

In the township of Soweto, bigger, popular establishments such as The Box Shop on Vilakazi Street – the historic stretch home to Nobel Peace Prize winners Archbishop Desmond Tutu and the country’s former President Nelson Mandela – are looking to the future with great uncertainty, and have been forced to devise alternative digital strategies as lifelines for the present.

Sifiso Moyo founded The Box Shop, a lifestyle and retail outlet with his business partner, Bernard Msimango, and today, the street it’s located on, which attracted thousands of local and international tourists every day prior to the pandemic, is eerily quiet.

It will be a while until planes of international visitors land again, so the duo have chosen to go to them – online.

“For The Box Shop, we built hype around online and have taken the entire offering that existed in our physical infrastructure into a digital platform and that has made us into an innovation space, giving us access to a global audience. We are beginning to see our products being sold in places like Switzerland and the United Kingdom and we now have started harnessing partnerships,” says Moyo.

The website was launched in May, but the bigger vision for the entity was to start as a retail outlet and work backwards into the manufacturing space.

Moyo says the coronavirus taught them two things – to adapt digitally, and to work in the value chain.

The shop now also makes face masks, sold to public hospitals and NGOs.

A short drive from Vilakazi Street is a restaurant named Sancho, selling African cuisine and founded by Thato Mothopeng, a serial entrepreneur who also founded the popular annual Soweto Camp Festival.

Mothopeng is one of the few entrepreneurs in the tourism sector without a formal degree or training, but has had a roaring business nevertheless and is quite well-known in the circuit.

Mothopeng says all SMMEs are at a standstill because business thrives on human contact. But business also needs to be flexible, he adds.

“There are opportunities in the harshest environments. I am using this time to review my strategies. I am also not panicking because the country is managing the crisis; this is an opportunity for SMMEs to reflect because our people are sober now.” 

He had to let go of a few employees and is working remotely.

Further in the township of Soweto, Thembeka Nkosi, the founder of Le Salon, has also developed her own coping mechanisms.

Her shop is shut, but people still seek her grooming advice. As per South Africa’s Level 4 lockdown restrictions, salons and beauty parlors are not allowed to operate.

“This [lockdown] is very stressful, more especially now because other businesses are operating. I still can’t make money, I still have to stay at home and not work,” rues Nkosi.

In addition to getting to spend more time with her five-year-old son, she has recently started sharing her haircare tutorials on social media.

“Now that shops are open to buy hair products, I send video clips to my clients and that brings me joy, knowing that I am still useful to them; even though it’s not making me any money yet, at least I am interacting with my clients,” she says, looking at the bright side.

Ronewa Creations is yet another small business in these parts.

Founded by Lesego Seloane and Dinah Kgeledi, the business offers landscaping services, garden maintenance and water harvesting solutions, and employs seven full-time workers. None of these services are allowed in the current phase of lockdown.

“Now that our province is still on Level 4, it is really difficult to focus because when we were working out our plans, there was so much uncertainty and we didn’t know how they could actually be implemented,” says Seloane.

She is grateful the duo have been active on social media, running a garden makeover campaign and offering landscaping designs for free.

“We are using a three-dimensional technology that revamps the look of gardens to give people an idea of how their gardens could potentially look like in the end.”

Despite the challenges, the two keep sane by spending time with family.

“If the business fails, I fail. If I don’t come out of my down moment quick, then I will fail and the entire organization fails,” says Seloane.

You can detect the determination in her voice to overcome this period, come what may.

Like many around her staring fear in the face, she has no other choice.

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This Single Factor Could Force Another Coronavirus Shutdown, Goldman Sachs Says

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With new coronavirus cases rising in 26 states, according to data from Johns Hopkins, and the national conversation turning to whether those states rushed to reopen their economies too quickly, new analysis from Goldman Sachs suggests that in the coming weeks, hospital capacity (rather than case numbers) is the factor most likely to prompt another lockdown.

KEY FACTS

  • Goldman’s experts say hospital data is a more reliable picture of the spread of the virus nationwide than positive test results, which fluctuate with changes in testing trends. 
  • The analysts noted, however, that “there is probably a high hurdle for states to reinstate lockdowns.” 
  • As new cases continue to rise across the country, Goldman’s analysts also tracked which states currently meet federal reopening criteria based on four factors: symptoms, cases, testing and hospitalizations and fatalities. 
  • Only Arizona and Alabama fail in all four categories, the analysts say; symptoms and cases are on the rise, positive test rates are high, and hospitals are nearing their maximum capacities. 
  • On the other hand, 19 states meet all four criteria for reopening, including several former hot spots like New York and New Jersey, and the vast majority of states meet at least three out of the four criteria.

KEY BACKGROUND

Along with Alabama and Arizona, California, Texas, and Florida have also seen sharp upticks in infections in recent days. Florida reported a record increase in new cases on four out of the six days between June 15 and 20, for instance. The number of confirmed cases since the pandemic started has now swelled to over 100,000, and Gov. Ron DeSantis said the uptick is “clearly” the result of a failure to follow social distancing guidelines. With cases on the rise, some places—like Arizona—are forging ahead with reopening plans while others—in MaineOregon, and Kansas, for instance—are tightening up restrictions again.

Sarah Hansen, Forbes Staff, Markets

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