Artificial intelligence developed in Pretoria helps detect hidden cases of tuberculosis before the disease develops

The rapid identification and understanding of new viruses can be crucial for preventing and reducing the impacts of future pandemics on public health and the economy.

Trends in Viral Discovery

In a common annual cycle, scientists manage to discover two or three novel viruses for humans. Although this number varies, the trend has remained relatively constant since the 1960s. Many of these viruses go unnoticed, requiring researchers to revisit old medical articles to find any mention of them, while others simply disappear from observation.

Landmark events, such as the discovery of HIV-1 in 1983 and Sars-CoV-2 in 2020, signaled the AIDS and COVID-19 pandemics, respectively, both resulting in tens of millions of deaths.

Challenges in Risk Assessment

When a new unusual virus is found in a patient—something likely in the coming months—the question arises as to how to determine if it can cause a public health emergency comparable to the AIDS or COVID-19 crises. The team at the University of Edinburgh has been using historical lessons about viruses to aid in this assessment.

Although pandemics present different characteristics, the most prominent causative agents recently are RNA viruses, in contrast to the better-known DNA ones. There are thousands of cataloged RNA virus species, and potentially millions, but only 239 affect humans. Recently, a catalog was released to point out the most dangerous ones.

Transmission and Evolution Factors

The type and severity of the disease are relevant indicators, but a pandemic only materializes if the virus is capable of spreading between individuals. This transmission can occur through physical contact, inhalation of aerosols, exposure to bodily fluids such as blood or feces, or through the bite of vectors like mosquitoes or ticks.

There are also viruses that can circulate among humans but have, so far, only caused localized outbreaks. This happens because their reproductive number (R) is low, causing infection chains to naturally die out. However, these R numbers are dynamic; an example of this was the Zaire Ebola virus in West Africa in 2014, when a virus restricted to rural areas reached a city.

Despite seeming reassuring, viral evolution is rapid, raising concerns about the possibility of a zoonotic virus acquiring human dissemination capacity. Scientists closely monitor avian flu in this regard, although there is no documented record of an RNA virus making such a leap. Rabies, for example, causes numerous human cases annually without exhibiting this characteristic.

A considerably greater threat lies in viruses that already possess person-to-person transmission capability. These can increase their transmissibility, as seen in SARS-CoV-2 variants, but their origin often traces back to animal viruses that were already circulating among humans. Historically, measles, mumps, and rubella probably originated in this pattern, as well as various viruses associated with colds and gastrointestinal problems.

Viruses Highlighted in the Catalog

Although the list contains only a few dozen names of viruses causing outbreaks, it serves as a strong indication of potential public health emergencies. Among the first included were the Zaire Ebola virus, Chikungunya, Zika, and Oropouche viruses—all insect-borne—and mpox (a DNA virus), all of which caused major epidemics.

Some less common viruses on the list gained notoriety. The Andean hantavirus, responsible for a recent outbreak on a cruise ship, and the Bundibugyo ebolavirus, currently spreading in Central Africa, are examples. However, neither the Andes nor the Bundibugyo virus has the ideal profile to trigger a global pandemic. If, on the other hand, a new measles-related virus emerged, the scenario would be drastically different, presenting a real risk of a world crisis greater than COVID-19.

The Andes and Bundibugyo viruses, despite not being pandemic, teach a vital lesson: both were in the process of spreading weeks before they were detected, just as happened with COVID-19. Improving the speed of identifying and understanding new viruses would prevent the next pandemic from having this initial advantage, which could significantly reduce the number of victims and economic damage.

Professional medical associations have voiced serious concerns regarding the medical certificates submitted to the Madlanga Inquiry Commission. These concerns arose after a medical certificate provided by the head of the Investigative Directorate Against Corruption (IDAC), Andrea Johnson, came under scrutiny. The review was prompted because she failed to appear at a scheduled Monday hearing, reportedly due to being urgently taken to the hospital, which led to the postponement of the hearings.

Examples of Certificate Usage

The Commission also received information that businessman Sulaiman Karim, who was due to appear at hearings this week, was spotted at a West Cape shopping center despite having submitted medical certificates. Other witnesses who submitted medical certificates on time included alleged political intermediary Brown Mogotosi and Farroz Khan from the Crime Investigation Department.

Chairperson's Position

The Commission Chairperson, Mbuyiseli Madlanga, expressed concern, noting that the submitted medical certificates contained no significant information. He commented on Johnson's certificate, stating that such documents are 'useless in the sense that they provide absolutely no information.'

Previously, the commission had indicated the possibility of summoning doctors to explain whether a witness was ill. Priscilla Sekhonyana, a representative of the Health Professions Council of South Africa (HPCSA), reported on Saturday that they took note of public discussions surrounding medical certificates. Sekhonyana clarified that issues with questionable certificates are not new, as about 2% of all complaints against doctors relate to allegations of fraud or insufficiently detailed medical documentation.

Medical Associations' Stance

Sekhonyana emphasized that the conduct of most registered practitioners is overwhelmingly professional and ethical, adhering to the guidelines and standards approved by the council for public protection. The HPCSA's annual report for 2024/25 shows that out of 2255 complaints received during the reporting period, only 31 (1.4%) related to medical certificates.

The Chairperson of the South African Medical Association, Mvusi Sizuka, expressed dissatisfaction that their profession is being drawn into incidents due to the actions of individuals. He stated that this is a serious matter they do not take lightly, acknowledging isolated instances of misuse of medical certificates, which he finds regrettable. Sizuka added that most doctors in South Africa work professionally and ethically.

Certificate Issuance Requirements

The HPCSA Head of Core Operations, David Mametja, noted that council-registered practitioners are obliged to act ethically and professionally with due diligence. Mametja explained that before issuing a certificate, consultation, diagnosis, and assessment of the patient's health status must take place to determine if they are fit for work. He also stressed that the certificate must contain important information about the practitioner themselves, including their registration number with the council, which helps identify fraudulent documents.

Mametja also stated that the recipient of the certificate has the right to reject it, but such a decision must be based on sound reasons. He believes there is no harm in an employer or recipient asking the patient to inform the practitioner what specific information should be provided, although this always depends on the patient's consent.

Support for Accountability and Confidentiality

Sizuka stated that they respect the concerns raised by the Madlanga Commission and support accountability across all sectors, including the medical profession. He clarified that SAMA is a voluntary medical association, not a regulatory body, and its role is to promote ethics and professionalism among members. Sekhonyana confirmed that the HPCSA has a well-established process for investigating and handling all complaints of unethical conduct. She also mentioned that there is a penalty system for practitioners found guilty of violating applicable professional and ethical norms.

Sekhonyana noted that they are aware of public discussions regarding the potential subpoenaing of registered healthcare workers to testify in legal proceedings and inquiry commissions concerning the certificates they issued. She stated that registered practitioners must comply with legal summonses and other legal procedures. However, if disclosure of clinical information is required by law, it must be limited to what is necessary and relevant to the proceedings, while preserving the dignity and privacy of the patient. In the absence of informed consent, practitioners can only disclose confidential patient information under court order or pursuant to a lawful directive from a competent authority.

The South African Medical Association Trade Union (SAMATU) stated that patient confidentiality is the cornerstone of proper medical practice. SAMATU President Thilidzi Sadiki emphasized that the correct approach is to respect the legal process while ensuring the protection of patient privacy within legally permitted limits. She called this balance crucial for maintaining public trust in both the justice system and the doctor-patient relationship.

According to new research by Discovery Insure, lack of sleep may be one of the most underestimated threats to road safety.

Driver Data Analysis

This study analyzed a four-year dataset on sleep and driving collected from over 10,000 Discovery Insure drivers. This research is one of the largest of its kind conducted in South Africa. The results showed that accumulating sleep debt over several consecutive nights is one of the strongest predictors of the risk of road traffic accidents.

Impact of Sleep Deprivation on Safety

The CEO of Discovery Insure, Robert Attwell, noted that poor sleep directly affects a person's ability to concentrate, reaction time, and decision-making process—all factors that influence driving behavior. He added that the study suggests that poor sleep can be five times more predictive of accident risk compared to traditional insurance metrics when viewed in isolation.

The study found that chronic sleep deprivation has a greater negative impact on accident risk than a single bad night's sleep. Furthermore, nearly 30% of Discovery Insure drivers accumulate some level of sleep debt while driving, and about half of the total impact of sleep on accident risk is linked to consistent poor sleep rather than isolated incidents.

Risk Comparison and Recommendations

Drivers who maintained a sleep debt of less than one hour for three consecutive nights had a 36% lower accident risk than those with a sleep debt of five hours or more during the same period. It was also found that drivers who regularly sleep seven to eight hours are 32% less likely to be involved in an accident than those who sleep insufficiently. Moreover, those who go to bed approximately one hour later than their ideal bedtime each night show a 36% reduction in accident risk, and drivers who get sufficient rapid eye movement (REM) sleep have a 14% lower risk.

Calls for Awareness

Discovery stated that many motorists continue to underestimate the danger of driving while fatigued. According to a 2024 survey, almost 90% of adults would say they avoid driving after consuming alcohol, but only half of them would say they would refrain from driving after poor sleep. The insurance company also cited research data indicating that staying awake for more than 16 hours can impair driving to the same extent as reaching or exceeding the legal blood alcohol limit in South Africa, which is 0.05%.

Globally, road traffic accidents claim about 1.19 million lives annually, with driver fatigue estimated to contribute to roughly one in five accidents. In South Africa, road traffic accidents cost the economy approximately 205 billion rand in 2023, equivalent to about 2.7% of GDP. Attwell emphasized that road safety campaigns have traditionally focused on speeding, distracted driving, and drunk driving, but recent findings indicate that fatigued driving deserves equal public attention. He concluded: 'Every safer journey begins the night before. If we can help more South Africans develop healthier sleep habits, we can help more people arrive safely, reduce the burden on families, and contribute to safer roads for everyone.'