The COVID-19 pandemic has had a profound impact on individuals and businesses worldwide. In Johannesburg, South Africa, a coffin maker named Casey Pillay experienced firsthand how the virus turned his business upside down and moved into his home.
COVID-19 Outbreak World Map
The Personal Impact of COVID-19
Pillay's wife, a midwife, delivered babies for coronavirus-positive mothers in Johannesburg, the epicenter of the pandemic in South Africa. The coffin maker knew that his wife would be infected was a matter of time. When she fell ill during the country’s surge in cases, she retreated to the main bedroom and Pillay withdrew to a bedroom next door.
Scared, he barely slept, managing a few hours before dawn as his wife wrestled with some of the worst days of her life. “I’d literally be on eggshells listening to what she was going through,” Pillay said Tuesday. “I would go in every now and then, fully kitted up, just to check vitals, whether she needed oxygen. When she recovered, we sat down and had a chat. She was really scared because at one stage she thought she was gonna die.”
Seeing someone with COVID-19 recover after so much exposure to death through his work was a blessing in disguise, he said. Pillay, a manager at the coffin-making business, said about 10 colleagues also were infected. All are now OK. Their survival reflects the relatively low death toll from COVID-19 in South Africa, and in Africa in general, as the continent appears to defy dire predictions that the virus would cause massive numbers of deaths.
Read also: Explore the story of Mark Laforest
Map of Africa
The Business of Death During a Pandemic
“It has been a crazy, crazy, crazy couple of months,” Pillay said. The need for coffins rose and fell as South Africa’s lockdown levels changed, but overall, he said, “business went down.” Under the strictest lockdown measures, so few people were driving in South Africa that the country’s terrible rate of vehicular deaths plummeted. And alcohol sales were banned, “so you weren’t having people fighting, murdering each other,” Pillay said. “Unfortunately, our whole business thrives on people dying.”
As the lockdown eased step by step and people were “not being disciplined” and going around without masks, the number of virus deaths increased. Now, a sense of normalcy is returning. But COVID-19 changed everything. The price of basic materials shot up as “every Tom, Dick and Harry became an essential provider,” Pillay said. Suddenly, a box of gloves was changing hands five times, with everyone taking a cut. What once cost $4.70 became $11.70 or $13.
Pillay scrambled to keep his workshop open and safe as orders rolled in. “The unfortunate part is, you’ve got so many workers and machines and can only do so much a day,” he said. The workshop bustles with people carrying raw wood, sanding it and attaching polished handles. And the entire nature of mourning in South Africa changed.
The government said COVID-19 burials should happen right away instead of waiting for the usual weekend funerals. “You had undertakers who now needed boxes on Monday, Tuesday, Wednesday,” Pillay said. A body now had to fit into three body bags, then the coffin, and “go straight into the grave.” With the number of people limited at funerals and graveyards, “people went for the cheapest boxes,” Pillay said.
Read also: Read about Mark Fusco's achievements
In normal times, even the poorest of the poor in South Africa “want to do the best, a kind of show-off thing, a bragging right for them” with quality coffins for their loved ones. Now, there is little time to appreciate it, and few people to impress. Sometimes, mourners could only park on the side of the road and watch the vehicle carrying the body drive by.
Looking Ahead
Pillay believes that the beginning of the Southern Hemisphere’s summer, along with South Africans’ relative youth and the perceived resilience of immune systems, will help his countrymen survive the next wave of infections that health experts are expecting. Again, it’s when, not if. Pillay already is watching cases rise again in Britain, in Spain.
“Yes, it’s imminent,” he said. “Definitely.”
Life has edged back toward normal after a surge in infections in South Africa in June and July that threatened to overwhelm public hospitals. Many of the more than 1 million graves that Gauteng province, home of Johannesburg, once hurriedly mapped out have gone unused.
Still, the toll from COVID-19 - which has killed more than 16,000 people in South Africa, nearly half of the continent’s more than 35,000 deaths - has been painful, and the world surpassing 1 million confirmed deaths has again led to reflection.
Read also: Remembering Christopher Bowman
Как пережить потерю близкого человека?
Domestic Violence: A Pervasive Issue
Domestic violence (DV) is violence that occurs in a domestic setting, such as in a marriage or cohabitation. In a broader sense, abuse including nonphysical abuse in such settings is called domestic abuse. The term domestic violence is often used as a synonym for intimate partner violence, which is committed by one of the people in an intimate relationship against the other, and can take place in relationships or between former spouses or partners.
Forms of domestic abuse include physical, verbal, emotional, financial, religious, reproductive and sexual. It can range from subtle, coercive forms to marital rape and other violent physical abuse, such as choking, beating, female genital mutilation, and acid throwing that may result in disfigurement or death, and includes the use of technology to harass, control, monitor, stalk or hack.
Worldwide, the victims of domestic violence are overwhelmingly women, and women tend to experience more severe forms of violence. The World Health Organization (W.H.O.) estimates one in three of all women are subject to domestic violence at some point in their life. In some countries, domestic violence may be seen as justified or legally permitted, particularly in cases of actual or suspected infidelity on the part of the woman.
Domestic violence often occurs when the abuser believes that they are entitled to it, or that it is acceptable, justified, or unlikely to be reported. It may produce an intergenerational cycle of violence in children and other family members, who may feel that such violence is acceptable or condoned. Many people do not recognize themselves as abusers or victims, because they may consider their experiences as family conflicts that had gotten out of control.
In abusive relationships, there may be a cycle of abuse during which tensions rise and an act of violence is committed, followed by a period of reconciliation and calm. The victims may be trapped in domestically violent situations through isolation, power and control, traumatic bonding to the abuser, cultural acceptance, lack of financial resources, fear, and shame, or to protect children.
As a result of abuse, victims may experience physical disabilities, dysregulated aggression, chronic health problems, mental illness, limited finances, and a poor ability to create healthy relationships. Victims may experience severe psychological disorders, such as post-traumatic stress disorder (PTSD).
Forms of Domestic Violence
- Physical Abuse: Involving contact intended to cause fear, pain, injury, other physical suffering or bodily harm.
- Sexual Abuse: Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person's sexuality using coercion.
- Coercive Control: A controlling behavior designed to make a person dependent by isolating them from support, exploiting them of independence and regulating their everyday activities.
- Economic Abuse: When one intimate partner has control over the other partner's access to economic resources.
Obesity and Mortality in South Africa
A study was conducted in rural South Africa to analyze the relationship between Body Mass Index (BMI) and mortality. The study, which involved 9,728 individuals, measured BMI in 2010 and tracked mortality rates until 2017. The findings indicated that individuals who met clinically-defined criteria for overweight or obesity had a lower risk of all-cause mortality than those of normal BMI.
The cohort consisted of individuals living in a rural area of uMkhanyakude District, northern KwaZulu-Natal. Demographic data was collected through household-based surveys, and deaths were verified with verbal autopsy interviews. HIV testing was conducted annually.
The study found that individuals with a BMI of 25.0 - 29.9 kg/m2 and those with a BMI of 30.0 - 34.9 kg/m2 had a lower hazard of death compared to those with a BMI of 18.5 - 24.9 kg/m2. Those with a BMI ≤18.5 kg/m2 had the highest mortality rate. These findings were consistent in women.
African Health Research Institute Logo
Key Findings
In one of the largest population-based cohorts in sub-Saharan Africa, with near complete mortality estimation, we found that all-cause mortality over seven years of observation was lower in those who had a BMI of 25.0 - 29.9 kg/m2 or 30.0 - 34.9 kg/m2, compared to those who had a BMI 18.0 - 24.9 kg/m2, according to standard, clinically-defined BMI definitions. This is consistent with the known J-shaped curve that links BMI and mortality. This pattern was preserved in a sub-analysis of women, though our ability to describe these relationships in men was limited by smaller sample size.
The study suggests that in this South African setting, the relationship between BMI and mortality conforms to a J-shaped curve in which overweight is not associated with an increased risk of mortality. This was particularly the case for women, such that the lowest risk of short-term mortality might be afforded by a higher BMI, which is clinically defined as overweight or obesity in current guidelines. This was also true in those who were confirmed to be HIV-uninfected in this analysis.
One potential hypothesis to explain these findings is that the determinants of higher BMI might be associated with improved access to healthcare, which in turn may be protective against many causes of premature mortality. Finally, we observed a lower risk of mortality due to infectious disease causes for those who were overweight versus those of normal weight. This finding was expected given that these deaths are likely driven in part by HIV and tuberculosis, both of which are highly prevalent and associated with wasting in their more advanced stages.
Table: Adjusted Hazard Ratios (aHR) for Mortality by BMI Category
| BMI Category (kg/m2) | aHR (All) | 95% CI (All) | aHR (Women) | 95% CI (Women) | aHR (Men) | 95% CI (Men) |
|---|---|---|---|---|---|---|
| ≤18.5 (Underweight) | 1.37 | 1.12 - 1.69 | 1.64 | 1.25 - 2.13 | 1.27 | 0.95 - 1.69 |
| 18.5 - 24.9 (Normal) | 1.00 (Referent) | - | 1.00 (Referent) | - | 1.00 (Referent) | - |
| 25.0 - 29.9 (Overweight) | 0.80 | 0.69 - 0.92 | 0.79 | 0.66 - 0.94 | - | - |
| 30.0 - 34.9 (Class I Obesity) | 0.75 | 0.60 - 0.93 | 0.76 | 0.58 - 0.94 | - | - |
| ≥35.0 (Class II Obesity or Greater) | 0.80 | 0.64 - 1.02 | 0.84 | 0.64 - 1.10 | - | - |