Johannesburg - South Africans might want to put their Christmas plans on hold, if medical experts are accurate in predicting that the fourth Covid-19 wave will hit around the festive season, with some saying, even earlier.
One expert warned the country may face a disastrous fourth wave if the majority of the population is not vaccinated.
Epidemiologist and infectious diseases specialist, Professor Salim Abdool Karim believes the fourth wave will largely depend on the emergence of new Covid-19 variants. The Centre for the Aids Programme of Research in SA director, said based on patterns of the virus observed during the previous three waves, there appears to be a three month gap between them.
“I don't have a crystal ball and I don’t know if there will definitely be a fourth wave but if we look at the trends about 20 months into the pandemic, there is a high likelihood that the fourth wave will follow about three months after the end of previous one, which is around the middle of December,” he said.
The former chairperson of the government’s Ministerial Advisory Committee on Covid-19 stressed that what will be critical in determining the fourth wave, is the variant, and if the variant comes in earlier, the wave will hit earlier but if it emerges later, then the fourth wave will be delayed.
Karim said the second wave was driven by the Beta variant, the third by the Delta variant and that the next wave will be driven by a new variant. In order to minimise the effects of the next Covid-19 wave of infections, Karim believes that vaccinations are vital.
“Based on what we have seen so far, vaccinations are doing reasonably well in preventing infections and very well in preventing severe disease. If a sizeable proportion of about 40-50% of our adult population is vaccinated by then, the wave fourth may take a different course.”
Karim provided the example of the UK, which has a similar population size to South Africa, and, where infection rates have been reasonably high but due to the high vaccination rates in that country, they are experiencing low hospital admission as well as death rates and as a result, face fewer lockdown restrictions.
“You can see that the stadiums in the UK are full and that restaurants are open,” he said.
But Karim warned that there is a fear that a new variant is able to escape some of the vaccine’s immunity.
“That might be a different problem but we don’t know if that will happen yet.”
He also added that South Africa could be in a good position when the fourth wave hits, if a reasonable amount of the adult population is vaccinated and if the jab is able to protect against the new variant.
“This could see much lower death rates and hospital admissions which could result in fewer restrictions.”
He said that while the current vaccination rate in the country has been running reasonably smoothly, it needs to pick up pace if the worst effects of the next wave of the virus are to be minimised.
“Our goal is to vaccinate around 40-50% of the adult population. There is no magical number we are aiming for but if we get to that point, we will be in a better position.”
Professor Shabir Madhi, a vaccinologist at Wits University, said South Africa can expect a resurgence of Covid-19 cases, however, the frequency and magnitude of it are dependent on vaccine coverage; the percentage of the population who derived immunity through natural infection (which is estimated to be as high as 60-70% in SA); and further evolution of the virus.
“It would, however, be surprising with the rollout of Covid vaccines and the high force of past infection, for further resurgences to result in as high rates of hospitalisation and death compared with what had transpired with the first three waves.”
“Over time, it is very likely that Covid-19 will become endemic, with occasional flare-ups. The frequency of repeat vaccination remains to be seen, including whether it will be required only for specific groups, which I think is most likely .”
Madhi says it is important that at least 90 percent of the population is vaccinated to avoid a horrific fourth wave.
“The number of South Africans that have been vaccinated is very modest. Also, unless we focus attention on ensuring high coverage (85-90%) in people older than 35 years, we still risk having hospitals come under pressure with a next resurgence.”
“The resurgence will likely differ in its onset by province, but I suspect it will start materialising from December onward. Of concern is the ongoing slow burn in many provinces with the current resurgence.”
“Behaviour would contribute to the resurgence, however, that is not only because of people going on vacation. Besides, going on vacation, which is largely a middle-class indulgence, more so in the current dire economic state in SA.”
Madhi adds it is impossible to predict which province will be hit hardest by the resurgence.
“It is almost impossible to answer, as it depends on multiple factors.”
Deputy Head of the South African Vaccination and Immunisation Centre (Savic) and Senior Lecturer and Researcher at the Department of Microbiological Pathology at Sefako Makgatho Health Sciences University, Dr Andrew Musyoki said various expects used previous experience and data to model and predict when the fourth wave may hit SA and so far the predictions are divergent.
“Some point to somewhere around October, another around November and yet another predicts the fourth wave somewhere around December. The main take-home message is that the infection waves cannot be accurately predicted because they mostly depend on human behaviour,” he said.
Musyoki said the first and second waves lasted for less than 1 and half years while the third wave has still not settled, after more than three months since it peaked.
“The most important thing to remember is that our decision to get vaccinated and, to observe all the measures to prevent transmission will keep us from a fourth wave of infection,” he added.
Musyoki said the current data from hospital surveys points to unvaccinated people as the ones to bear the brunt of future infections. Reports on assessment of hospitalisation, high care or ICU admissions and those that are on ventilators show that more than 95% are those who are unvaccinated. The Sisonke results showed that the healthcare workers vaccinated in the programme had protection against even the emerging variants.
As of September 10, more than 14,367,000 vaccines have been administered with those fully vaccinated being just over 7 million.
“The vaccination numbers are still very low and we need to do better. The encouraging news is that there is more data supporting that those vaccinated are protected from the adverse outcome of hospitalisation, need for high care and unfortunately death. So the severity of future infections can only be averted by being vaccinated. I encourage everyone eligible to be vaccinated and advocate for vaccination,” said Musyoki.
Health Department spokesperson, Popo Maja said according to the scientists’ projections, SA is likely to have a fourth wave around November and December and that large metros are likely to be hardest hit but the severity of the fourth wave can be reduced by ensuring that everyone adheres to the Covid-19 regulations and non-pharmaceutical preventative measures.
“An added major preventative measure is to encourage as many people who reside in our country to get vaccinated. It is upon all of us to do the right thing: physical distancing, hand and hard surface sensitising and getting vaccinated. Health professionals who take care of us when we are sick tell us that the most severe cases of Covid-19 are of those people who have not been vaccinated,” he said.