Johannesburg - Could South Africa experience its most devastating wave of Covid-19 cases in the upcoming months?
While scientists have warned this week that a more vicious strain of Covid could possibly be on its way, health experts in the country have called for calm.
This follows a report by researchers at the Africa Institute for Health Research in Durban, in which they warned that the coronavirus is still able to mutate, despite the current period of calm, and may produce a more vicious version in the future.
Scientists issued this warning after they studied the case of a person with Aids who was infected with the “Omicron” mutant from corona infection, and he was unable to get rid of it for six months, due to his weak immune system.
The study stated that when the virus mutant remains in the patient’s body, for many months, it finds ample time for it to multiply, and then, the possibility of it secreting a new, more fierce mutant increases as a result of the modifications and changes that occurred in it.
Epidemiology researcher Alex Segal, the academic supervising the study, explained that the virus, which stayed for a long time in the body, caused greater inflammation in the lungs, in a situation similar to what was caused by infection with previous strains of the coronavirus.
Over time, the virus mutated and became more capable of killing cells, and if it were transmitted to others, they would have the same severe symptoms.
However, Professor of Vaccinology at Wits University Shabir Madhi, said there was no reason to believe that the next variant would or would not be more virulent.
“The study showed that mutations over time can make the virus more antibody evasive,” Madhi told the Saturday Star.
“This is unsurprising, considering what we experienced with Omicron and its subsequent sub-lineages. Despite such mutations, the T cell immunity which is what likely drives protection against severe disease has remained relatively intact.
“This is probably even more so in countries such as South Africa where there is extensive infection-induced immunity and hybrid immunity in vaccinated individuals.”
Madhi said that while sporadic outbreaks of Covid were possible, it’s unlikely to translate into large spikes of severe disease or death.
“For all intent, the pandemic is very much over, with the extensive infection-induced immunity resulting in an infection fatality rate no higher than would occur after seasonal influenza infection. This has now been the case for the past nine months.”
Leading epidemiologist, Professor Salim Abdool Karim said it was difficult to predict the severity of the new variant.
“What will happen next is unpredictable, and we would normally have expected to see a new variant several months ago because each variant comes three months after each other,” said Abdool Karim, who is also the director of the Centre for the Aids Programme of Research in South Africa (Caprisa).
“But the one thing we are unable to predict right now is the severity of the new variant, Pi.”
Abdool Karim explained that they are also unsure at this stage when Pi will start rapidly spreading .
The world-renowned epidemiologist said that he and his colleagues have seen several reported cases of the virus in immuno-compromised individuals, such as those with cancer, advanced HIV, or autoimmune diseases.
“These individuals get a chronic, persistent infection and the virus tends to stay with them for a longer period of time.”
This is different from normal Covid-19 infections as Abdool Karim said that these individuals develop antibodies and are able to clear the virus in about 10 days.
“A small portion of people, in particular the elderly, develop severe Covid-19 infection and the virus leads to severe illnesses,” he said.
“We don't know why it happens, we just know that their immune systems don't produce antibodies to clear the virus.”
Abdool Karim added that in these cases, the virus replicates itself and grows within the infected individual which could lead to the virus mutating.
“We would expect anyone who is immuno-compromised to develop mutations and this will lead to more immune escape and these individuals might have low levels of antibodies.”
Deputy Vice Chancellor for Research and Innovation at North-West University and member of the Ministerial Advisory Committee on Vaccines, Professor Jeffrey Mphahlele said that although the risk of a devastating next wave remains low, it’s critically important that South Africans remain vigilant because Covid-19 is a relatively novel disease.
“The virus responsible is mutating from time to time, mutations may enhance transmission and disease severity. It is highly unlikely that it will cause the pandemonium we have seen in 2020 and 2021 regardless of the extent of mutations,” he said.
Health Department spokesperson Foster Mohale said he expects the next wave to be less severe than we have seen so far.
“There is a high level of immunity at community level and it's difficult to predict when the next wave will land and its severity,” he said.
Research Professor and Academic Head in Divisions of Virology and Immunology, at the University of the Witwatersrand, Penny Moore said in some rare cases, people with weakened immune systems can shed Sars-CoV-2 for prolonged periods, and that the virus may mutate.
“This is why it is essential that as a country, as we celebrate World Aids Day, we ensure that people living with HIV have access to ARVs, restoring their immune systems and enabling them to clear Covid-19 quickly,” said Moore.
“New Sars-CoV-2 variants will continue to emerge, and we constantly monitor this. But South Africa has a high level of immunity, with ongoing vaccine programs, which has dramatically reduced the numbers of deaths.”