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The fifth Covid-19 wave might be hitting SA sooner than expected but health experts warn against panic

A doctor takes a swab from a woman to test for the COVID-19.Picture by Chinatopix Via AP.

A doctor takes a swab from a woman to test for the COVID-19.Picture by Chinatopix Via AP.

Published Apr 30, 2022

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Johannesburg - The National Department of Health (NDoH) has noted with “concern” the current spike in Covid-19 infections in some parts of the country amid fears that SA may be entering a fifth wave.

People are being urged to take extra measures to protect themselves.

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The department said two sub-variants of the Omicron strain are currently in circulation but there’s no talk of any lockdown or any further Covid-19 restrictions.

There are fears that SA may be entering the fifth Covid-19 wave earlier than expected after a sustained rise in infections over the past 14 days that seems to be driven by the BA.4 and BA.5 Omicron sub-variants.

Health Minister Joe Phaahla said although hospitalisations were picking up there was so far no dramatic change in admissions to intensive care units or deaths.

He said at this stage health authorities had not been alerted to any new variant, other than changes to the dominant one circulating, Omicron.

NDoH spokesperson Foster Mohale said Covid-19 remains a life threatening disease and vaccination remains the most effective weapon for protection.

“There is no need for the public to panic at the moment, but people should continue adhering to preventative measures and vaccinate. The National Institute for Communicable Diseases (NCID) and other health experts are closely monitoring the situation in order to establish the patterns of disease progression. Although it is too early to tell what drives the current spike of infections, all unvaccinated and partly vaccinated people are urged to protect themselves through vaccination,” he said.

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Mohale stressed that the lifting of the State of Disaster does not mean Covid-19 is over. Epidemiologists predict the fifth wave to hit around the winter season, which is also associated with flu.

The latest figures from the NICD reported 4 146 new cases of Covid-19 identified in SA, bringing the total number of laboratory-confirmed cases to 3,780,444. This increase represents a 18.3% positivity rate. The NDoH reported four deaths in the past 24 – 48 hours. This brings the total fatalities in SA to 100,355 to date.

Head of The South African Vaccination and Immunisation Centre at Sefako Makgatho Health Sciences University Professor Hannelie Meyer said while there has been an increase in Covid-19 cases, it’s too early to tell if the fifth wave is upon us.

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“The scientists are keeping a very close eye on the data, and we will have to wait another week before we will have more certainty about whether it is just a resurgence in cases or whether it could be the start of the fifth wave,” she said.

Meyer also cautioned that there is no need for panic.

“While we have no certainty about anything, all we need to do is not to let our guard down, which means to make sure you are vaccinated, wear a mask when indoors in public areas, make sure there is enough ventilation, and keep social distancing. This is especially important for people over 60, those with underlying conditions and those who are immunocompromised,” she concluded.

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Professor of Vaccinology at Wits University Shabir Madhi said while South Africans should be cautious during the fifth wave, when it hits, there was no need to panic.

“We need to be cautious, but there is no need to panic as we live with the virus,” said Madhi.

“Any pretence that we achieve much with regulations aimed at preventing infections is dismissive of what transpired in South Africa and agnostic to the detrimental impact on South Africa which disproportionately affected the poor.”

“Healthcare facilities should, however, be prepared. The focus in a South African context, unlike countries able to truly minimise infections en masse, is about minimising severe disease.”

“There needs to be an ongoing effort required to get beyond the 65% or older than 50 vaccinated to at least 90%.”

He said the current resurgence of Covid cases in South Africa is due to a sub-lineage of Omicron, known as BA4.

“South Africa is on the cusp of a resurgence, after the high infection rate with Omicron- albeit massive decoupling of infections and severe disease materialising.”

“ The current resurgence is likely due to a sub-lineage of Omicron- BA4. Most of the immunity in SA, unfortunately, resulted from infection, more than 80% infected since the start of the pandemic.”

“In addition, more than 40% received at least a single dose of a Covid vaccine. The evidence indicates hybrid immunity protects as well as the vaccine.”

“In addition, infection only induced immunity has been shown to be more protective than two doses of Pfizer only induced immunIty in a recent Qatari study.”

“That is not to say people should go out to be infected - as that comes at a cost of suffering and a loss of life, which is not the case with vaccines.”

“Nevertheless we cannot dismiss the impact that infection-induced immunity, that inadvertently evolved in SA despite restrictions, will have on the trajectory of the pandemic.”

Madhi said we are likely to experience an increase in cases during the fifth wave.

“It’s likely that we will experience many infections, more so in people not infected during the Omicron wave, but also some reinfections after Omicron if it had occurred some time ago. Infections are least likely if you have hybrid immunity.”

Madhi says however that it is possible to prevent infections.

“We can prevent infection by using the right type of mask (N95 type) and wearing it correctly.”

“It is important to also avoid indoor poorly ventilated spaces, which is something that needs to be considered for anyone at high risk of Covid irrespective of whether they have been vaccinated or not.”

Meanhwile Professor Refilwe Phaswana-Mafuya, a Director at the SAMRC/UJ Pan African Centre for Epidemics Research Extramural Unit, and Professor of Epidemiology and Public Health, in the Faculty of Health Sciences at the University of Johannesburg, said it was important that South Africa achieved higher vaccination rates as we enter into the fifth wave.

“We need effective targeted interventions by yesterday,” said Phaswana-Mafuya.

“We need higher vaccination rates and higher booster rates among higher-risk groups without health literacy, essential workers who are more exposed due to their living and working conditions, people with underlying conditions –prioritization of the most vulnerable groups is key.”

“We need to ask ourselves, is there still outreach work that needs to happen in terms of vaccine literacy? Definitely yes? We need to start moving away from blanket approaches to tailored responses, i.e: we need to shift from overall numbers to who is at higher risk and why they are at risk. Who is most affected by the recent surge? How are we addressing the needs of those most affected?

“Are there still interventions needed in terms of structural drivers? Surely Yes. Who ends up being hospitalized at younger ages?”

“The underlying determinants would not have changed since the past waves. It is important to do an updated analysis using the same dataset we used in 2021 to compare the older data to the newer data.”

“This will assist a great deal in having focused interventions, discerning what is of strategic importance rather than seemingly being reactionary. Identification of critical impactful interventions is key.”

Phaswana-Mafuya added that it was important that South Africans also don’t become complacent during the fifth wave.

“We need to guard against complacency at all cost, managing the risk is key driven by existing evidence of differential impacts.”

“We should take into serious consideration the risk heterogeneities and differential impacts of Covid-19.”

“While we continue mobilising people to adhere to evidence-based interventions such wearing masks, social distancing and hand sanitisers.”

“We should also focus on the bottom lines, such as poverty, unemployment and homelessness, for a much sustained response.”

“Focusing on the one side and overlooking the contextual realities of the majority of South Africans will always bring us back to square one.”

“Context is key! We will never become adequately ready until we address the underlying factors that drive disease severity, morbidity and mortality in South Africa, our analyses of surveillance data clearly demonstrated this. These will steer the ship in the right direction.”

However, she doesn’t believe that reinstating lockdown regulations will be necessary for the fifth wave.

“We are two years into the epidemic and are entering or fast approaching the fifth wave. I do not think that lockdown regulations can sustainably and magically overcome the underlying structural determinants of Covid-19 that drive disease transmission and severity resulting in differential impacts for different population groups such as overcrowded environments, inaccessible health care facilities, limited hospital capacities, under staffing and related public health system issues.”

‘We need to go beyond a short-range view and focusing on a long-range perspective that addresses health inequalities and inequities. This requires interventions to address occupational and living conditions that drive new infections, disease severity, and death.” “We are now two years into the epidemic; we need to start saying who is being affected most, why are they being affected and start looking at interventions to address those.” “Two years into the epidemic we really need to start addressing these. This is not divide and rule, it is the reality.”

“We cannot keep delaying those structural and resource-based interventions anymore. We need to strengthen public health systems, resources, processes, systems, and structures so that we do not worry about whether hospitals would be full.”

“We need to find out which hospitals will become more overwhelmed by new infections and why.”

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