TALKS of a fifth wave of the Covid-19 pandemic has South African’s flustered once again as infections rise daily.
According to an AP report, the new wave of Covid-19 infections in South Africa may be driven by a new variant known as Pi and could spread faster than Omicron.
Ozayr Mahomed, a public health specialist at the University of KwaZulu-Natal, said South Africa should brace for a high number of infections.
He said research had shown that the fifth Covid-19 wave would be driven by a new variant, Pi, that would spread faster than Omicron and infect more people quicker. The ministry of health has, however, not yet declared the country as undergoing a fifth wave of the pandemic.
Professor Ramneek Ahluwalia, a qualified physician and a health systems, policy and management specialist, said there were several factors happening in South Africa at the same time, which had led to a blip in our Covid-19 infection rate.
“We have just come out of a festive season in which there was a lot of socialisation and a lot of mobilisation of people.
“People went home (to different provinces), there were different functions, and we had the Easter holiday period. This is exactly what the virus enjoys - moving from one human to the other in a quick space of time. And so, human behaviour attributed quite tremendously towards where we find ourselves now.
“At the same time, the second factor was the national state of disaster, which obviously was rightfully removed, but it also came up with the point that there was no need for mask-wearing in certain settings.
“However, the mask-wearing in a closed environment or in indoors is important with an airborne disease, not only for Covid-19 but for any airborne disease.
“The third factor that happened, at the same time, is that we seem to have entered winter earlier than we usually do, in April. So all of these factors combined, and happening, at the same time led us to arriving much earlier than we would have anticipated in the scientific world when it comes to Covid-19.”
Ahluwalia said a fourth factor was that the virus - which as per normal virus evolution where viruses mutate - had mutated.
“So, this existing Omicron variant found joy during this time in mutating itself and kind of changing its shape and structure. It started developing more. It started becoming more aggressive, more contagious. We now have the BA.4 and BA.5 mutations.
“Similarly, these new sub-variants of the same Omicron variant began showing different clinical patterns. More importantly, it developed into a shape which became unrecognisable to the human body when it enters. We call this immune evasion.”
There are new mutations of Omicron that have made matters more challenging, he said.
“In terms of these mutations, we are seeing different symptoms in different patients. Common symptoms associated with the current predominant sub-variants are sneezing, nasal congestion, sore throat, cough and fatigue. Some people also report gastrointestinal cramps and other stomach-related conditions. If you notice any of these symptoms, it’s best to immediately test for Covid-19, and if positive, to immediately self-isolate. If symptoms get more severe, seek medical assistance.
“This is the first time that we have seen a sub-wave of the same Omicron also behaving as if it's a new variant of Covid-19 because it has established all the properties that a variant establishes. There are three properties: when it becomes more contagious, which is more transmissible, it changes its clinical pattern. This means it changes its virulence. And the third important thing is that it becomes immune evasive.”
He said the virus had changed its shape in a way that when it entered the human body - despite you being vaccinated or despite having a previous infection, which means you have some immunity - the body does not recognise it for some time.
“This then gives this virus free reign in our body to bind to human cells and multiply. We call this a viral load. This means we are bound to get a breakthrough infection. This means we get some infection, but because we are vaccinated or had the previous infection down the line, our bodies start recognising this once it has slightly multiplied, and then, eventually, it is overcome.
“This is why we are not seeing a severity of infection and why we are not seeing mass hospitalisations again, which means vaccines are still safeguarding people in ultimately overcoming the virus.”
Immune system, vaccinations
Ahluwalia said our immune systems, which are our first, second and third line of defence, are reacting to the new mutations.
“The first two lines are being slightly defeated by the new mutations. But our third line of defence, which we call Member T Cells, which are built through vaccines and an acquired immunity, find control, at least not leading to a stage of death or severity of disease. So yes, getting vaccinated and timely booster shots is critical because eventually, what we always want is not losing human lives, not getting ICU admissions and not getting severity of disease.
“You have to go for both the annual flu vaccine and your Covid vaccines because the last thing you want is having Covid supplemented by a flu infection because your body is already fighting a major virus, and then it has another virus at the same time. So if you can find protection and you can prevent it, do so.”
Ahluwalia said prevention was not just via vaccination.
“Wearing a mask indoors will prevent you from contracting both flu as well as Covid because they are both airborne diseases. Keep ventilation good in rooms: have doors and windows open even though it's winter. The vaccination will boost your immune system to fight these infections. All of this becomes handy during the winter season when the flu season will join or partner with Covid to attack our human bodies.”
Ahluwalia said some scientists believe some of our provinces are already in the fifth wave because they are looking at the criteria by which we classify a wave.
“The criteria is that when a third of the last peak is reached for seven consecutive days, we start classifying that we have entered into a new wave. Indications are for many provinces currently, specifically the three bigger provinces, that we are almost entering or may have entered the fifth wave.
Ahluwalia said as much as the virus was mutating and had a high affinity now to a younger age group than its previous predecessors, children are seemingly still far more stronger and protected - both in acquiring and spreading the virus like adults do.
“This means that we have this inbuilt phenomena that helps us to not be concerned too deeply as far as young children of concerned. Young children are becoming positive, no doubt they can be possible carriers, but their levels are far lower as compared to an adult.
“What is advised to all parents and schools is, if you ask my personal advice from a scientific world, to please ask children to wear masks during winter and especially indoors. Ventilation is critical in schools.
“Having windows and doors open, getting good sunlight and a good breeze indoors will definitely help prevent infections. And lastly, for children who are above the age of 12, they should be vaccinated when they have access to vaccinations. This is important to help us safeguard through the winter, especially when the virus is at its peak.”
He said while the current sub-variants are causing us to lean towards the fifth wave spike, another hard lockdown was not expected, but that could change depending on the viruses' evolution.
“We have to keep in mind psychosocial issues and development issues. These are one of the two big economic and social indicators that we have to be careful and sensitive over. When it comes to schools, education and child development, in terms of what has been lost over the last two years, we need to be careful.
“We have to strike a balance. We need to figure out how do we still develop our young people in both psychosocial and resilience abilities while we have to understand and live with the virus, which has an airborne nature at this time.
“That requires us to think out of the box. It requires interaction with our curriculum. We have a little bit of online or digital interactive sections, a hybrid mechanism of working, finding more extra-curricular systems of growth, even if a hard lockdown has to be imposed.”
Ahluwalia urged students and staff, who are returning to campuses, residences, classrooms, laboratories, offices and other indoor congregation settings to continue daily use of its Covid-19 screening tool, HealthCheck, before leaving home or residence for work or educational institutions.
Ahluwalia said there was fatigue around the virus.
“I fully understand this. It has not been easy over the past two years, but there is a balance that is required. We need to educate our people. When crises like these waves that are happening hits, we need to see media houses informing people. This will help go a long way in building a consensus among our population to fight challenges like these because we will have to fight more in the future.
“Climate change, our lifestyle, human population growth, there are multiple factors that play a role, irrespective our immune systems. These are all contributing factors towards a difficult few decades and centuries for our future population. It is now for us to understand that these problems are not going to come down. They are going to always be around. We need to always be prepared. This pandemic is a big wake-up call.”
Ahluwalia is also the CEO of Higher Health, an organisation that focusses on safeguarding the health of South African students and youth and holistically supporting the progress and completion of their studies.