OPINION: People should not let their guard down and be complacent.
By Dr Zameer Brey and Dr Yogan Pillay
AS WE write this South Africa is beginning to experience some respite from the third Covid-19 wave. We hope that the only waves we will all be discussing in December, relate to the beach and that the expected surge in cases in Q4 will be a blip rather than a wave. Cases have declined steadily over the past 2 weeks and positivity has now dropped to single digits at about 9%.
Hospitalisations have decreased by 23% week on week as have deaths. For the first time in weeks, we saw 100 deaths on Sunday passed, 58 to be exact. However, this respite may not last very long and depends on our behaviour, including use of masks, social isolation and vaccination coverage.
Based on evidence we have now, we know that these combined tools can be really effective in flattening a forth wave with individual responsibility and collective effort.
Many scientists think that South Africa will experience a forth wave before the end of the year. This is largely based on the patterns seen between the first and second and second and third waves. These differences are largely driven by clusters, population density, movement of people, differential rates of infection of the different variants and levels of immunity from previous waves.
Before the anticipated fourth wave what should South Africa do to prepare for it and flatten the curve?
Protecting health workers
There is a high level of fatigue experienced by front-line health workers. They have experienced personal loss with family members and friends’ demise as well as when their patients die. A colleague recently said to us that he “has never seen so much death in his entire career as he saw in the last 18 months”. They have had to take precautions to ensure that they and their immediate family members do not get infected.
Many health workers did get infected and sadly some have died. To protect front-line health workers, managers need to urge them to take leave to rest and spend time with their families. In addition, additional psychosocial support should be provided to them.
The physical exertion this epidemic placed on the health system was significant but pales in comparison to the mental and psychological trauma front-line workers have had to endure to date, with likely long-term consequences.
The public can find creative ways of thanking health-care workers and celebrating their heroic efforts to date. Our words, gestures and encouragement will be invaluable for them personally and for morale across the system.
If there is an increase in Covid-19 patients need admission in December – when many health workers take leave – hospitals will be short staffed. This may be exacerbated if injuries and trauma rise with increased access to alcohol.
Protecting the most vulnerable and playing our part
There should be increased communication with communities and those at higher risk for Covid-19 infection (people over the age of 50, those with diabetes, hypertension, obesity) to take additional precautions to protect themselves.
People should not let their guard down and be complacent. To date, less than 50% of the 50+ population have been vaccinated and we will need about 1 million of us who are 60 years + and 1 million 50+ years to reach the target coverage rate of 75%. We have enough vaccines and vaccinators but need to support the most vulnerable to get to a vaccination site.
Play your part by identifying someone in your family or community who needs help and offer to assist them. The sooner we get higher rates of coverage, the sooner we are likely to return to some level of pre-Covid normalcy.
Seek health care – it’s safe and important
Many people did not receive care for routine health conditions, during the peak of the first 3 waves and when the country was in lockdown levels 4 and 5.
Some services suffered tremendous setbacks and likely pushed back progress in 5 –10 years back . TB testing dropped 35% when we know that we are not testing and treating some 160 000 persons with TB each year. Similarly HIV testing rates declined by more than 22%. In-hospital maternal mortality rates increased by almost 23% in less than 12 months – an extremely worrying trend. Many people were fearful of visiting health facilities or did not have access to transport or facilities were closed.
It is safe to visit health facilities and people who need health care should seek health care. The major gains made in decreasing deaths from HIV, TB, as well as deaths in pregnant women and children may be reversed if people do not attend clinics for testing and treatment of HIV and TB, antenatal care and immunisation of children.
Protecting the economy and end of year festivities
In order to protect access to routine health services, save lives and protect the economy from further erosion we need to ensure that all workers are vaccinated and that we work together to ensure that the number of Covid-19 infections do not escalate to levels that require the government to implement stringent lockdown.
If the number of Covid-19 cases rises sharply in December and the government imposes severe lockdown, this will result in the cancellation of the usual Christmas and end of the year festivities and have a significant economic impact on the travel, tourism and entertainment sectors – leading to more job losses.
Covid-19 silver-linings?
While the Covid-19 pandemic has presented the country with many challenges, socially and economically, we need to also consider the opportunities that it presented.
South Africans pulled together to respond to the pandemic – showing the social cohesion is possible even in the context of significant inequities. To address the impact of the pandemic on livelihoods, the government was able to increase financial support through a range of different grants. This can pave the way towards a basic income grant that many argue will assist millions of South Africans.
Bending the curve of the anticipated 4th wave
It is critical to ensure that the fourth wave has a lower peak than any of the previous waves and that the number of people who are severely ill are reduced. Both of which will reduce the need for severe lockdown and decrease the pressure on the health system.
The fly in the ointment – like we saw in the second and third waves – is if there is a different variant to the delta variant and if it is highly transmissible and virulent. This is not known at this time. But what we do know are that vaccines are working.
Data from the Western cape shows us that 95% of all Covid cases admitted to hospital in Cape town were amongst the unvaccinated and 97% of deaths were among the unvaccinated. If we accelerate our vaccination coverage we can collectively bend the Covid curve and look forward to an enjoyable and much need festive period for everyone. Each of us has a role to play . Hope to see you on the beach in December!
In 2007 Madiba said that “it is in your hands to make a better world”. This is as relevant today as when he made this statement. Getting vaccinated and encouraging others to vaccinate, using masks and social distancing are all in our hands.
*Brey is a senior programme manager at the BMGF (Bill & Melinda Gates Foundation) and Pillay is affiliated with the Center for Innovation in Global Health at Georgetown University.
**The views expressed here are not necessary that of IOL.