Gauteng has already entered its fourth wave of Covid-19 infections, says Professor Shabir Madhi, the dean of the Faculty of Health Sciences and professor of vaccinology at the University of the Witwatersrand.
Madhi told Health24 that this was based on the province’s positivity rate of 19%. The positivity rate refers to the percentage of all Covid-19 tests that come back positive.
Gauteng accounted for 72% of new Covid-19 cases on 30 November, according to the National Institute for Communicable Diseases (NICD).
“Other provinces are likely to follow in the next three to four weeks,” he said.
According to Madhi, one can determine whether a country or province has entered a new wave when the positivity rate is greater than 10% for at least two consecutive weeks.
Fourth wave ‘inevitable’
Spokesperson for the Department of Health, Foster Mohale told Health24: “Essentially [a fourth wave] is inevitable and we should act as if we are in a wave.”
Mohale said that the identification of the start of a new wave is dependent on which definition is used.
The NICD previously referred to a new wave as “an occurrence, after the previous peak, where the caseload returns to at least 30% of the previous peak’s caseload.”
Health24 reached out to the NICD for comment and did not receive a response at the time of publication.
‘It’s what we expected’
During a media briefing on Monday, Dr Michelle Groome, head of the division of public health surveillance and response at the NICD, said: “We’ve seen an increase in the number of cases in Gauteng. For all intents and purposes, Gauteng has entered the fourth wave – we’re seeing high positivity rates. This is most likely going to extend to the other provinces…”
But acting director-general (DG) of the health department, Dr Nicholas Crisp, said during the briefing: “It’s purely academic…whether Gauteng is actually already there or not there. It’s a question of time and this is what we expected would happen roundabout now.”
Gauteng has 4 407 functional beds, Freddy Kgongwana, the head of hospital services at the Gauteng Health Department, said on Monday, News24 reported.
He added that the department aimed to hire an additional 1 000 healthcare workers, but that it was ready for the fourth wave.
Reducing severity of fourth wave
The new variant of the virus that causes Covid-19, Omicron, is potentially driving cases in Gauteng and scientists believe that it may have already spread to the rest of the country. The variant of concern has also been found in 11 other countries.
For the past couple of weeks, experts and officials have urged people to behave responsibly over the upcoming holiday season.
Madhi said that to reduce the severity of the fourth wave, health facilities must ensure that they are adequately resourced and prepared for the resurgence.
Projections by the South African Covid-19 Modelling Consortium team also indicated that the country is expected to have fewer Covid-19 hospital admissions during the predicted fourth wave.
However, the scientists cautioned: “Whether or not the admissions will result in overwhelmed hospitals and avoidable Covid-19 deaths also depends on how much hospital capacity can continue to be made available.”
Curbing virus transmission
Madhi added that people should also take precautions and follow Covid-19 public health measures.
He said: “Minimise indoor gatherings, especially in poorly ventilated spaces and where unvaccinated [people are] allowed to roam as they are also likely not to adhere to other recommendations, e.g., adequate face-masking when indoors.”
Madhi stressed the importance of vaccination: “Get vaccinated and a booster dose as soon as it is available – this will help to protect especially against severe disease, but it also reduces the risk of infection and infectiousness.”
Booster doses of the Johnson & Johnson vaccine are being offered to healthcare workers who were part of the Sisonke 1 trial, although uptake has been worrisome.
Said Madhi: “They need to step forward to receive a booster immediately, and not wait for their preferred choice of vaccine. Although a Pfizer boost will likely confer greater protection against infection and mild Covid-19 than a J&J boost (as is the case for AstraZeneca and Pfizer vs even Pfizer and Pfizer), boosting with either will likely protect similarly against severe Covid, even due to Omicron.”
Professor Ian Sanne, head of Right to Care and a member of the ministerial advisory committee (MAC) on Covid-19, also told Health24: “The Sisonke boost team leadership is encouraging all healthcare workers to take up the offer of the J&J boost as soon as possible as the study enrolment will stop on 17 December.”
Pfizer and BioNTech have already applied to have their Covid-19 vaccine approved by the South African Health Regulatory Products Authority for use as a booster, according to reporting by Bloomberg in November.
Vaccines and Omicron
While research on the Omicron variant is ongoing and results are expected within the next few weeks, some experts believe that the current vaccines will still be effective against severe disease caused by the variant.
“Protection of the vaccines is likely to remain strong,” epidemiologist Professor Salim Abdool Karim said in the briefing.
He added: “I don’t know this definitively – the studies are being done – but based on what we know, we can expect that … the vaccines should hold well in preventing hospitalisation and severe disease.
Madhi said that there would be breakthrough infections (people who get Covid-19 after being vaccinated). However, infections will happen less in this group than in those who are unvaccinated, he said.
“[And] despite an increase in case rate, even among vaccinated, they will be less likely to end up in hospital,” Madhi added.
Antibodies, T cells
Madhi explained that this was due to one arm of the immune system, known as antibodies, which plays a fundamental role in preventing infection and mild Covid-19 disease. In this regard, protection against Omicron (similar to Beta which dominated South Africa’s second wave), will be diminished, according to Madhi.
But there is another crucial part of the immune system, called T cells, which confers protection from severe disease.
Madhi explained: “However [the vaccinated] will likely have relative sparing of the T-cell immunity, which is less affected by the mutations, and is considered to be the main driver in protecting against severe Covid-19 – even due to the Beta and now likely the Omicron variant.”