Bracing for the third wave
The third wave may not be as bad as the second one, since at least 30% of the SA population has had the virus
ýA third wave of Covid infections is inevitable, says Aspen Pharmacare executive Stavros Nicolaou — but it is unlikely to be as bad as the second wave.
Nicolaou, who is also head of Business for SA’s public health workgroup, says there is greater “natural immunity” in the population. At least 30%-40% of the country is believed to have already had it.
Nonetheless, SA won’t escape winter deaths, as the season always sees a rise in respiratory infections, made worse by people gathering indoors where ventilation is poor, he says. Every year, SA reports about 11,000 flu deaths.
Nicolau says that getting a flu jab is critical, since it would be better if hospitals didn’t become simultaneously overwhelmed by flu and Covid cases.
He says SA is not in the third wave yet. “Deaths are low and daily infections are rising off a low base.”
But there are signs that new infections are rising, at least in Gauteng, the Northern Cape, the Free State and the North West.
It takes about two to three months for an increase in transmission to reach a peak, writes the SA Covid-19 Modelling Consortium (SACMC), a group of academics led
by Prof Harry Moultrie of the National Institute for Communicable Diseases (NICD).
But the SACMC predicts that in all five of its scenarios of future infections and in “the absence of a new variant, we expect the peak of the third wave to be lower than the second wave”.
Depending how it plays out, deaths could range from 7,800 to 70,000 in this wave, the consortium predicts.
But it adds the disclaimer that “these results are subject to substantial uncertainty due to the incompleteness of the seroprevalence and other underlying data, and unknown future population behaviour”.
It predicts Gauteng will have the worst third wave across all scenarios, due to the higher concentration of working-age adults and people with co-morbidities, and the lower estimates of previous infections in the province.
The NICD notes that at the end of 2020, at the height of the second wave, there was an increase in admissions of patients going to private hospitals with respiratory infections — more so than in the first wave.
In its latest report on such infections in the private sector, it says it is seeing an increase of infections in the Free State and the North West.
Covid test positivity ratios, a good measure of the illness, increased to 29% in the Northern Cape at the end of last week, 16.9% in the Free State and 12.3% in the North West.
If Gauteng is to be the epicentre of the third wave, it is bad news that one of the main state hospitals that treated severely ill Covid patients, Charlotte Maxeke Johannesburg
Academic Hospital, is still shut down after a fire raged through it almost a month ago.
Wits University professor Guy Richards says the hospital was treating 150 Covid patients at the time, often with various forms of oxygen and ventilators.
The hospital shutdown is going to be “a major problem”, he says. “The number of people we were admitting was about 20 per day. During the major part of the surge [there were] 120 to 150 patients in the hospital. So that will be a huge load that will have to be taken by areas which don’t have the capacity to manage them.”
Aslam Dasoo of the Progressive Health Forum says SA is in the same position now as when the pandemic started.
“We can confidently say that in the past year and a half nothing has changed in the structure of our
society, or in the structure of the national response, that would give us a better shot during this impending wave.
“And that’s truly tragic, because we need not have been in this position.”
Dasoo continues to call for the private sector, such as mining companies, to be allowed to buy vaccines as SA’s rollout is yet to start.
And he is critical of President Cyril Ramaphosa being distracted by ANC leadership battles, saying he needs to take charge of the pandemic and the faltering vaccine response.
Nicolaou points out that vaccinations will be not given to people older than 60, who are at high risk of complications, before winter and even when the rollout starts, it will take time to scale up.
And so it is up to people to avoid indoor gatherings and groups larger than 10, which Dasoo says are known to spread the disease faster.
NICD acting executive director Prof Adrian Puren echoes this sentiment: “Social activities and small gatherings should take place outdoors, if possible, or in well-ventilated areas with open windows and doors, as proper ventilation plays an important role in reducing the spread.”
But it seems there won’t be hard lockdowns if and when a third wave hits. “We have got better at balancing lives and livelihoods,” says Nicolaou.
The economy can’t afford shutdowns, adds Dasoo. “We’re not suggesting closing down schools or shutting borders. But when people’s behaviour can be altered, then I think we’ll see impact. You may be able to reduce the peak of the wave, maybe you’re able to reduce the extent and its duration. That’s all we have right now.” x
We’re not suggesting closing down schools or shutting borders. But when people’s behaviour can be altered, then I think we’ll see impact
Aslam Dasoo