SA has changed tack on mitigating impact
IN THE final days of 2021 the government eased its Covid regulations. On December 30, the government scrapped a curfew that had been in place since March 2020.
It also initially announced an easing around quarantines and contact tracing but subsequently reversed these plans. Nevertheless, its approach sets a new trend in how countries are choosing to manage the pandemic. Shabir Madhi and colleagues reflect here on the boldness and the risks.
What are the main elements of its new approach?
The government has decided to take a more pragmatic approach while keeping an eye on severe Covid cases and whether or not health systems are imminently under threat.
This reflects acceptance that governments will increasingly be looking for ways to live with the virus cognisant of the detrimental indirect effects that restrictions have been having on the economy, livelihoods and other aspects of society. This is particularly pertinent in resource constrained countries such as South Africa.
The latest announcements mark a significant departure in the way forward. They mark a pragmatic approach that balances the potential direct and indirect detrimental effects of Covid.
Our hope is that the government continues to pursue this approach and doesn’t blindly follow policies that are not feasible in the local context, and ultimately yield nominal benefit.
The new, more nuanced approach is in stark contrast to reflexively imposing higher levels of restrictions as case rates increased.
This suggests that the government has taken note of commentary that has provided suggestions to focus on whether the health facilities are imminently under threat, rather than simply going to higher levels of lockdowns.
The main element of the new approach arises from a high level of population immunity. A sero-survey conducted in the country’s economic hub, Gauteng, just prior to the onset of the Omicron wave indicated that 72% of people had been infected over the course of the first three waves. Sero-positivity was 79% and 93% in Covid-19 unvaccinated and vaccinated people older than 50 years, a group that had previously made up a high percentage of hospitalisations and deaths.
The sero-survey data show that immunity against severe Covid in the country has largely evolved through natural infection over the course of the first three waves and prior to the advent of vaccination. This has, however, come at the massive cost of 268 813 deaths based on excess mortality attributable to Covid-19.
Is it clear what the goals are?
The goal has to be minimising hospitalisation and death. It is unnecessary to be stressing out the economy, other health services and livelihoods in South Africa.
The death rate with Omicron wave in South Africa is on track to be approximately one-tenth compared with the Delta wave. This means it possibly on a par with deaths caused by seasonal influenza pre-Covid – 10 000-11000 per annum.
This death rate also needs to be considered relative to other preventable deaths. TB is an example, which is estimated to have caused 58 000 deaths in South Africa in 2019.
It’s impossible to say what the characteristics of future variants would be over time. But the experience with the Omicron wave in South Africa provides some comfort that immunity against severe disease and death will continue tracking downward, particularity if vaccine coverage can be increased to 90%, particularly in the 50-year-old plus age group. The high force of infection that has likely transpired with Omicron will also further contribute to enhancing protection against severe Covid-19 in the immediate future.
What are the risks?
The major risk is the unpredictability of new variants that evade all aspects of past infection and vaccine induced immunity. But this is likely to be the result of the evolution of the virus rather than any changes in policy.
Another risk is failure to change the pandemic mindset and failure to appreciate that with Omicron the epidemic phase of Covid-19 is coming to an end. The country and all its institutions and people need to prepare to get back to a previous life – most notably the health services.
The South African government appears to have come to appreciate that the past practices have had limited success in preventing infections, and fully appreciates the detrimental effects that restrictions have had on the economy and society. In addition, it has run out of road to continue with what has unfortunately not yielded much benefit. Despite all the severe lockdowns, South Africa still ranks high with a Covid death rate of 481 per 100 000.