Johannesburg – It has been two years since the first Covid-19 case was reported. Life changed drastically. Through the help of modern medicine and researchers, we now have more information on the virus, and we are better equipped to deal with it, say researchers.
President Ramaphosa relaxed the rules giving people the freedom of not wearing masks outdoors but keeping it mandatory to wear indoors. The new ruling has baffled people, but there is science behind it.
Dr Waasila Jassat (MBBCh, MMed, FCPHM), medical doctor who works at the National Institute for Communicable Diseases (NICD), explained that with the newfound information and people being vaccinated, it is safer to start returning to some degree of normality.
“We have learned a lot about SARS-CoV-2 since early 2020 in terms of transmission and detecting and treating COVID-19. Initial measures of containment in 2020, which largely relied on quarantine and contact trace, hand sanitising, temperature and symptom screening, are now being thought to be less effective in our national response.”
Jassat says this is largely because we have entered a new phase of the pandemic with the availability of vaccines, new treatments and “having achieved a high level of immunity in SA”.
“In an effort to transition to a new normality of living with Covid, we are also relaxing other regulations around outdoor gatherings, including the need for masks. However, there is still a need to limit indoor gathering and to ensure well ventilated indoor spaces, and mask wearing. During periods of higher transmission (during a wave), we would still advocate for social distancing and mask wearing,” explained Jassat.
The reason for easing these conditions is based on information with regards to how many people test positive and how the virus is spread. Regulations consider the number of people infected who have a test done.
“We know that along with droplet spread, SARS-CoV-2 is also spread by aerosols. We know that a lot of transmission happens from asymptomatic people who we rarely detect on testing anyway. We know that only about 10%-15% of the people who are infected actually do the test. We have therefore removed the need to quarantine and contact trace, removed isolation for asymptomatic people and reduced the duration of isolation as most spread is likely to happen in the first few days when most infectious.”
Along with the mask rules being eased, social distancing has also reduced. Even with it being reduced, it is still a viable option to reduce transmissions, more effectively during a wave or periods of slower and lower transmission rates.
“Limiting your contacts is the best way to prevent transmission. Most transmission likely occurs in the home setting among family members and visitors who spend long periods together in indoor, poorly ventilated spaces, so it makes more sense to be careful with those types of indoor contacts. Outdoor contact in well ventilated areas is less of a risk for transmission. Ventilation is absolutely key.”
Now, Jassat is convinced they know enough “about the virus and its mode of transmission and about the effect of vaccination on reducing transmission. What is less understood is if “there are any genetic, biological or social factors,” that can help to determine the risk of infection and the severity of it.
A doctor, who preferred to remain anonymous, agrees with Jassat but feels the public has not been doing their part.
“The problem is it’s one sided. The public are not always doing their part when it comes to their health. People wanted a vaccine and now that it is here, they don’t want it.”
The General Practitioner (GP) said, there remains doubt over the vaccine for some people, but research has shown that vaccines are doing what they are intended to do.
“What is very clear is that vaccines have been shown to be highly effective at reducing the risk for severe infection, severe disease, hospitalisation and death. The key intervention right now in our response is ensuring we achieve a higher coverage of primary vaccination and booster doses are given to those who are at high risk to ensure that they are protected from hospitalisation and death.”
High risk is still regarded as those over fifty and those with comorbid disease. Research has not only given us knowledge into how the virus is transmitted but it has also given us insight into what treatments work and what doesn’t.
Early studies in 2020, says Jassat, showed the effectiveness of steroids, high flow oxygen and anticoagulants for hospitalised patients. These formed the anchor of clinical guidelines. Systematic reviews gave evidence of what did not work.
“Proposed treatments like hydroxychloroquine, colchicine, ivermectin, and vitamins were also shown to not be effective in treating COVID-19. Studies showed that antivirals like remdesevir, and monoclonal antibodies may be effective, but these were unaffordable in most of SA. In other countries, antibody treatment like Regeneron was used with good success, but these also showed less effectiveness against variants and were expensive,” said Jassat.
As of late 2021, new antivirals such as “Paxlovid from Pfizer and Molnupiravir from Merck” have been shown to be effective at treating early Covid for those at high risk of severe disease, however it is anticipated that they would only be approved and available in SA by end 2022.
The NICD gathered research using the national hospital surveillance system and the results indicated to them that the hospital mortality rate was sitting at around 23% which is quite high. It further revealed that the most at risk of mortality were older, males, dark-skinned and those with comorbidities like hypertension, diabetes, heart disease, kidney disease, cancers, obesity, HIV and TB.
“Our studies also showed that a large number of people experience persistent symptoms after hospitalisation with Covid (or Long COVID). These findings have informed key strategies around vaccinating high risk individuals to reduce risk of hospitalisation, severe disease and death.”
Long Covid is something almost unheard of, but it is something that can occur in a person who decides to treat themselves, said the GP.
“People think that surviving those two weeks of Covid is the end goal. They do home remedies without getting medical help. Then you have “Flu symptoms” which keep recurring or never totally disappear. People must seek out professional help.”
According to Maria Van Kerkhove of the World Health Organisation, there is a lot of misinformation about the virus spreading. Such as Omicron is mild, the pandemic is over, and this is the last variant we will experience.
The pandemic isn’t over. A new wave is likely to occur when a new highly transmissible variant emerges. China has locked down the city of Shenyang as health authorities recorded 4,770 new infections across the country. People can become careless as our restrictions are eased and lifted but if people continue to follow non-pharmaceutical interventions (NPIS) – wearing masks and hand sanitising – a new wave can be prevented, said Jassat.
“It mostly depends on the characteristics of the variant, but certainly can be limited by individual NPIs, especially indoors. These measures are more important, given that in SA, there is unlikely to be higher level government restrictions. We should ensure that while we reduce restrictions and limits on gatherings and mask wearing, that during a wave we still have higher vigilance, and take more individual and workplace measures to reduce exposure, including limiting gatherings during waves.”
However, Jassat said, even with new variants, while there has been some loss of effectiveness, vaccination has still been shown to be highly protective against severe disease, hospitalisation and death.
“We therefore need to ensure high risk vaccination coverage and boosters for those at high risk.”
People need to remind themselves of the first wave. When hospitals are overburdened and understaffed. Another wave will only worsen it, said the GP.
With all this in mind, Jassat believes the government made the right move when it comes to easing restrictions, lessening isolation days and in some cases removing it completely due to “the human, economic, social and societal cost of these measures. But also because of high immunity in SA.”
The economy has suffered from the pandemic, and it is important “to open schools and resume some level of normalcy,” while also maintaining “individual measures to protect against transmission,” and ensuring “high vaccination coverage and booster doses for those at high risk, which will likely protect even with emergence of new variants.
