Advice to Government: SA can get through the Covid-19 maze ahead of the festive season – here's how

It is the festive season again, and it once again feels scary. Despite the vaccines, there is a new frightening-sounding variant in town, Omicron (on the back of several we all now know – Delta, Beta and others). While our normal advisories are directed to you, the public, here we step away from that tradition and point this at our politicians and advisers. We are concerned that sometimes the noise of South Africa’s robust politics means the lessons of the last two years get muddied and diluted. So here are some thoughts, adapted from a Twitter feed and Conversation piece.

https://www.dailymaverick.co.za/article/2021-11-28-omicron-is-the-new-covid-kid-on-the-block-five-steps-to-avoid-ten-to-take-immediately/

We have, however, included some tips below for individuals and families – there is plenty you can do to protect yourselves this December (clue: vaccines and use the great South African outdoors and sunshine).

We are faced with a major surge, sadly with only nine million of the population having received at least two doses of a Covid-19 vaccine. So, we do need to get vaccinated as soon as possible (this includes getting “booster” doses as soon as eligible for them) and adhere to public health interventions that we all have come to know and hate. We have had several lockdowns and we have a lot of scientific, epidemiological and human behaviour data on what works and what does not, in terms of containing this pandemic. 

But first, let’s focus on what measures do not work:

No more restrictions (except on indoor gatherings)

At best, lockdowns may have somewhat delayed infections in the prior three waves, but an estimated 60% to 80% of South Africans have been infected, and at the expense of huge social and economic suffering. Lockdowns have no place anymore. They distract the country from where our energy needs to be – on supporting vaccination programmes and supporting the health system. Crucially, there is no value in imposing bans on outdoor activities such as visiting parks and beaches. People need to be outdoors for their health and well-being, and there is much better ventilation outdoors than in many other places that people were allowed to gather last year while walking on the beach was banned.

Unenforceable restrictions, and those we know will not be adhered to, do more harm than good

The television images of mass political rallies, often unmasked, in flagrant disregard of emergency regulations, undermines public health messaging, and makes it easy for the public to disregard more important protection messaging. 

Alcohol bans protected health facilities and ICU’s at infection peaks, but these bans have driven alcohol sales into a black market, which undermines policing and tax collection, punishing much of the population in the name of protecting the health system. The country needs to discuss sensible legislation on alcohol, noting the impact on society and the health system. This discussion should be broader than Covid-19.

Curfews are completely unnecessary. The virus does not restrict transmission to the early hours, and curfews inflict further suffering on shift workers, often the poorest. There might be a role for limiting alcohol consumption in public at bars, taverns and shebeens etc, but that needs to be tailored at a regional level based on whether health facilities are imminently under threat. 

No more travel bans 

This virus spreads very easily, and travel bans between provinces and countries clearly did not work with the previous lockdowns, as the virus hopped easily from one area to the next. Resources focused on enforcing these should be used elsewhere.

Importantly, it is very bad form criticizing international ‘’red lists’’ while considering banning interprovincial travel or with neighbouring countries. 

Stop delaying or creating unnecessary hurdles for vaccine boosts for high-risk individuals

We have a mountain of unused vaccines that are about to expire. We have sufficient evidence that boosting in key groups is likely to further protect them. Let it happen. It is no longer a matter of lack of vaccine supply in South Africa, it’s lack of vaccine uptake. Let over 65s get boosters immediately.

Stop talking about herd immunity

It isn’t going to happen (this virus will circulate and recirculate, like the other coronaviruses), and talking about herd immunity undermines vaccine confidence, providing fuel to opportunistic anti-vaxxers whenever completely predictable mild infections occur in vaccinated people.

Do not waste any resources on contact tracing

There is no role for it when the virus is already circulating widely and there is not the capacity to contact trace or quarantine/isolate properly. 

What SHOULD be done?

Prepare health facilities: This is critical, and this time do it in deed, not word. When the third wave arrived, proudly predicted by some provincial modelers, there were new facilities opened in the same provinces with no staff and no oxygen. Over 2,000 interns and community service doctors still await their 2022 placement confirmation. Coal-face workers were repeatedly failed by planners and managers in the prior three waves. We cannot afford to have this happen a fourth time. Hospital-based staff have learnt a great deal in managing severe Covid-19, using steroids and oxygenation strategies, but they need beds, nurses and other staff, and reliable oxygen supply. 

Monitor infection rates and act swiftly: Hospitalisations lag two to three weeks behind infection, so when infection rates rise, there is some time to prepare facilities. Previous waves frequently saw infection rates being noted to be rising, but little attention being paid to timely deployment of additional hospital resources.

Get an urgent second vaccine to all healthcare workers and others who were given a single J&J jab: It has become clear there are no “single-shot” vaccines – even J&J needs at least one more vaccine, either another J&J or Pfizer. Health care workers who participated in the original Sisonke trial, an urgent and necessary trial, are now clearly under-vaccinated, and should urgently get a top-up. Otherwise, they will be facing the fourth wave less protected than the South African public, an unacceptable situation. All adults who received a single dose of the J&J vaccine should be immediately boosted with either a J&J or Pfizer vaccine. If we delay, we will have preventable cases of Covid-19 hospitalisation in underimmunised individuals. 

Enforce vaccine passports for entry into public spaces, including places of worship, taxis and restaurants: We know vaccine mandates are controversial, but they have been implemented with relative ease and success in places such as France, and have considerably driven vaccine uptake. People who refuse a safe vaccine endanger others and health care systems. Consider vaccine mandates for companies – they have been very effective in the US.

Aggressively improve access to vaccination; make getting a vaccine very easy: Use pop-ups in areas (taxi ranks, malls, grants queues) and drive-throughs, and ensure that getting a vaccine is dead-easy. Even consider door-to-door programmes, which have been used in places in the Eastern Cape. Expand incentive programmes and use community champions. Discard immediately the need for people eligible for a third dose of vaccine to provide a medical certificate testifying to their eligibility. The vaccinated are those who can be trusted to do the right thing.

Focus on meaningful communication programmes: Emphasise the danger of crowded indoor spaces, and how ventilation (opening windows and doors) is highly protective, and how masks in indoor crowds may provide some protection. We now know that surfaces play little, if any role, in transmission, so de-emphasising this surface-wiping message makes sense. Although washing hands does not reduce risk of acquiring Covid it makes general health sense and should be maintained. Draw in actual communication experts to help make content and platforms more appropriate, and messaging that extends beyond finger-wagging at matric rage parties.

Reflect hard on why vaccine targets are not being met: As we write, only a third of South Africans have received at least a single dose of vaccine, largely through the private pharmacy chains or non-governmental organisations. Many countries in the world have achieved substantial vaccination rates, in far less time. The South African government has missed every self-imposed target by a huge margin. This is a devastating failure of our people, and of our health care workers. We need new energy, and new plans, with the health minister and acting DG given the resources and total government support that brought the entire country to a standstill in March 2020.

Continue to focus on vaccine procurement and fight vaccine inequity: Delivery has not always matched promises from vaccine suppliers. The only reason this hasn’t been a problem is that the vaccine programme has been so slow. But suppliers have prioritised rich countries, even when payment has been made, and this should be made public. Quietly and meekly accepting this is not acceptable. We must continue to protest the patent situation, and advocate for expanded production, while holding manufacturers accountable for delivery promises.

Start thinking about the smart use of antigen tests: These can give a result quickly and cheaply, and while not as accurate as a PCR test, can be used far more broadly. In a world where we need to start travelling and opening up again, and where short-course antiviral drugs may be used to treat and prevent the virus, these tests may well be very useful in our homes, clinics, workplaces and schools.

We need to live with the virus: It is almost certainly here for good. We have lots of other circulating nasty viruses and we do not routinely shut down our society with devastating economic, societal, educational, mental health and other health effects. We need a rational, thoughtful approach to balance the real health effects of Covid-19 with living happy lives.

Be bold with next steps: We have many lessons learnt from the past two years. We can make 2022 a much better year. We need to tailor our response on what is appropriate for our context and stop blindly following advisories and initiatives of others that is not applicable or implementable in our own context. DM/MC

Author list:

• Professor Shabir A. Madhi, Dean Faculty of Health Sciences and Professor of Vaccinology at University of the Witwatersrand; and Director of the SAMRC Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand


• Professor Marc Mendelson, Head of the Division of Infectious Diseases & HIV Medicine at Groote Schuur Hospital, University of Cape Town


• Professor Francois Venter, Division Director, Ezintsha, University of the Witwatersrand


• Dr Ndiviwe Mphothulo, private practice


• Professor Shaheen Mehtar, University of Stellenbosch


• Professor Lucille Blumberg, Right To Care


• Professor Lucy Allais, Department of Philosophy, University of the Witwatersrand and Johns Hopkins University


• Dr Jeremy Nel, Head of Department, Infectious Diseases, University of the Witwatersrand


• Professor Yunus Moosa, Head of Department of Infectious Diseases, UKZN 


• Dr Jantjie Taljaard, Tygerberg Hospital and Stellenbosch University.


• Professor Regina Osih, Aurum Institute and Vanderbilt University School of Medicine


• Dr Sarah Stacey, Clinical Head of Unit, Division of Infectious Diseases, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand


• Dr Samanta Lalla-Edward, Ezintsha, University of the Witwatersrand


• Professor Wolfgang Preiser, University of Stellenbosch.


• Professor Imraan Valodia, Dean: Faculty of Commerce, Law and Management; and Director: Southern Centre for Inequality Studies, University of the Witwatersrand


• Dr Aslam Dasoo, Progressive Health Forum.


• Professor Glenda Gray, University of the Witwatersrand and Medical Research Council


• Professor James McIntyre, CEO, Anova, and School of Public Health & Family Medicine, University of Cape Town


• Professor Eric Decloedt, Stellenbosch University


• Professor Alex Van Den Heever, University of the Witwatersrand


• Dr Joana Woods, Ezintsha, University of the Witwatersrand


• Professor Morgan Chetty, Visiting Prof Health Sciences, Durban University of Technology