South Africa faces an Omicron-induced patient care crisis unless the current government policy of isolating Covid-19 infected healthcare workers for 10 days is rapidly changed.
This emerged yesterday from two of the country’s top Covid-19 experts, Richard Lessels, one of the infectious disease experts who discovered the Omicron variant, and leading vaccinologist, Shabir Madhi, dean of the Faculty of Health Sciences at the University of the Witwatersrand.
Victor Khanyile, the deputy director of human resources at the department of health, said there were 72 678 public sector healthcare workers infected as of 6 December, representing 18% of the entire public healthcare workforce — 403 443 clinical and support staff.
Gauteng, at 17 008, has the highest number of healthcare workers infected followed by the Eastern Cape with 11 975 and KwaZulu-Natal with 11 246.
“We do daily surveillance in our expanded programme on immunisation, and we’re monitoring the situation,” Khanyile added.
Uniquely, Omicron has the ability to re-infect people who caught Covid-19 in previous waves, or those who are vaccinated, creating mild breakthrough infections, said Allison Glass, lead clinical virologist at Lancet laboratory’s molecular biology unit. This, coupled with the 10-day healthcare worker “isolate and contact trace” public healthcare policy, poses a tangible threat to patient care in general wards.
Although the variant is still under intense study, it is so far causing only mild to moderate disease — but it has spread faster than any previous mutation.
It is rampant in Gauteng, particularly Tshwane, North West, Mpumalanga, Limpopo, Eastern Cape and KwaZulu-Natal. It is expected to be in all provinces within a fortnight.
Initial laboratory studies indicate that it might be shorter-lived than previous variants but, according to Glass, it’s too early to draw any conclusions.
Tertiary and secondary hospital managers are relieved that their understaffed intensive care units and high care wards are not under any immediate Covid-19 threat and can continue handling the routinely high volumes of non-Covid patient traffic.
But, it’s the general wards the experts are worried about.
Sources close to the Ministerial Advisory Committee on Covid-19 said the health department held urgent meetings on Wednesday to discuss reducing the 10-day isolation period to five days as soon as possible.
“I suspect they’d love to scrap isolation altogether in this current context, but the World Health Organisation [WHO] is very conservative, so they’ll almost certainly compromise at five days,” one source said.
Madhi called for the scrapping of any isolation, saying that although there were “massive” numbers of people becoming infected, the infections were mild.
“The bigger problem is the pressure that isolating healthcare workers will put on the healthcare system. They must immediately reconsider the isolation policy. There is very little reason why vaccinated people with breakthrough infections should be in 10 days of isolation. It should at most be five days, if at all,” he said.
“In fact, if they are asymptomatic, I’d go so far as to say don’t isolate at all, just wear a face mask and do proper hygiene. The current isolation policy will just put pressure on other healthcare workers and compromise your ability to deliver quality healthcare.”
Madhi said the Johnson & Johnson vaccine booster shots being urgently administered to healthcare workers have a milder antibody response to Omicron than the two-dose Pfizer shots. He cited a study published on Tuesday showing that the neutralising antibody activity to Omicron of the Pfizer vaccine had decreased 40-fold compared with the Beta variant.
“So, it’s completely predictable that the Johnson & Johnson vaccine produces a rather modest antibody response compared to Pfizer — and, yes, breakthrough infections will now occur with all vaccines. On the flip side, there’s very little indication that breakthrough infections are progressing to severe disease,” he added.
He described the health department’s staff isolation infection policy as “obsolete”.
Lessels said overall hospital admissions were rising at a rapid rate, compared with previous Covid-19 surges, but stressed that this was from a much lower base, there being very few hospital admissions or Covid-19 hospital bed occupation at the beginning of November.
Describing some of the unique properties of Omicron, he said: “It’s not just the number of mutations, but where they fall and what we understand. What also comes out clearly is that it’s very different to everything else we’ve seen. Though some mutations were familiar, we’ve never seen this combination of mutations. As we get more data and do more sequencing, we can then plug that in to build the family tree of viruses.”
Nearly nine months ago, just under half a million healthcare workers were vaccinated with one shot of the Johnson & Johnson vaccine in the country’s Sisonke implementation trial. From 9 November they have been getting a booster shot of the J&J jab in a new leg of the study.
Francois Venter, deputy executive director of the Wits Reproductive Health and HIV Institute and an adviser to the Ministerial Advisory Committee on Covid-19, agreed with Madhi, calling isolation and tracing of infected healthcare workers, “a complete waste of time.”
Emphasising that he was speaking in his personal capacity, he said halving the isolation time would help protect the health service, “but we should be focusing on mask wearing and learning to live with the virus instead”.
Madhi added: “I’d be very surprised if the number of those who die of Covid in this wave come anywhere close to what was experienced in the last three waves. Not just because of vaccination [currently standing at 43% of the population], but a big issue is the large percentage of people who’ve developed T-cell immunity through natural infection. A recent sero-prevalence study in Gauteng shows 72% of the population were infected during the course of the first three waves.
“So, with Omicron we have a paucity of care crisis due to an obsolete quarantine policy, which achieves absolutely nothing. We can only identify about 10% of those infected. The other 90% are unknown to us, so putting people from that 10% in quarantine achieves nothing in curbing the spread of the virus.”
Glenda Gray, chief executive of the South African Medical Research Council and lead investigator on the Sisonke healthcare worker trial, was unavailable for comment.
Speaking at a Discovery Health Covid-19 update webinar on Tuesday evening, Lessels warned the anti-vaccination lobby against using the non-lethal characteristics of Omicron to dissuade people from getting inoculated.
“A lot of the spread happens around the time of symptom development, not when in ICU or hospital. Our understanding about this virus and its evolution is still developing. We cannot let what we know so far feed into disinformation and misinformation, with people saying there’s nothing to worry about,” he said.
“There’s no evolutionary pressure on this virus to become less virulent. What we need is real world data on how the vaccine effectiveness is holding up against severe disease, hospitalisation and death. Over the next few weeks the data will improve.
“Through the rest of December and into January we’ll gradually build up a picture of what we’re dealing with, not just in South Africa, but world-wide.”