As the Covid-19 pandemic rips a trail of devastation through South Africa — particularly in Gauteng, which is more than midway through the third wave — the country has been shifted to the adjusted level 4 lockdown.
Alan Christoffels, the director of the South African National Bioinformatics Institute, says anything the country can do — including a stricter lockdown — to reduce the spread of the virus “will help our overstretched health system”.
“We see hospitals in Gauteng pleading for assistance. We cannot ignore this request.”
Marvin Hsiao, a virologist at the University of Cape Town/Groote Schuur Complex of the National Health Laboratory Service, says the third wave was triggered by the gradual increase of social gatherings and mobility. “Level 4 restriction will play an important part in limiting the size of the third wave when people are not voluntarily restricting their contact with others.”
Hsiao says that earlier tough restrictions might have been more effective in easing the burden on Gauteng’s hospitals and prevented a number of deaths.
However, for other provinces, he says “it is a perfect time [for the level four restrictions]” because the third wave is yet to reach its peak in those areas.
But Jo Barnes, an epidemiologist at Stellenbosch University, says the new restrictions won’t make a “serious dent in the progression of the third wave. Restricting the population without serious efforts to address the other factors — namely the failings of the health system, including the poor performance of the vaccine rollout — can only work if it is instituted early enough and properly overseen.”
Barnes called attention to the country’s “vulnerable” health system and “seriously inadequate” management.
“Official denials until the grave situation on the ground is obvious cannot be used to eventually kick-start action. By then it is too late. Expecting an understaffed healthcare sector to work under awful and dangerous conditions to compensate for bad policy decisions is unwise, to put it politely.”
On 29 April, the South African Covid-19 Modelling Consortium (SACMC) projected the peak of the third wave would possibly be lower than the second, with hospital admissions also expected to be lower than the second wave.
South Africa recorded 1 000 new cases daily at the end of April, and surpassed 2 000 a week later, in May.
Adrian Puren, acting executive director of the National Institute for Communicable Diseases (NICD) said: “When we saw this mark trajectory in the Gauteng region, the Modelling Consortium painted various scenarios … it did state that it does not take into account the fact that there would be a different variant.”
Almost two months later South Africa — and the epicentre, Gauteng — finds itself in the firm grip of a third wave.
New infections have soared and are now nearing almost two million since the first case was detected in March last year. And, on Wednesday, the country reached a grim milestone of more than 60 000 Covid-19 deaths.
This week the NICD confirmed the major uptick in cases in Gauteng is driven by the Delta variant — the same variant that caused a brutal second wave in India.
The Delta variant was first detected in South Africa in May and is 97% more transmissible than the original lineage of the SARS-CoV-2, according to an NICD report that was released this week.
The Beta variant — first detected in South Africa —showed a 64% majority in Gauteng cases during May but by June, this had reduced, and the Delta variant now makes up 53% of the province’s infections, according to genomic data generated by the Network for Genomic Surveillance in South Africa.
The NICD’s Puren does not agree that authorities were taken off-guard by the Delta variant. “We observed the [Delta] variant initially. The numbers were small.
“But remember, there are lags and I think that’s probably one of the challenges. To get results for variants can take up to two weeks. So there are these lags that I think certainly contribute to those gaps in our knowledge.”
He said the Delta variant “gained traction because it is potent in terms of transmissibility. That’s always been a major concern.”
But is implementing an adjusted level 4 lockdown the answer to the now more dominant Delta variant, the under-pressure health systems and the continued rise in the death toll?
Jonny Myers, emeritus professor in public health medicine at the University of Cape Town (UCT), said, responding to the third wave is important but that it is equally important to prepare for the fourth wave.
“It’s not one or the other. Hospital preparation responds to the third wave and vaccination to the fourth one,” said Myers.
The third wave is expected to stretch until late August or early September, with each province responding differently to the virus, said Myers.
The Northern Cape, Free State and North West have been experiencing their third wave since April. The Northern Cape has already come down from its infection peak, the Free State has peaked and the North West is showing slower growth in the number of infections.
These three provinces have recorded their highest daily death rates since the start of the pandemic in March last year.
Myers said that Gauteng, the Western Cape and Limpopo are currently experiencing exponential growth in infections and Gauteng is expected to reach its peak in the next week or two.
The Western Cape and Limpopo are expected to peak in the next month before showing a decline in August. The Eastern Cape and KwaZulu-Natal are showing a more gradual growth in the number of infections.
It was thought that after the second wave a proportion of the country’s population had acquired a degree of immunity against the then-dominant Beta variant.
Wolfgang Preiser, the head of medical virology at Stellenbosch University, said it was believed that Gauteng, having had a less severe second wave, would make the third wave different from the coastal provinces because Gauteng had less immunity against the virus. But the Delta variant now being dominant has changed this projection.
In the end, says UCT’s Myers, “vaccination is the only way out of this pandemic”.