On 17 July, South Africa reached a grim milestone: more than 200 000 excess deaths since the start of the Covid-19 pandemic, as reported by the South African Medical Research Council (SAMRC). This contrasts with the official laboratory-confirmed Covid-19 cumulative deaths reported on the same date of 66 676.
This puts excess deaths at three times official Covid-19 deaths. This multiple has been known for some time. Slightly more than half of all testing is in the private sector, whereas the majority of the population rely on public health. Add to that results from a survey of blood donors that suggested more than 60% were infected in some parts of the country and it is clear that testing dramatically undercounts true infections.
Another grim statistic: Statistics South Africa reports that life expectancy has reduced by more than three years during the pandemic. Although this is a short-term effect because deaths are disproportionately among the older, it is yet another statistic that shows the pandemic is serious.
Statistics don’t tell the whole story – to those who knew them and loved them, the dead are not just a number. Last week, I heard of someone aged 32 who died of Covid. I have heard of many other older people who’ve died but the young are not immune.
The media tends to focus on celebrities, but others make up most of the numbers and deserve to be remembered for what they were worth to those who were close to them.
What exactly is an “excess death”? In a normal year — one without any special disasters — there is a relatively narrow range of variation in how many people die over a given period (usually measured over a week, to smooth out short-term fluctuations). Excess deaths is a measure of how many people more than the “norm” have died. The actual SAMRC calculation is a little more complex than that (for example, to factor out effects such as reduced trauma deaths during lockdown).
In South Africa, we have reasonably accurate death reporting. In India, where reporting is less accurate, a recent study has shown that their excess deaths could be as much as 10 times the official Covid-19 toll. How many have truly died in countries with even poorer medical and statistical infrastructure?
Amid these grim figures, you still run into people who believe the whole thing is a hoax and see all manner of crazy rumours about vaccines on social media.
The Delta variant particularly is reason to wake up. Although it does not appear to be more deadly than previous variants, its high transmissibility pushes the herd immunity level to about 85% of the population.
Herd immunity is a good target for vaccination. If any more than that fraction of the population is immune, any new outbreak fizzles as R, the average number of new infections per infected person, is less than one. But, if you let the infection run out of control, the number of people infected overshoots the herd immunity level. In practical terms, everyone will get infected with a variant as contagious as Delta.
Even without the Delta variant, a “herd immunity” policy was ill-considered. With the original estimate of R0 (R in a population where no one is immune and there are no countermeasures) of 2.5, herd immunity was at 60% of the population and if infections had run unchecked (assuming no new more contagious variants emerged), epidemiology theory says it would only stop when nearly 90% of the population had been infected.
Vaccination up to at least herd immunity will confer wider immunity than that, if some of the vaccine-hesitant already have some immunity from having previously been infected. But vaccination after recovering from infection should give a boost against reinfection and there is some evidence that a vaccine can clear lingering symptoms.
Given that we have lost more than three years of life expectancy so far, do we really want this to run unchecked?
Yet this is what Covid deniers and anti-vaxxers seem to want.
The harm these attitudes do is twofold.
First, disbelief that there is a pandemic feeds into disregarding measures such as wearing masks, keeping a safe distance from others, washing or sanitising hands and good ventilation that slows the spread. Second, vaccine hesitancy reduces the chances of arriving at herd immunity without overshooting and infecting a lot of people who have no protection against serious illness and death.
Ironically, the people who most disbelieve science are doing the most to prolong the pandemic. Look at what is happening in the United States now, where the most vaccine-hesitant states are struggling with growing hospital admissions and deaths.
From the start, the science has been clear. Contain the spread with non-pharmaceutical interventions until a vaccine can be used. Nothing has changed this. The most unexpected development is more transmissible variants. These exist mainly because containment failed. The SARS-Cov-2 virus mutates much slower than the flu virus but if there is a lot in circulation the odds of new variants increases.
With strong implementation of non-pharmaceutical measures, we could contain the spread. Accurate contact tracing mostly removes the need for a lockdown. Taiwan, for example, has only had a relatively mild lockdown in response to the Delta variant and had no lockdown at all in the initial phase of the pandemic, despite a lot of travel from China.
Efficient containment could prevent the need for all but sporadic lockdowns. Yet the incessant disinformation campaign militates against containment.
Now we are in the accelerating vaccine roll-out phase. I want this to be over. Don’t we all? Get your damn shots. Stop paying attention to drivel on social media. We can beat this — but with expertise, not fake expertise.