The decision to move South Africa back to alert level one after a 130-day COVID-19 third wave, has been questions by some medical experts, who ascribe it to politics rather than science, writes MedicalBrief.
President Cyril Ramaphosa last week announced a later curfew, larger gatherings of up to 2,000 people outdoors and the sale of alcohol up to 11pm. But some scientists fear the predicted fourth wave and COVID infection rate is likely to accelerate, along with the relaxed regulations, because of the local government elections taking place on 1 November, and their associated campaign activities.
Speaking to the Mail & Guardian, public health specialist for Western Cape Health Prof Hassan Mohamed of Stellenbosch University said that at the beginning of last week, more than 17m vaccine doses had been administered nationwide, and 8.5m adults were fully vaccinated.
“This is less than 25% of the adult population. While we are ahead of many countries, this is far from satisfactory for us to relax restrictions. It is still not at an acceptable level, particularly in poorer communities,” he said, adding that the fourth wave of COVID-19 “is currently projected to occur at the end of the year”, and that that “it would be better to not go below level 2 restrictions”.
He argued that a balance between opening up the economy and maintaining some control measures was needed. “We need to significantly strengthen our vaccination efforts and keep infections at a low level if we wish to move in the direction of some kind of normality,” said Mohamed, who believes that COVID-19 will be present for many years.
“We need to adapt accordingly. This means some forms of infection control need to continue, such as mask-wearing, physical distancing, good ventilation and limiting gatherings.”
Helmuth Reuter, professor and head of division of clinical pharmacology at Stellenbosch University, agreed the country should remain on lockdown level 2 “until a higher vaccination coverage [is reached] and until the completion of elections”. He said that looking at previous patterns he expected the fourth wave to “probably” start in December and last until March 2022.
However, said M&G, Benjamin Kagina, a senior researcher in vaccinology at Vaccines for Africa at the University of Cape Town, believes that with low transmission rates, high vaccination coverage rates and people adhering to health protocols, “it is possible to avoid a fourth wave”.
“The challenge is the public fatigue in practising preventative measures as well as the emergence of new variants that are more transmissible and waning of vaccine-induced immunity,” he said.
But the South African Medical Association (SAMA) is far more pessimistic, reports Sunday Times. With the country emerging from a devastating third wave and still far from achieving vaccination targets, both SAMA and academics said Ramaphosa appears to be ignoring scientific advice and putting politics before people’s health.
An early fourth wave of COVID infections, thousands of avoidable deaths and the possibility of spending the festive season under hard lockdown: these are the grim prospects, they say, if the easing of restrictions on the size of gatherings backfires, as some fear it will.
While the president is banking on an accelerated vaccination campaign, including an additional 16m doses of vaccine by mid-December, which he said may save 20,000 lives, there is scepticism about the target being reached.
The experts warn that the move to level 1 and the crowds expected at election campaigns will create super-spreader events.
The Sunday Times understands that pressure from churches was also a factor in the decision to allow a maximum of 2,000 people at outdoor gatherings and 750 indoors. Charismatic churches with auditoriums for 6,000 people are believed to have asked for permission to fill every other seat.
But Pastor Siphiwe Mathebula from Hope Restoration Ministries in Kempton Park, east of Johannesburg, said religious leaders were not consulted. “They just wanted to do this for themselves,” he said. “This is not about the church, it is about the elections and them wanting to campaign.”
Amid criticism of the size of crowds at campaign events for the elections, the president cited falling infection rates for the decision to allow the gatherings.
SAMA chair Dr Angelique Coetzee said she agreed with the decision to ease the lockdown to alert level 1. However, “what doesn’t make sense is having outdoor gatherings of 2,000 and indoor of 750”.
“It doesn’t make scientific sense, it makes political sense. I think four weeks after elections we will see the impact of this. We are nowhere near herd immunity, and I need to see the science that says 2,000 people in a rally would be safe.”
Prof Mosa Moshabela, deputy vice chancellor of research and innovation at the University of KwaZulu-Natal, agreed that the decision to raise limits on the size of gatherings appeared to be political. “In my opinion, there is no scientific basis for the relaxation of the number of people allowed at gatherings.”
William Gumede, associate professor in the Wits University school of governance, said it appears politics is trumping economic and health concerns, and he accused Ramaphosa of ignoring the lessons of the Indian elections in April.
“They did not follow protocols, it was a free-for-all and it became a super spreading event,” he said. “If we get another wave, we may, after the elections, sit with a big health and economic crisis because the government will have to introduce another hard lockdown.”
Ramaphosa admitted that that campaign activities posed the greatest risk to a surge in new infections. “We have a responsibility to ensure that the regulations are followed and all health protocols are observed during the election campaign.”
He said being vaccinated was “not only about protecting yourself and those around you”. “It is also about preventing new and more dangerous variants from emerging, as the virus is able to spread and mutate in unvaccinated populations.”
However, this statement was received with scepticism from social media users as well as by some of the leading health experts, reports The Independent.
Scientists have said there is no scientific proof that unvaccinated people will spread variants more than vaccinated people.
Prof Linda-Gail Bekker from the University of Cape Town’s Desmond Tutu HIV Centre said although it is known that unvaccinated people are more likely to become infected, none of the current COVID-19 vaccines offers 100% protection against infection.
Bekker, who is also a co-lead investigator of the Sisonke trial administering the COVID-19 Johnson & Johnson vaccine to healthcare workers, reiterated that this means it is not only in the unvaccinated where infection can occur.
SAMA’s Coetzee said a concern at this point would be that vaccinated people and non-vaccinated people would spread the same virus. “Vaccinated people, due to their antibody response, will however spread far less with a viral load than unvaccinated people.”
Speaking in Katlehong, outside Johannesburg, last Friday, Ramaphosa rejected accusations of adjusting the regulations to suit elections. “This is not about elections. When I electioneer, I wear my ANC T-shirt, my ANC lumber [jacket], and my language is completely different. We know how to make those divisions,” he said.
The Sunday Times adds that the easing of restrictions coincides with the first “Vooma vaccination weekend” to revive the flagging jab rollout.
An average of 175,000 daily injections were administered between Monday and Friday, only about 70% of the target Ramaphosa outlined when he said: “To reach our goal, we need to administer an additional 16m vaccine doses this year, or around 250,000 first-dose vaccinations every single work day of every week until mid-December.”
Since phase 2 of the rollout began on May 18, after the vaccination of nearly 500,000 health workers in phase 1, the 250,000 daily target has been met only 14 times, notes Sunday Times.
But Wits dean of health sciences Shabir Madhi said the rollout is heading into what his fellow vaccinologists refer to as a “valley of death that people fail to appreciate until it is upon them”. He blamed poor planning before the rollout began and said SA is facing “probably a mix of apathy, vaccine hesitancy, anti-vaxxers and [issues with] access”.
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