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Most State of Disaster restrictions 'unfit for purpose', say SA's top health experts

End all curfews, school and outdoor activity restrictions, and do away compulsory mask-wearing outdoors. And stop the “hygiene theatre” at many workplaces, venues and restaurants: the spraying of hands repeatedly with alcohol sprays combined with thermometry, both of uncertain quality, and recording of names and cell numbers with no intention of following up, all of which is a waste of time and distracts from things that make a difference — opening windows and encouraging ventilation.

These and other recommendations were issued by a group of South African medical experts urging the government to end the country’s State of Disaster. In an op-ed in the Daily Maverick, the group wrote that there was no need to continue with the existing restrictions and other time and money-wasting efforts, and that precautionary measures and focuses should be directed elsewhere.

President Cyril Ramaphosa last week (19 January) flagged its ending, but while leading health professionals, like those writing in the Daily Maverick op-ed, say this should be done immediately, others say the process should not be rushed, for various reasons, including gaps in SA’s public health and crisis management.

According to the Sunday Times, Professor Mosa Moshabela, deputy vice-chancellor of research and innovation at the University of KwaZulu-Natal, said “it’s not as simple as it sounds” because pandemic regulations cannot be implemented under the National Health Act as it stands.

“Our regulations are linked to the Disaster Management Act. If we end the State of Disaster, then we don’t really have the legislation to anchor those regulations. If anyone were to challenge the regulations in court, they would win.”

Health department deputy director-general Dr Nicholas Crisp said the need for regulations went beyond the department. “Once [the State of Disaster is] lifted, each minister must implement his or her own regulations. There will be no National Coronavirus Command Council needed for decisions,” he said.

Business for SA’s Martin Kingston also cautioned against acting in haste. “There needs to be a streamlined and seamless process of integrating [regulations] and as business, alongside all the other social partners in Nedlac, we have asked to be part of that process so that it can be efficient,” he said.

University of Cape Town medical historian Mandisa Mbali said the latest one-month extension of the State of Disaster to February 15 underlined gaps in public health and crisis management. “We need to ask about the extent to which the Disaster Management Act is fit for purpose in the medium to long term,” he said.

In the Daily Maverick, Francois Venter, Ezintsha, Faculty of Health Sciences, University of the Witwatersrand (Wits), Marc Mendelson, head of Infectious Diseases and HIV, University of Cape Town, Jeremy Nel, HOD, Infectious Diseases, Wits University, Lucille Blumberg, Right To Care and University of Stellenbosch, Zameer Brey, health systems adviser and Groote Schuur Hospital board member, and Shabir A Madhi, Dean, Faculty of Health Sciences and Professor of Vaccinology, Wits University, wrote that worldwide, including within the World Health Organization, assessments are taking place of the measures most suited to the new phase of the pandemic. Topping the list are vaccination, good indoor ventilation, and close monitoring of the virus and other possible pandemic threats

South Africa needs to do this too, the group wrote. Most State of Disaster measures still in place are unfit for purpose, and others require tailoring. Being on permanent “Code Red” affords little protection against a hyper-transmissible SARS-CoV-2 variant such as Omicron and entails unacceptable societal costs.

They said the focus on COVID-19 has set back many other health programmes and broader socioeconomic and educational programmes. Further evolution of SARS-CoV-2 may generate more variants, but the foundation of protection from severe disease, hospitalisation and death that is our immune response — whether by prior infection (now, very conservatively, an estimated three quarters of South African inhabitants) or by vaccination (for about a third) — has been consistently exhibited across the three waves caused by the different variants.

The vast majority of South Africans now have immunity, meaning COVID-19 in 2022 is likely to have a similar death rate to seasonal influenza (10,000- 11,000 deaths a year) in the pre-COVID era, as opposed to the 290,000 COVID- related excess deaths over the past 22 months of the pandemic, and much lower than the projected 58,000 annual TB-related deaths.

The time is now to immediately end measures that serve no purpose, some of which are detrimental, they write. End the State of Disaster, because there is no reason for the continued use of this legislation, nor for the National Coronavirus Command Council. The government should rather focus on the vaccine programme and protecting health facilities from the impact of large numbers of admissions.

The State of Disaster and its restrictions have been severe on education, and every resource should be focused on making 2022 a “back to normal” year. Unfortunately, the education minister has announced further rotational learning — a huge mistake, they wrote.

Children experience only a very small chance of harm from infection with SARS-CoV-2, except for those under one year of age or with underlying medical conditions. Children suffer illnesses from flu and a range of other viruses and infections too, and “we sent them to school before this pandemic, understanding the massive benefits to child health and development”.

They recommend halting social distancing in classrooms, and restrictions in class sizes: vaccine mandates are appropriate for all educational staff, for their own health and to protect children by avoiding further disruptions to teaching. Teachers or other educational workers should be assisted with attention to ventilation and encouraged to wear masks indoors if they are in high-risk groups.

“The ongoing restrictions on allowing family visitors in hospitals are unnecessary and cruel, and masks should no longer be compulsory outdoors. Vulnerable people may choose to wear a mask outdoors in crowded circumstances, while understanding that vaccinations will provide the greatest protection to their health.”

The group wrote that South Africans must eventually accept that indoor restrictions will have to end too. Vulnerable people may be advised to avoid crowded indoor venues when the COVID caseload is high, and/or wear a mask for added protection.

Having routine foot-pump hand sanitisers at the entrance to bathrooms, food markets and crowded venues is good hygiene, and one of the few things that should continue— not for the prevention of COVID-19, but for all the other nasty bugs.

“Fogging” is another waste of time and money, which can be harmful. Government departments, despite their own guidelines from early 2020, persist in shutting down police stations, grant offices and schools, at massive cost. Fogging is potentially harmful to health, using damaging chemicals, and is only used in highly focused infection outbreaks in health facilities. Cut it out. There is no scientific basis for the fogging and closure of any venue, including police stations and other government buildings after the diagnosis of an infected case.

Stop all PCR and antigen testing at borders. There is no reason for insisting on this when the virus is circulating so widely. It is a massive money and time-wasting international industry, with no health benefits. South Africa, a victim (and previous proponent) of baseless travel bans, should take widely communicated step that the ONLY requirement to enter the country is proof of vaccination (or medical reason for not having vaccination), mainly to protect our hospitals and ICUs.

Reduce isolation. Currently, confirmed COVID-19 cases are asked to isolate for 10 days from their test (if no symptoms), or from the beginning of symptoms. Numerous countries have shortened this to five days, and this approach, with a return to work and society using a mask for the next five days, is sound.

Vaccines are our major protector — everything else is a mitigator — and a radical new strategy is needed that makes getting vaccines as easy as buying milk and bread.

South Africa has already inadvertently reached 70% “immunity” due to the high force of infection and roll-out of vaccines. Besides which, the 70% target for vaccine coverage is outdated and now a totally arbitrary value because herd immunity (ie when the virus is unable to transmit in the community) is no longer an option.

The main focus of the vaccine drive should be to achieve >90% vaccine coverage in people older than 50, and to provide third doses to very high-risk groups, they wrote.

In addition: replace the cumbersome EVDS systemʼs registration requirements with a simplified guideline; allow the private sector to separately procure and distribute vaccines, and start a proper seamless door-to-door campaign that aims to reach the millions of poor and undocumented.

Government support to vulnerable populations thus far has been poor, and unfocused, so attention to this group — delivery of medication at home, food security, home vaccinations and other assistance — should receive priority.

The group calls on the government to set up a permanent pandemic preparedness body, be it a Ministerial Advisory Committee on Emergency Preparedness or Strategic and Technical Advisory Group, to monitor global threats, ensure that the policies and procedures are in place to rapidly move the country into pandemic mode (if needed), and that supply chain requirements are met.

They pointed out that there are also several current pandemics continuing to kill tens of thousands of people every year in South Africa — TB, pneumonia, HIV, antibiotic-resistant infections. Many are prevented by vaccines or treatment — and greater attention needs to be focused on those, too.

There is no doubt that the State of Disaster should be ended now, the writers urge. The continued lack of accountability and transparency the Act affords to politicians for unscientific and irrational decision-making on issues of public health is long past justification.

 

Daily Maverick article – Experts: End South Africa’s national state of disaster (Open access)

 

Sunday Times article – Experts warn against quick ending of Covid state of disaster (Open access)

 

See more from MedicalBrief archives:

 

DoH warns of chaos if calls to end State of Disaster are heeded

 

Madhi lashes DoH and calls for end to State of Disaster

 

Cape Town mayor joins Western Cape calls for total lifting of SA’s State of Disaster

 

 

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