COVID-19 denialists cause headache for doctors

Though the fourth wave of COVID-19 has been mild, those who deny they have the virus have caused a headache for doctors because invariably, they help it to spread.

Experts are aware that many didn’t test for COVID-19 as it might have ruined their holiday. It wouldn’t have been a problem if they had isolated themselves, they say, however, many chose to ignore their symptoms, spreading the virus further.

“Denialists are a big headache,” says Dr Solly Lison, a Cape Town-based family physician, “so ventilation and small groups are essential. Having a window open when you are driving is also crucial.”

Lison has seen statistics indicating that the number of new cases has been declining at a slower rate in the Western Cape than it did in Gauteng. “Maybe that’s because people from Gauteng were here in the Western Cape [for their holidays],” he says.

Hatzolah’s statistics show that the number of new cases has been progressively decreasing over the past four weeks in Gauteng. In the week of 10 December 2021, 714 new cases were recorded, while 63 have been registered this week.

Currently, Hatzolah has 174 active cases, six COVID-19 patients in hospital, and 16 COVID-19 patients on home oxygen. Most of its cases have been occurred in the 20 to 60 age group.

“From what we are seeing at the moment, the symptoms seem to be a lot milder than previous variants,” says Darren Kahn, the executive general manager of Hatzolah Medical Rescue. “We do notice that vaccinated patients [who land up on oxygen] are certainly coming off oxygen a lot quicker than those who haven’t been vaccinated. But in general, people are certainly not as ill as they were previously.”

Kahn believes many haven’t joined the Hatzolah programme during this wave because they aren’t so sick.

“Omicron, which dominates in South Africa, is highly transmissible but less virulent, causing far less morbidity and very low actual direct mortality,” says Professor Efraim Kramer, a leading international expert in emergency medicine with a specialty in mass gatherings. “It will, as expected, spread globally, which is good because it gives those infected a natural immunity without severe illness.

“Therefore, with Omicron, we are learning to live and cohabit with it, like every winter flu. Of those who do get infected, some are mildly symptomatic, others are asymptomatic, but both spread the virus,” he says.

“The only large factor is vaccination, and that’s a personal choice. So, should we all carry on as normally as we can with Omicron, with or without the virus, and get on with our lives? Yes. It’s not a case of denying it, it’s a case of living with this uninvited guest in our daily lives.”

Dr Daniel Israel, a family practitioner in Johannesburg, says, “The Omicron variant peaked in Gauteng over the holidays, and we saw larger numbers than we had in the third wave. That proves the contagiousness of it. From what we are seeing as GPs, serious patients and admissions have been few and far between. Our practice alone has had three admissions, two of which were unvaccinated.”

He and Lison agree that many didn’t test because they didn’t want it to ruin their holiday.

Lison puts this down to the cost of the tests and the many false negatives recorded. He says the latter is a result of “people immediately testing after being in contact with somebody who had COVID-19. That’s the wrong thing to do. You’re going to get reliable positive results only on day five or six.”

Doctors agree that the wave is dissipating.

“The epidemic curve should reach baseline within the next 10 days to two weeks in Gauteng, and perhaps slightly later in the Western Cape and KwaZulu-Natal,” says Professor Barry Schoub.

Schoub, who chairs the Ministerial Advisory Committee on COVID-19 Vaccines, says the fourth wave was almost entirely driven by the Omicron variant in South Africa and ranked as the most extensive in terms of numbers of individuals infected, but it was significantly milder than preceding waves.

He says more than 90% of severe cases of COVID-19 in the fourth wave were in unvaccinated individuals. He and other experts agree that though Omicron is a vastly milder variant, it’s not harmless, especially for the unvaccinated.

Says, Lison, “They aren’t getting the chest infections to the degree they did before, and they are feeling better quicker.”

“Hospitals were much busier in December 2020,” says Lison. “There were many more PUIS [persons under investigation] who were dropping oxygen levels at that time. [Now] we don’t have to ensure that they get oxygen. They are coping better.”

Lison agrees that “people aren’t testing” when they show symptoms, and are often just isolating. He’s concerned that “people aren’t covering their noses” and that neck gaiters are “useless”.

“It stops you spitting as you speak, but you will get infected through it, and you will pass the infection through it as well. You need to wear a minimum three-layer mask covering your nose.”

The outlook for 2022 with regard to new variants is unclear, Schoub says, but it’s reassuring that “the great majority of the South African population do have antibodies to the virus, and this partly contributed to the relative mildness of the fourth wave. Hopefully, this will also contribute to ameliorating the effects of subsequent variants which may arise in the course of the year.

“Unfortunately, more than 50% of individuals in South Africa still haven’t been vaccinated. It’s imperative that every effort needs to be made to increase vaccine coverage in the population if we hope to bring the pandemic under control.”