From 0 to 10 in a month – COVID-19 fifth wave upon us

The fifth wave of COVID-19 has begun in Gauteng and the Western Cape, according to medical experts, with case numbers increasing substantially over the past two weeks.

Seventy-five new cases of COVID-19 were recorded in the community in Johannesburg during the week of 25 March to 1 April this year. By contrast, since last Saturday, 182 new cases have been recorded in the province. Nine of them are on home oxygen, while two are in hospital. These numbers are comparatively low because these days, many who contract COVID-19 don’t report it.

On 3 May, the National Institute for Communicable Diseases recorded 1 685 and 473 new cases in Gauteng and the Western Cape respectively. A month earlier, on 3 April, it recorded 369 and 167 new cases in those two provinces respectively.

“We’re seeing an increase in test positivity to above 20% in the past week, with large increases in case numbers,” says Johannesburg family physician Dr Sheri Fanaroff. “We know that many people aren’t testing, and many positive rapid tests aren’t reported, so the official numbers are largely underestimated.”

Cape Town family physician Dr Solly Lison has 11 patients who have or have had COVID-19 in the past three and a half weeks. “That’s a lot in my practice,” he says. For about eight weeks prior to this, he didn’t have any COVID-19 cases in his practice.

The increase can be attributed to the highly infectious Omicron sub-variants, BA.4 and BA.5, says Professor Lucille Blumberg, a consultant for Right to Care. “We also had a lot of religious gatherings recently and spent Easter holidays together. I think it all sort of collided.”

Doctors across the Western Cape have been seeing many more patients with COVID-19 recently, according to Lison, who is also the chairperson of Cape Primary Care – Qualicare, a group of 500 general practitioners (GPs) in the province.

“We do know virus particles have increased in the waste water, so there’s a resurgence of the virus in Cape Town,” he says. “The western area of the Cape Peninsula is much more contaminated than the other three areas.”

Netcare hospitals have recorded an increase in both hospitalisations and the number of patients testing positive, says Netcare Group Chief Executive Dr Richard Friedland.

“The vast majority of COVID-19 admissions, just more than 250 at the moment, are patients who have incidental COVID-19 – people who happen to be in hospital and who tested positive for COVID-19, but weren’t there because of it,” he says. “In other words, they came in because they were giving birth, or for elective surgery, or some other procedure. A small percentage of COVID-19 cases, about 20% of our cases, are being admitted for COVID-19. In other words, they come in because they were sick with COVID-19.”

He says those patients generally tend to be more elderly with a lot of comorbidities.

“The length of stay of those with incidental COVID-19 isn’t any longer versus the people who are coming in for other conditions,” says Friedland. “This is no different to what we saw in the fourth wave. Those who require intensive care have a longer length of stay. Also, the mortality rates were very high in the first three waves, low in the fourth wave, and we have experienced low mortality rates in this wave as well.”

Hospitalisations at Netcare Linksfield Hospital are still low, even though it recorded an increase over the Pesach period. “Relatively speaking, from zero to over 10,” says Dr Carron Zinman, a pulmonologist at the hospital.

She says GPs are seeing more positive cases than hospital admissions.

“Even though it’s mild in terms of not causing hospitalisation, we are still seeing people who are very symptomatic and who develop long COVID-19 with its multitude of symptoms,” says Zinman.

Symptoms being presented include congestion, sore throats, coughs, headaches, and upset stomachs. They have also noticed patients presenting with fever, cold shivers, muscle aches, and tiredness. Some patients feel weak, while others have a lack of taste or smell.

“It’s difficult to differentiate COVID-19 from influenza and RSV [respiratory syncytial virus] clinically, and the only way of doing this is by testing,” says Fanaroff. “We seem to be seeing a slightly worse clinical picture in some patients, with chests a little worse than what we were seeing in the fourth wave.”

Lison says COVID-19 affects your muscles, including your heart muscle. “It’s recommended therefore to return to gym and full physical activities only three or four weeks after full recovery from active disease to reduce the possibility of cardiac effects,” he says.

“We have become a lot more complacent about it because it doesn’t seem to be causing such a severe illness upfront. But it’s going to leave a lot of people with long-standing problems.”

All the doctors emphasise mask wearing because the virus is spread in the air. “Put a mask on when you’re inside with lots of people. Keep the windows open,” says Blumberg.

Doctors urge people to keep a social distance where possible, avoid large gatherings, and stay at home when sick – even if it’s not with COVID-19, protect the vulnerable, take vitamin D tablets, and most importantly, vaccinate.

Says Fanaroff, “Vaccinating and boosting remain our best defences against severe illness. I would encourage anyone who hasn’t yet had a booster to get one as soon as possible.”

Flu vaccines are also recommended as “flus are probably going to make a reappearance and that just adds to the respiratory infections”, says Blumberg.