Pull up masks for the third wave

With the plummeting temperatures across South Africa, our community has once again descended into concern and despair as new COVID-19 infections skyrocket. This round seems even closer to home.

My cell phone is once again saturated with COVID-19 contact questions. For me, it has been a week of encouraging maximal caution among community members against the backdrop of having witnessed the devastating bereavement that this virus has recently unleashed on a few patients and close friends.

We need to understand that pandemics are dynamic. In the first article I wrote for the SA Jewish Report in March 2020, I spoke of a predicted short-term future of “pumping the breaks on social distancing” by epidemiological experts. These is precisely how this pandemic has ensued. South Africa is well into its third surge, and this is the time for this “pumping”. Let’s give some context.

As of 7 June 2021, there are 21 700 active cases in Gauteng alone, a number that’s probably better estimated as 31 000 due to untested individuals. Over the past seven days alone, there has been a 36% increase in cases. Most notably, the positivity rate of cases has increased from <4% to >13% in just a couple of weeks.

The Jewish community, unfortunately, outshines these humbling statistics, with 235 new cases loaded on the Hatzolah Wellness Programme in the past week (1 to 8 June 2021). This is more than its maximum number of cases at the peak of both the first and second waves. My own practice has admitted more COVID-19 patients to hospital in the past month than it has admitted over the past six months.

Another change in the dynamic of this wave is the astounding transmissibility amongst children. I clearly remember the claims of “COVID-19 doesn’t affect children” last year. This week, I have diagnosed COVID-19 in several young children under the age of seven.

However, let’s not despair that this picture was unexpected, nor that we are ill-equipped to deal with it. Let’s understand that it’s in our power to curtail the pandemic and overcome it.

On a societal level, there are several vaccines emerging on the market that have each shown demonstrable efficacy against serious disease. It’s important to understand that breakthrough infections may still be reported after vaccination, but the level of immunity attained by the vaccines has shown impressive results against serious disease and death across all variants, including the South African variant.

In the world’s history of viral outbreaks, there has been a pattern of viruses mutating into variants that are clinically milder, although endemic, and which haven’t imposed ongoing significant risk to life. It’s thought that the Russian flu of 1889 was most likely a coronavirus itself which mutated into a more tolerable disease that eventually abated without a vaccine! Even in our own lifetimes, we have seen the famous H1N1 “swine flu” impose less of a real threat to individuals each year, in spite of the fact that this virus is far from eradicated and still rears its head each winter.

Professor Barry Schoub, virologist and the former head of the National Institute for Communicable Diseases, explained to doctors on an online education webinar this week that the goals and likely outcome of the vaccination programme isn’t to eradicate COVID-19 but rather to convert the SARS-COV-2 virus into just another coronavirus that, at most, causes mild disease. This goal is reachable and probable.

On the ground, we have learnt over the past 16 months how to drop the number of new infections quickly. The old thinking was “stay home, save lives”. The new thinking is “don’t let your guard down, even with your most trusted friend”. I have had a plethora of patients recounting to me recently that they were infected by “a harmless interaction”. During previous peaks of this pandemic, we have learnt that the attention to simple details like interacting with loved ones with masks religiously worn, wearing the masks properly, interacting in only well ventilated spaces, and not participating in unnecessary shared meals have each been paramount.

There is, indeed, understandable COVID-19 fatigue after 16 months of social curtailment, but it’s important to realise that previous peaks have been short lived and the prediction is that in six to eight weeks, we’ll once again be able to relax some of these measures.

The biggest question at the forefront of most lay people’s minds at the moment is, “Will this pandemic ever end?” We can be deeply grateful for the formidable achievements of Israel, the United Kingdom, and the United States (US) amongst other developed nations that have answered this question with a resounding “yes”. The US, with a population of 328 million people, has vaccinated 52% of its population. Its infection rates have decreased from 208 000 new cases per week in January 2021 to 14 000 per week in June 2021. Israel, which has vaccinated about 60% of its population, recorded its first day this week with zero new cases in spite of conducting 7 575 tests on the same day. Israel’s positivity rate is now 0%, with only a handful of active cases in the country, and Israelis are no longer are required to wear masks in outdoor public spaces! Developed countries and past pandemics have taught us that this pandemic will indeed end.

So, what is the week’s take-home message? We must understand that prevention is better than cure. We can relatively easily prevent COVID-19 infections; to cure complicated patients is far more challenging. Let’s pull up our socks for the next few weeks and bring the infections in our community under control. Let’s look forward to future widespread vaccinations that will indeed eventually be offered to all adults, and we really can look to a brighter future without the overhanging clouds of COVID-19.

• Dr Daniel Israel is a family practitioner in Johannesburg.