With the approaching winter months coupled with the recent repeal of the National Disaster Act, South Africans have watched with concern a surge in COVID infections. The Conversation Africa spoke to infection specialist Veronica Ueckermann about the current course of the pandemic in the country.

How is the latest peak different from previous ones?

In mid-May, the number of COVID cases in South Africa rose again.

The latest data also shows that hospital admissions have increased in both the public and private sectors, albeit far less than previous peaks. The proportion of intensive care patients is also lower – as are the deaths.

This shows that most of the identified cases were mild or incidental (in other words, they tested positive when they were hospitalized for something else). A similar pattern emerged with the fourth wave, which was short-lived in December 2021/January 2022.

The fourth wave of COVID-19 infection in South Africa was dominated by the Omicron variant, classified as a “variant of concern” by the World Health Organization after it was reported by South African scientists.

The problem with the Omicron variant was its increased transmissibility, leading to a rapid increase in cases and high test positive rates. It became clear that the clinical presentation of this variant differed significantly from its predecessors.

It had lessened the severity of the illness. And more incidental diagnoses in patients hospitalized for other reasons.

The current increase in infections is associated with the BA .4 and BA.5 sublineages of the Omicron variant. It may be early, but it seems that they have similar clinical manifestations.

It is to be hoped that the decoupling observed in the fourth wave between the number of cases and hospitalizations and deaths can also be observed in these subvariants.

Where to from here?

The evolution of the pandemic reflects changes in both the SARS-CoV-2 virus and human hosts.

The evolution of the SARS-CoV-2 virus is an adaptive process to increase transmissibility and evade host immune response (especially antibody-mediated neutralization).

As far as the human host is concerned, larger sections of the population have some immunity to the virus – whether through vaccination or through previous infection.

In the future, we will likely see SARS-CoV-2 becoming endemic with seasonal variations and the need for updated vaccines and booster shots. COVID-19 will not go away, but we will be able to manage the impact it has on our lives and healthcare systems.

Compared to the earlier part of our pandemic, our understanding of immunity to SARS-CoV-2 has improved. And the role of neutralizing antibodies, T cell responses and B cell responses has been well described.

Emerging variants may have mutations to evade neutralizing antibodies, but this does not result in complete loss of immunity from vaccines or natural infections, as the other components of the immune response are preserved. Booster vaccines also generated robust immune responses to the Omicron variant.

As much as we wish to return to pre-pandemic reality, complacency and total abandonment of caution at this stage is likely to result in increases in cases, hospitalizations, morbidity and mortality. Caution is not yet to be thrown overboard so that we protect ourselves and the most vulnerable.

What about long-term effects?

The changing landscape of the COVID-19 pandemic has led to the emergence of a new syndrome known as “Long COVID”. Although this is less dramatic than an acute severe infection, it has a significant impact on the quality of life of those affected.

The syndrome is defined as persistent symptoms (such as fatigue, palpitations, shortness of breath, muscle fatigue, chronic cough, insomnia, and “brain fog”) that appear 12 weeks after initial infection. The incidence of long COVID is higher in patients who have been hospitalized. But it has also been described in mild acute infections.

The functional impairment associated with long-term COVID has significant social, psychological, and economic impacts on individuals and their communities.

In addition, adequate evaluation and treatment of patients with long COVID is likely to continue to place an additional burden on strained healthcare systems.

Has the healthcare system suffered collateral damage?

Significant collateral damage has been done to the healthcare system over the years of the pandemic.

Treatment for chronic diseases and other infectious diseases such as HIV and tuberculosis (TB) have suffered. For example, the decline in global TB rates has slowed. In addition, the number of people receiving TB treatment fell significantly during the pandemic. TB-associated deaths are predicted to increase by between 5% and 15% over the next five years.

The setbacks occurred because the fallout from the pandemic significantly hampered the treatment of patients with chronic diseases. These included:

  • Healthcare facilities overwhelmed with acute patients during the various waves

  • Partial lack of public transport

  • The closure of some outpatient facilities and

  • Fear of individuals contracting COVID in healthcare facilities.

As healthcare workers, we hope that the current variants of SARS-CoV-2 will cause milder illness, but we should not forget that hospitalizations and deaths from COVID-19 continue to occur.

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