Covid-19: Second wave wouldn't be unexpected, but hard lockdown a ‘blunt tool’, says top expert

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  • Many countries are experiencing a second Covid wave, and scientists are worried that SA is heading in the same direction
  • However, implementing another hard lockdown is impractical as the first one pretty much proved unsuccessful in containing the spread of the virus
  • Instead, the focus needs to be on responsible behaviour by South Africans, and avoiding gatherings in poorly ventilated spaces

Many countries that had initially controlled the spread of Covid-19 infection are now struggling with a second wave, and the case may be no different for South Africa.

In fact, a second wave is not completely unexpected, said Professor in Vaccinology at Wits University, Shabir Madhi during a MyHealthLIVE webinar held on Wednesday.

Nelson Mandela Bay, as an example, is very much in the midst of a resurgence of the virus, said Madhi. Similarly, there are clear signs in the Garden Route of one taking place.

“A resurgence is not completely unexpected. All the countries that went through a first wave essentially have had a resurgence take place,” he said. 

The virus never went away

“The virus is very much entrenched in the country and is still circulating. There was a subsiding of the first wave in SA due to two reasons: Firstly, a high percentage (up to one third) of the adult population in major urban metro areas were infected,” explained Madhi, adding:

“With that, and the adherence to the non-pharmaceutical interventions (NPIs), such as the wearing of face masks; physical distancing; and avoiding overcrowded spaces, it was enough to bring about an interruption in the chain of transmission of the virus.”

However, the problem is that once the NPIs are removed from the equation, the percentage of the population that is infected is below the threshold that’s required for there to be sustained interruption in the chain of transmission of the virus, he said.

“So when we start allowing for mass gatherings, such as the matric Rage Festival held in KZN last week, rest assured: we’re going to get a resurgence.”

Madhi added that the increase in Covid cases are a clear indication that people have become complacent in implementing NPIs.

“When people start gathering during the vacation period, especially gatherings in poorly ventilated indoor areas, we’re going to see more virus transmission starting to take place.”

We can expect to see a much more generalised resurgence starting to take place across the country around February next year – unless the behaviour of South African citizens become more conscious and we act sensibly in what is required of us to avoid a second wave, said Madhi.

How we can avoid a second wave

The single most important factor in circumventing another massive escalation in Covid cases is simple: avoid gathering in poorly ventilated indoor spaces, said Madhi.

“Walking around on a beach without a mask – that’s not the problem. The problem is when families gather in groups of 10s, 20s, in a small space with poor ventilation. If you’re gathering as a family, gather outdoors.

“If you’re planning on going to a restaurant, insist on getting an outdoor table. You certainly shouldn’t be going to pubs and shebeens and clubs, which are in enclosed spaces and overcrowded." 

Understanding superspreader events

Superspreader events refer to many people who attended the same event and got infected almost immediately over a short period of time. These events are key drivers in the spike in Covid cases, such as the Rage Festival, said Madhi.  

“And the reason why these superspreader events are so dangerous is because information about the virus now shows that it is airborne, and it appears to be the major source of acquisition of the virus.

“This means that when an infected person coughs and breathes, they release their microscopic contaminated droplets. In poorly ventilated areas, those droplets can remain suspended in the air for up to two hours, and all it takes is for other people in those vicinity to literally inhale those contaminated particles and they can become infected. 

“It’s not about having 10% or 100% occupancy – even at 50% occupancy in a restaurant, you can still get the same sort of superspreader event, so ventilation is absolutely essential,” Madhi said. 

‘If you want to party, party outdoors’

“If you want to party, party outdoors. That will lead to some level of security in at least preventing superspreader events,” said Madhi, stressing that maintaining physical distancing is still critical, especially for prolonged periods of time and with people that you don’t engage with on a daily basis, and well as who are symptomatic.

“Wearing a face mask and then engaging in a mass gathering in poorly ventilated areas is an exemplar of irresponsible behaviour,” said Madhi.

Opening up borders: does this make SA vulnerable to an increase in cases?

“Certainly not”, said Madhi, saying that at this stage of the epidemic, opening up the borders to international travellers would have a negligible effect on the  increase in the number of cases.

“We’re not a country such as South Korea or New Zealand who were successful in containing the spread of the virus and are wanting to guard against an importation of cases, which might result in outbreaks in those countries.

“In the South African context, as well as European countries that are experiencing a resurgence, the number of infections happening on a daily basis – irrespective of whether it’s due to international travel or not – is not really going to have an impact on a resurgence,” Madhi explained. 

Hard lockdown did not succeed in containing spread of virus

Madhi stated that South Africa is a good example of how unsuccessful a lockdown has been to contain the spread of the virus, saying that all it achieved in the country, other than causing havoc to our economy, was to delay the timing of the peak of the virus.

“It provided some opportunity for our healthcare facilities to be better equipped in dealing with hospitalised cases, and in preparing and procuring enough PPE. But beyond that, the lockdown had zero effect on the infection rate, and some marginal effect on mortality.”

In fact, South Africa was one of the few countries where during Level 5, ongoing community transmission was still occurring.

“All that a lockdown does, in a South African context, is delay the inevitable, so that is not the best strategy – especially now that the healthcare system is reasonably prepared,” he said.

"The only difference another hard lockdown is going to make is that we will likely experience a second wave in March or April, instead of February. 

“It’s not going to have a meaningful impact in terms of the number of people who will end up getting infected with the resurgence. It's a blunt tool and not fit for purpose in dealing with the challenge of a resurgence,” said Madhi.

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