Low vaccination numbers failed to make big difference amid Covid-19 third wave - Groote Schuur prof

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  • As the Western Cape exits the third wave, Professor Marc Mendelson says the vaccination programme did not greatly ease the burden of Covid-19.
  • The third wave exceeded the numbers seen in the second wave and also exceeded the duration of both prior waves, he says.
  • South Africa was seeing the same results documented in other countries with much higher vaccination rates, Mendelson pointed out - those admitted to hospital are largely not inoculated.

The vaccination programme did not greatly ease the burden of Covid-19 in the Western Cape as too few people have been inoculated to have made a significant difference, Professor Marc Mendelson of Groote Schuur Hospital lamented.

The one exception, however, has been the reduction in serious infections of healthcare workers, which eased clinical service provision, the head of the Division of Infectious Diseases and HIV Medicine told News24.

As the Western Cape exits the third wave, Mendelson said he felt mixed emotions as the public hospital this week closed the first of its Covid-19 high care wards.

"On the one hand, we are all happy to see the numbers come down and wards close until needed again. On the other hand, happiness is offset by the sadness of loss of so many lives," he said.

ALSO READ | Western Cape cases will need to halve before province is considered out of the third wave

According to the latest statistics released by the provincial health department on Thursday, 19 426 people have died in the Western Cape since the outbreak. A total of 15 203 of the 513 732 recorded cases are active, with 968 reported within the last 24 hours.

Premier Alan Winde confirmed that the province has vaccinated, with at least one dose, 36.6% of the adult population and is the leading province in the percentage of the 18+ population who have received their jab to date. A total of 1 821 815 have received at least one injection, of which 133 038 or 22.75% are fully vaccinated.

The third wave had been especially taxing in terms of having to deal with anti-vaxxers and proponents of unproven treatments, Mendelson said.

"The former was not an issue until this wave, and the latter has been a continuing disappointment, but very much a continuation of an approach taken by too many during the first and second waves. People with too little knowledge are far too quick to contradict healthcare professionals and scientists, who bring years of specialist experience to bear in mitigating the pandemic."

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Many questions had been put to healthcare workers about resentment towards unvaccinated people requiring hospitalisation as the country moves toward all being offered the jab and having access to it, Mendelson said.

"Our job is to provide you with the highest level of care and service available. We do not discriminate against vaccinated or unvaccinated, in the same way as we don't discriminate against other social factors or compliance to prevention or treatment modalities for other diseases.

"We are here to care and to advise, based on our collective experience gained during our education and own careers, in addition to the lessons we learnt through history."

And what the current wave proved, was that vaccination did indeed protect against severe infection, hospitalisation and death, he maintained.

South Africa was seeing the same results documented in other countries with much higher vaccination rates, Mendelson pointed out - those admitted to hospital were largely not inoculated.

He explained:

Breakthrough infections will occur as no vaccine is 100% effective and part of the immune response may wane to a variable extent. However, the power of vaccination to protect against this most feared consequence of Covid-19 has stood the test of time and variation in circulating virus, [that is to say] the delta variant.

The only infection to have ever been eradicated is smallpox, which was achieved through vaccination, Mendelson said.

"We are agonisingly close to eradicating polio through vaccination and eradication of other viral infections are closer now than ever. In all likelihood, Covid-19 will be here to stay for a long, long time to come, but our greatest chance of mitigating its effects and co-existing with it, is through vaccination to compliment or enhance protection gained by natural immunity in those who have been infected.

"As our knowledge of SARS-CoV-2 develops, there is the added hope that our vaccines and prevention programmes will evolve to one day see its eradication."

In the Western Cape, the third wave exceeded the numbers seen in the second, Mendelson said. It also exceeded the duration of both prior waves.

"With each successive wave, and in particular because there is little respite for healthcare workers between waves [with the] need to attend to the continuing stream of non-Covid-19 patients admitted and the large number of outpatients, particularly those awaiting non-urgent surgery whose access to care may have been delayed, stress for healthcare workers increases," he said.

But especially traumatic to hospital staff and those they treat had been having to inform patients in the unit that a family member had died.

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He was concerned about the mental health of healthcare workers who may have not been as fortunate as Groote Schuur staff and patients who have a psychiatrist and psychologist offering support in the most difficult of circumstances.

Despite putting up boundaries to enable staff to do their job, they do become attached to their patients, especially owing to prolonged hospitalisation periods and the absence of their loved ones from their bedsides, Mendelson said.

Nursing staff, junior doctors and other members of the health workforce frequently filled that role and often losing patients felt akin to losing a friend.

He explained:

With limited intensive care and high care resources, prioritisation tools have to be used to try and ensure that patients with the best chance of survival get the highest levels of care available. Depending on how full the ICUs and HCUs are at any given time, this may vary from an ICU only accepting the youngest, fittest patients with no pre-existing diseases or those with just one pre-existing condition under a defined age limit.

"This means healthcare workers having to make difficult decisions, which translates to some patients dying with no further options available. This is not a new phenomenon for South Africa's resource-limited health system, but the degree to which we are having to make these decisions is leading to an intense degree of 'moral injury' in our healthcare workforce, particularly when we lose young patients, who also sometimes die just from the pure severity of illness.

"We've had patients under 20 years of age die at Groote Schuur Hospital and we have looked after far too many under 40 years of age with the same outcome."

Mendelson said the current Covid-19 vaccines administered in South Africa provided excellent protection against severe disease, hospitalisation and death.

"That is the most important effect that one could ask of a vaccine. We want it to save your life," he said.

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"The vaccine does also reduce your risk of mild-moderate Covid-19 and asymptomatic infection, but to a slightly lesser extent depending on the vaccine and variant. This is not an infection to take chances with.

"The reality is that we have witnessed young, fit people die in addition to older people with pre-existing illnesses, many hundreds of thousands sick, and an estimated 10% may go on to have longer term symptoms (long-Covid), which are debilitating, and affect young and old alike."

Accelerated vaccination uptake was the surest way to be able to "live a more normal co-existence with SARS-CoV-2 going forward" and would provide the best chance of reducing reliance on more socially limiting public health measures, Mendelson said.

"Natural infection does provide good immunity, but it's an awful big gamble to take with your life and that of your loved ones."  

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