The writing has been on the wall since the start of the pandemic – and just like the experts warned, South Africa now finds itself in the clutches of a cataclysmic third wave of infections.
In Gauteng hospitals have run out of beds as the virus spreads like wildfire through the province and our economy continues to take a beating with lockdown level 4 having been extended to stave off the scourge.
By all accounts, the third wave is more devastating and overwhelming than the first two. Fortunately, SA’s vaccination programme seems to be ramping up as more and more citizens get the jab.
But how exactly will the vaccine protect you from the new variant? And will it work if the virus mutates again?
We speak to experts to answer all your burning questions.
ALPHA, BETA, DELTA: JUST HOW MANY VARIANTS ARE THERE?
To date several SARS-CoV-2 variants have been documented. According to Professor Hannelie Meyer, the head of the South African Vaccination and Immunisation Centre (SAVIC) at Sefako Makgatho Health Sciences University, not all variants persist as some disappear soon after they emerge.
That’s why the World Health Organisation (WHO) categorises all documented variants as either “variants of interest” or “variants of concern”.
It’s the variants of concern we need to look at as there is clear evidence of its significant public health risk, Meyer says.
There are currently five variants of concern around the globe: Alpha, identified in the UK; Beta, found in SA; Gamma, first detected in Japan; Delta, identified in India and Lambda, first detected in Peru.
“The latest variant of concern is the Delta because it’s rapidly becoming dominant in many countries across the world – including SA,” Meyer says.
The Alpha variant is predominantly active in the Western Cape, says internationally renowned virologist and head of the ministerial advisory committee (MAC) on Covid-19 Professor Barry Schoub.
“As far as we know we don’t have Gamma variants in the country,” he adds.
As South Africa struggles to cope with the spread of the Delta variant, the Lambda strain has started rearing its head. According to a report published by the KwaZulu-Natal Research Innovation and Sequencing Platform, the Lambda variant started spreading through South America last month.
By 14 June, WHO declared it a “variant of interest” after Lambda was found in 31 countries, including Chile, Argentina and Ecuador and Australia.
Also referred to as C.37, the Lambda variant accounts for about 81% of the cases reported in South America.
“At this stage it’s not a problem in South Africa yet,” says Dr Angelique Coetzee, chairperson of the South African Medical Association.
ARE ALL SYMPTOMS THE SAME?
Since the start of the pandemic people have been educated to look for symptoms associated with the virus that has caused more than 63 000 deaths countrywide. These include dry cough, fever, loss of taste and smell, chest pain or difficulty breathing.
However, Dr Angelique Coetzee, chairperson of the South African Medical Association, says it’s difficult to clearly outline the symptoms of the Alpha variant.
“We don’t have that information as it’s not as fast spreading in SA,” she says.
With the Beta variant – which was the dominant variant until recently – symptoms include a sore throat, the loss of taste and smell, high temperature and body aches and pains.
There’s also very little information on the symptoms of the Delta variant. According to Professor Meyer, it seems as though the early onset symptoms of infection is very similar to those of the common cold.
“This includes nasal congestion or ‘sniffles’, scratchy, itchy or sore throat, mild headache and feeling tired,” she says.
These symptoms might be brushed off as a cold while you might have Covid-19.
HOW IS THE DELTA VARIANT SO CONTAGIOUS?
Labelled by WHO as the “fastest and fittest” variant, the Delta variant is 60% more contagious than others. “Preliminary data estimates it is 30 to 60% more transmissible than the Beta variant,” Meyer says.
Being so highly transmissible, it’s spreading fast among the unvaccinated population.
According to Ravindra Gupta, Professor of Clinical Microbiology at the Cambridge Institute for Therapeutic Immunology and Infectious Diseases, scientists consider two components when they look at the transmissibility of any virus.
First, they study how the virus can replicate faster and make more infectious variants, but there is also an “antibody-escape component” that looks at how the virus mutates and avoids some of our antibodies.
This is why people who were previously infected with the Beta variant may not be immune to the Delta variant and could be susceptible to reinfection with the Delta variant, Meyer says.
HOW SHOULD YOU TREAT IT?
With the symptoms of the Delta variant mimicking that of a common cold, the danger is people might ignore it and will therefore not isolate or test for Covid-19.
Most patients have a mild infection, particularly those in the young and healthy age group. “We still need evidence from South Africa but early evidence from the UK suggests there is an increased risk of hospitalisation within 14 days of testing positive for Covid-19 compared to the Alpha variant,” Meyer says.
While there’s no concrete evidence that the Delta variant will make you sicker than the others, Schoub says it’s still important to treat the symptoms and take the necessary precautions as if you have Covid-19.
“If you’ve been in contact with someone who is positive, and you show any symptoms three to five days later you should get tested,” he advises.
WHEN WILL IT ALL END?
Experts suspect the virus is here to stay because just as they start to get a grip on it, the virus keeps surprising them with new mutations. “The virus will always be there,” Professor Schoub says.
“But I think eventually science will conquer the variants.”
To do this, scientists need to make sure the virus doesn’t cause so much severe disease. “If there are enough people who are immune to the virus either from being infected or from the vaccine then it will stop circulating. Hopefully, it will eventually be a minor disease.”
As experts continue to learn about the virus and its variants, they will also learn how better to manage it over time, he adds.
HOW EFFECTIVE ARE THE VACCINES IN SA AGAINST THE VARIANTS?
The good news, Professor Meyer says, is that the Covid-19 vaccines South Africa is rolling out does protect against developing severe disease, hospitalisation, and death due to the Delta variant.
While there’s no clinical-trial data on the effectiveness of the Johnson & Johnson vaccine against the Delta variant in South Africa yet, she says laboratory studies suggest that the vaccine may be even more effective against the Delta than the Beta.
The J&J vaccine, which is given as a single shot, provides an estimated 64% protection against moderate to severe disease and 82% protection against critical Covid-19.
“Further good news is that data also suggests the vaccine works effectively up to at least eight months post-vaccination, which means a booster dose isn’t necessary at this stage.”
Based on data from the UK, the Pfizer vaccine, which is given in two doses, has shown high levels of protection against hospitalisation with the Delta variant after the second dose.
ARE OTHER VACCINES BEING CONSIDERED?
The South African Health Products Regulatory Authority (Sahpra) has provided an emergency use authorisation for the CoronaVac Covid-19 vaccine, manufactured by Sinovac Life Sciences Co in China.
However, associate professor Kenneth Mak from Singapore says there’s little data on the effectiveness of the Sinovac vaccine against the Delta variant.
Because it takes a very long time to register medicines in SA, Sahpra will not register the vaccine unless they have sufficient data on it.
There are also conditions attached to the emergency use of the CoronaVac Covid-19 vaccine. “The applicant has to periodically provide vaccine safety reports and results of ongoing studies before it can be approved for use or in this case emergency use,” Professor Meyer says.
Meanwhile, Professor Rose Burnett from SAVIC says Sahpra is busy with a “rolling review” of the application for the Sputnik V vaccine made in Russia.
This means Sahpra will review the company’s data on a continuous basis until sufficient evidence on efficacy and safety has been provided. “National regulators can only evaluate an application that has been submitted by a locally licensed applicant,” she says.
Since Sahpra hasn’t received any applications for the registration of the vaccines manufactured by Moderna and Novavax, these vaccines cannot be considered for use in SA.
CAN YOU CHOOSE YOUR VACCINE?
You don’t have a choice of vaccines as government selects which vaccinations are sent to vaccination sites around the country.
Meyer says the various vaccines are being equally distributed across the provinces. “The government considers various factors in distributing vaccines, including vaccine availability and logistics. For example, if it's a mobile clinic vaccination site, then having the single dose J&J vaccine is easier to administer," she says.
"As more vaccines become available, the options available to the public in a specific area are likely to increase."
The J&J vaccine is being used mainly for teachers, while the Pfizer vaccine is available at all the other sites.
If for example you have an allergy or contraindication on the specific vaccine offered at the site you are attending, you'll be referred by the vaccinator to another site where the alternative vaccine is available, she says.
"But if you don't have a specific allergy or contraindication, since all vaccines are more or less the same in terms of efficacy and safety, I recommend you get the vaccine that's available to you.
“For example, the Covid-19 vaccines available in South Africa use the spike protein of SARS-CoV-2 to train the immune system. So, when you get vaccinated, your body develops an immune response against the spike protein of the SARS-CoV-2 virus,” she explains.
This means that when you are exposed to SARS-CoV-2, your body already has antibodies and immune cells. These allow you to fight the virus before it can multiply, establish disease, and make you sick.
While the vaccine can’t stop the virus from entering your body the great advantage is that you will not develop severe disease because your immune system has been trained and will clear the virus from your body before it can establish disease.
Meyer says vaccinations are the only way to safely bring our country closer to reaching population immunity. “The Covid-19 vaccines we are using in South Africa have been shown to be highly effective at preventing severe Covid-19 disease and death from Covid-19,” she says.
So far, South Africa has only managed to fully vaccinate 2,3% of the population, which is around 1,36 million people. There’s still a lot of catching up to do, according to Barry Schoub, professor emeritus of virology at Wits University in Johannesburg.
Yet there have been reports of batches of vaccines being thrown away at the end of the day because they don’t “keep”.
There will always be a certain percentage of vaccine wastage, says health sciences lecturer Hannelie Meyer.
Vaccines are based on different technologies and have different properties, which is why each vaccine has its own storage requirements. The period it can be stored at a certain temperature also differs from vaccine to vaccine. “Vaccines exposed to undesired temperature ranges will result in a loss of potency and can also result in adverse events following immunisation,” she says.
Should there be any deviations from the storage requirements, vaccines must be discarded for patient safety.
But experts say one of the ways to avoid wastage is to allow walk-ins because of the recent no-show rate. According to DisChem, about 70% of people who have registered didn’t pitch for their vaccines.
Walk-ins have now been opened in Gauteng for those 50 years and older while vaccination for people between the ages of 35 and 49 will start on 1 August.
You can register for a vaccine appointment at your local pharmacy if you are far from the site government allocates to you.
To register on the department of health’s Electronic Vaccination Data System all you need is access to the internet, your ID number or passport, contact information and your work or home address.
Meyer says there will be no vaccine wastage if you go to a different place instead of your registered site because the system will pick up your ID number. Walk-ins are now also open in case you miss your appointment.
*For more information on the EVDS registration and the Covid-19 Public Hotline go to sacoronavirus.co.za
EXTRA SOURCES: NEWS24.COM, NYTIMES.COM, BUSINESSTECH.CO.ZA, TIMESLIVE.COM, DAILYMAVERICK.CO.ZA, JNJ.COM, DAILYMAIL.CO.UK, NGS-SA.ORG, NEWS24.COM, NICD.AC.ZA, KRISP.ORG.ZA,