Lessons from two SARS-CoV-2 waves in South Africa

As of July 2021, at least four worrying variants of the SARS-CoV-2 pandemic will be circulating worldwide, which has led to nearly 180 million documented viral infections and nearly 4 million COVID-19 deaths worldwide since December 2019. Have evolved virus with sufficient mutations to cause significant changes in viral properties such as increased transmissibility or an adverse change in the COVID-19 epidemiology; increased virulence or change in clinical appearance; or decreased effectiveness of public health and social interventions, available diagnostics, vaccines or therapeutics. 1

  • Abdool Karim SS
  • De Oliveira T

New SARS-CoV-2 Variants – Clinical, Public Health, and Vaccine Effects. In The Lancet Global Health, Waasila Jassat and colleagues2

  • Jassat W.
  • C. to change
  • Ozogwu L
  • et al.

Difference in mortality among people hospitalized with COVID-19 during the first and second waves in South Africa: a cohort study. describe the effects of a circulating variant first described in South Africa (501Y.V2 or B.1.351), now known as Beta, with increased transmissibility and immune evasion. 3WHO
Tracking of SARS-CoV-2 variants. The South African second COVID-19 surge coincided with the onset of the beta variant, which is characterized by a rapid spread and higher infection, ingestion and mortality rates than in the first wave – the authors thus draw conclusions about the differences in virulence between the ancestors and beta variants. This includes evidence of higher morbidity and mortality in the beta variant, although the authors suspect that the conclusion of higher virulence in the variant had several caveats: most notably, the difficulty of real biological effects on the quality of care when one is under pressure differentiate between advised and overwhelmed health system. This 13-month study of two waves powered by two different lines of virus is both interesting and educational. We can draw several important lessons from this South African COVID-19 case study. The first is that hospital overcrowding at the height of a COVID-19 surge is a major cause of increased mortality. Therefore, a critical public health action is to find ways to mitigate overcrowding through rapid expansion of hospital facilities or through what is known as a curve flattening strategy. Hospital facilities can be expanded, especially if this includes field, general, and high care beds rather than intensive care facilities that require more limited, specialized clinical and technical expertise. Flattening the curve, on the other hand, can be more difficult. How effective non-pharmaceutical measures were in this regard, including tightly regulated lockdowns, remains a matter of debate. A combination of the above strategies could have reduced the impact of COVID-19 in the South African first wave, with strict lockdowns including a ban on alcohol reducing hospital demand and overcrowding, particularly in emergency and intensive care units, and reducing the acuteness of the surge. This may have given health systems enough time to expand and prepare. New variants not only lead to re-infection, bypassing the pre-existing immunity to a previous infection, but also new mutations favor the survival of the virus with characteristics such as improved transmissibility which leads to faster spread, more acute increases with inherent hospital overcrowding and subsequent increases Mortality. 1

  • Abdool Karim SS
  • De Oliveira T

New SARS-CoV-2 Variants – Clinical, Public Health, and Vaccine Effects. This effect, which Jassat and colleagues describe, could have led to increased mortality in the second wave. After considering age, gender, race, co-morbidities, health sector, province, and weekly intake, there was still a residual elevated mortality rate (aOR 1.31, 95% CI 1.28–1.35) that they thought might be due to the Virus itself. Appropriate management of chronic illness and comorbidities is essential during and between COVID-19 surges. Chronic SARS-CoV-2 infection in patients with decreased immunity could be a key mechanism promoting the development of worrying variants

  • Karim F
  • Moosa MYS
  • Gosnell BI
  • et al.

Persistent SARS-CoV-2 infection and evolution within the host associated with advanced HIV infection. Globally, in the past 18 months, we have observed restricted access and length of stay of patients with HIV, tuberculosis, and non-communicable diseases such as diabetes and cancer. 6The global fund
The Impact of COVID-19 on HIV, TB, and Malaria Services and Health Systems: A Snapshot of 502 Healthcare Facilities in Africa and Asia. Strengthening health systems to ensure continued care for chronic illnesses will be critical in limiting new types of concern. Finally (and perhaps the most important lesson), vaccinations and immunization protection are urgently needed in the COVID-19 pandemic. The speed at which COVID-19 vaccines have been developed, tested and reviewed for emergency approval is both unprecedented and critical as we consider possible ways to control the epidemic. Numerous vaccines are now available on the WHO lines list and show adequate vaccine efficacy, even in the face of alternative strains of virus from ancestors. Country and cohort studies are starting to publish real-world efficacy data showing not only benefits for the most clinically at risk but also reductions in transmission as a result of decreased community viral load as a result of vaccination. South Africa and Africa as a whole do not yet have the same vaccination density as the rest of the world. This is mainly due to vaccine supply, global availability of vaccines and vaccine nationalism. 8

  • Katz IT
  • Weintraub R
  • Bekker LG
  • et al.

From vaccination nationalism to vaccination justice – finding a way forward. The consequences could translate into sustained uncontrolled transmission of SARS-CoV-2 in Africa with sustained replication and the risk of new and potentially problematic varieties of concern for the treatment of HIV.9 The First Decade of Antiretroviral Therapy in Africa. The consequence then was the unnecessary loss of young people’s lives simply due to cost, availability and neglect. In just a few months, new worrying SARS-CoV-2 variants have spread around the world. The unfair distribution of COVID-19 vaccines will lead to far greater global devastation from a pandemic. The time to act with conviction and vaccinate the whole world is now.

We do not declare any competing interests.

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