South Africa has for all intents and purposes entered the 5th wave of the Covid-19 pandemic with a sustained rise in the number of infections reported over the past two weeks. The resurgence is earlier than expected and more clarity on whether it is indeed the beginning of the 5th wave, its extent and the severity of disease will only become available over the next two weeks.

This was confirmed this morning by Health Minister Joe Phaalha and scientists who joined him in a virtual media briefing convened after a sharp rise in the number of new infections and positivity rate in the past 14 days.  

Hospital admissions increasing

According to Phaalha, the number of new infections reported since Monday rose by 137% compared to the previous week while hospital admissions are also increasing, particularly in Gauteng, KwaZulu-Natal and the Western Cape, the three provinces that account for 85% of the new cases.

Dr Waasila Jassat from the National Institute for Communicable Diseases (NICD) noted that while there is currently no indication of an increase in Covid-19 related- and excess deaths, it is still early days.

Phaahla said that there are currently 2027 people in hospital of whom 192 are in ICU. Almost 400 of the patients have been admitted in the last 14 days.

New Omicron lineages driving resurgence

Prof Richard Lessells of the Genomic Sequencing Network of SA (NGS-SA) confirmed that the resurgence is currently driven by the two new sub-lineages of the Omicron variant, BA.4 and BA.5 that are replacing the previous dominant BA.2 lineage, and not a new variant. However, there is no guarantee of lasting immunity against disease after infection with the previous lineages or other variants.

“There is a very complex mix of immunity in South Africa that is acquired from the vaccines and from infections with all the different variants that we have seen in the previous four waves. It is quite likely that the new lineages might relate to a different capacity to get around immunity against infections, particularly that acquired from infection with the BA.1 lineage,” Prof Lessells elaborated.

Infection doesn’t guarantee immunity

“Waning immunity against infections happens quite quickly. However, it is critical to remember that immune protection against severe disease is different from immunity against infection. The waning is less prominent for severe disease as it is much harder for the evolving virus to get around all the different layers of the immune protection. The key measure against all these variants and lineages will therefore always been vaccination to prevent severe disease. That is regardless of whether you have been infected before – one time or multiple times. Vaccination and boosters are therefore essential in protecting against severe disease and death,” Prof Lessells stressed.

Giving a public health perspective, Prof Mosa Mashabela from UKZN’s Department of Health Sciences said that the drivers of the rise in infections include a complex interaction between behaviour, the new sub-lineages, waning immunity from previous infection and South Africa now moving into winter in a constantly changing environment.

He stressed government’s responsibility to protect the integrity of the health system and ensure that adequate services are available, should the 5th wave become more serious as the state of disaster comes to an end.

Growing concern over long Covid

Prof Mashabela also expressed concern about the increasing burden of long Covid, emphasising that the risk of developing the many symptoms of long Covid is not restricted to those who had severe disease.

“Even when people had mild disease and didn’t need to go to a hospital, they can still develop long Covid,” he cautioned.

The NICD is currently doing a study on long Covid in which patients who had been hospitalised are followed up for a year. Dr Jassat says data gathered up until now, indicate that a month after discharge from hospital, 88% of patients still had Covid symptoms. At three months, 66% reported persistent symptoms and at six month 49%.

“These symptoms that include brain fog, lack of concentration, shortness of breath, fatigue and headache are quite debilitating, and many of these patients are reporting having lost their jobs and not being able to participate in normal daily activities,” Dr Jassat added.

Asked about South Africa’s supply of Covid vaccines and the possible adding of other vaccines to the Pfizer and J&J jabs that are available, the DoH’s Dr Nicholas Crisp said the country has more than enough doses and was not planning to acquire more in the foreseeable future.