The Ministerial Advisory Committee (MAC) on
Covid-19 has requested that the quarantining and tracing of contacts of
patients with Covid-19 be discontinued with immediate effect as it is
ineffective and adds to the current economic burden.

The proposal is contained in an advisory
sent to Health Minister, Dr Joe Phaahla and signed by the MAC’s co-chairpersons,
Prof Koleka Mlisana and Prof Marian Jacobs.

According to the MAC, the discontinuation of
quarantining should apply equally to vaccinated and non-vaccinated contacts.
Furthermore, no testing for COVID-19 should be required for contacts irrespective
of the exposure risk, unless the contact becomes symptomatic.

The committee said several changes to
the Covid-19 situation had occurred since the start of the pandemic in South
Africa last year, necessitating the re-evaluation of the management of the
disease.

“The proportion of people with immunity to
COVID-19 (from infection and/or vaccination) has risen substantially, exceeding
60-80% in several serosurveys. We have learned more about the manner in which
COVID-19 is spread, and also now have to contend with variants of concern whose
epidemiology differs from that of the ancestral strains of SARS-CoV-2.
Crucially, it appears that efforts to eliminate and/or contain the virus are
not likely to be successful. Therefore, it is critical that the role of
containment efforts like quarantine and contact tracing is re-evaluated,” the
MAC wrote.

It added that quarantine is not an
effective measure for containing the spread of the virus as testing is heavily
skewed towards detecting symptomatic cases. However, a very high proportion of
cases are asymptomatic (a local study estimated the symptomatic proportion as
being just 16% of all infections) and the vast majority of these go undetected.

In addition, among the small proportion of
symptomatic cases, testing is far from universal, since patients may not seek
testing when their symptoms are mild and when testing would be burdensome and
expensive. Furthermore, the SARS-CoV-2 test sensitivity is suboptimal,
sometimes leading to false negative results.

“The inability of the current testing
strategy to identify the bulk of cases is illustrated by the high SARS-CoV-2
seropositivity rates seen across multiple provinces in serosurveys, implying
that only a fraction of cases (perhaps one in ten, or even less) are ever
diagnosed. It stands to reason that if the vast majority of cases are not
diagnosed, then the vast majority of case contacts are also not diagnosed. This
means that quarantining and contact tracing are of negligible public health
benefit in the South African setting,” the MAC noted.

“As current testing only identifies a small
minority of all COVID-19 cases, quarantining contacts of these cases serves no
demonstrable general public health purpose. Furthermore, quarantining is not
feasible in many social settings, and is associated with both significant
strain on staffing levels and costs to the individual and to the broader society.
Since quarantining contacts of cases no longer serves a public health role,
identifying contacts of COVID-19 cases (i.e. contact tracing) equally serves
very little role. In addition, contact tracing is impractical once the COVID-19
caseload rises (due to the large number of contacts that have to be identified
for each case), and is extremely burdensome in its use of human and financial
resources,” the MAC concluded.