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01 April 2021 | Story Andre Damons | Photo istock
The Easter weekend runs the risk of being a major catalyst for the third wave and people’s behaviour will be the primary driver of transmission for the third wave.

Similar trends as during the festive season of 2020 – when the behaviour of people was driving COVID-19 transmissions and played a role in the second wave – have emerged due to the Easter holidays, and may contribute to a third wave. 
“This means that we can already anticipate gatherings and a higher rate of travel during the next three weeks. As a result of this as well as non-adherence to the non-pharmaceutical interventions, we can anticipate this event to serve as a catalyst for transmission.” 

“If nothing is done to prevent this, it is anticipated that the Free State will see a steady increase and a potential third wave between 17 April and 26 June,” says Herkulaas Combrink, the interim Director of the UFS Initiatives for Digital Futures and PhD candidate in Computer Science at the University of Pretoria (UP).

The Easter weekend runs the risk of being a major catalyst for the third wave

According to him, the vulnerability and population density dynamics in each province, the behaviour of people, and the social norms between communities must be taken into consideration to contextualise the impact of Easter on disease transmission – especially when looking at SARS-CoV-2.

For the Free State, the Easter weekend runs the risk of being a major catalyst that will lead up to the third wave, says Combrink. “If no interventions are put in place and people do not adhere to non-pharmaceutical interventions to mitigate the spread of the disease, then we will see a steady climb and increase in cases up until that time. This means that the behaviour of people will be the primary driver of transmission for the third wave.”

Reducing the severity of the third wave

According to Combrink, who is involved in risk communication and vaccine analytics with other members of the UFS, we may be able to reduce the severity of the third wave if the variant remains the same and the vaccination roll-out plan is in full effect. It will also help if the correct number of people are vaccinated, the general population adheres to PPE and mitigation strategies, and people practise the appropriate behaviour as indicated in all official COVID-19 communication, including the UFS COVID-19 information page.  

According to Prof Felicity Burt and Dr Sabeehah Vawda, both virology experts in the UFS Division of Virology, the current vaccination programme is aimed at reducing the severity of the disease among health-care workers. Prevention of further waves of infection through vaccination will require sufficient coverage to induce at least 70% herd immunity in the country. Currently, no country has achieved that level of herd immunity through vaccine programmes – this is the long-term goal of vaccination. 

“Irrespective of the government’s vaccination programmes and schedules and a virus that may mutate and perhaps become more virulent, the fundamental ways to protect yourself remain unchanged, namely social distancing, wearing of masks, and regular hand washing. People need to realise that this ‘new normal’ is going to be with us for a while and remains the best defence against all SARS-CoV-2 viruses and even provides protection against other respiratory pathogens.”

Vaccines and mutations

The exact frequency of mutations differs between different types of viruses, but generally, SARS-CoV-2 is known to have a slower ‘mutation rate’ than other RNA viruses because of its built-in ‘proofreading’ enzyme. The true mutation rate of a virus is difficult to measure, as the majority of mutations will be lethal to the virus. Irrespective, very few have actually resulted in clinical impact. 

“This highlights the rather gradual process of mutation, so vaccines should remain effective or at least partially effective in the near future, as they elicit antibodies that target different parts of the virus. Continuous surveillance of SARS-CoV-2 is necessary and ongoing to monitor for changes that may impact vaccines and diagnostic tests,” the experts say.

According to Prof Burt and Dr Vawda, scientists are continuously monitoring the situation to detect if the current vaccines would remain effective and to try to adjust them accordingly. How or when the virus will mutate in a clinically significant way is unknown, so at this point, the current vaccines have been shown to be effective against severe disease and hence have application in reducing significant disease. 

“There remains a lot unknown about the extent of protection and the duration of protection, and it is obviously hoped that the vaccine’s immune response in the human body would be able to provide at least some protection or decrease the possibility of severe disease even against potentially newer variants.”

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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