On a hot, sticky day at the end of January 2020, more than 300 people crowded into a lecture theatre at Tygerberg Hospital while Wolfgang Preiser, a professor of virology, adjusted his microphone.
Sitting on the podium among his colleagues from Stellenbosch University, Preiser had arrived with notes and a presentation that would shine off the big white screen at the front of the room.
About 10km away, Cape Town International Airport was its usual busy self at the end of January: intrepid travellers from colder countries who had come to soak up the summer and family members returning home to their loved ones.
Dotted among the moving crowds were travellers, mainly from Asia, already wearing masks.
The so-called novel coronavirus had already sunk its claws into China and a few other Asian countries. Europe and America had just seen their first cases.
But on the tip of Africa, it remained theoretical at this point and, as Preiser and his team briefed those present, it felt more like science fiction than an impending reality: a graphic of an isolation room and a staff member in personal protective gear came up on the screen with some bullet points on a preparedness strategy.
With the rows of lecture hall seats filled to capacity, many of those present — doctors, nurses, journalists, researchers — found a spot on the floor. Before the briefing, the crowd did what South Africans do, chatted and joked with familiar faces and strangers alike.
The room became a microcosm of the public opinions that would follow over the next two years. Some said: “This may be the last time you’re in a crowded room without a mask on.” Others said: “I doubt this will ever come to SA. Look at some of the other scares and we were never hit.” Still others said: “Who knows if China is telling us the whole story.”
Fear, panic, conspiracy theories and denialism were already planting their seeds.
After the briefing, Preiser kept calm and answered a deluge of questions from the audience. He emphasised how lucky we were to be in summer during the outbreak.
“It is going to become increasingly challenging for those in the northern hemisphere,” he said, “because they will also be having their winter flu season and the symptoms of the two conditions are very similar.”
At the end of the briefing, Preiser packed up his bag and left the room.
February was the lull before the storm and, while most South Africans went about their daily lives, Preiser was preparing for the worst.
By March that year, the sanitised images of isolation rooms on the white screen had become a scary reality.
No longer science fiction, the country now faced the prospect of being a full-blown victim of this deadly pandemic.
It would take time for the numbers to grow, but before long even the idea of an isolation room at a hospital for a diseased person became a distant dream.
Exactly a year later, on January 31 2021, about 1.5-million confirmed cases of what by then was called Covid-19 had been recorded in SA.
Official deaths in the country stood at about 44,000, though the actual toll was probably three times higher.
By then, Preiser was immersed in the ongoing nightmare, and yet there was still more to come: by January 31 2022 there had been more than 3.6-million cases in the country and about 95,000 deaths, though again the toll was actually three times higher.
Today, steady and rational as ever, Preiser is looking back at the past two years, but mainly he is looking ahead, carefully sifting through the lessons that have become crucial to ourselves and the planet.
And while the rest of us now smile with unmasked faces, Preiser is worried we will have “let a good crisis go to waste” by not learning from the global tragedy.
“To be honest, I wonder if the world has really learnt anything. The pandemic was a crude wake-up call,” he said in an interview with Sunday Times Daily this week. “Despite ample warnings, the world was quite unprepared when Covid-19 struck in early 2020.”
These warnings had come in the form of the original SARS in 2003 and MERS in 2012.
These had resulted in “scenario-planning exercises that highlighted problems”, and yet the world was caught off guard with Covid.
Many scientists these past two years have focused on human health when considering how to manage a pandemic, but Preiser keeps reminding everyone of the bigger picture.
News broke recently in SA of two monkeypox cases, a disease which, as Preiser points out, is completely of human making given how we treat animals.
“The wild animal trade, and also high-intensity animal husbandry, are risky and need to be controlled strictly. In 2003, there was already a monkeypox outbreak in the US — imported mammals from West Africa were kept together with North American prairie dogs that were then sold as pets. The imported animals carried the virus and gave it to the prairie dogs, who then passed it on to their new owners. How crazy is that?”
He says we need efficient public health systems that “recognise problems early” and we also need to be prepared to tackle them “quickly and decisively”, for example, having enough PPE, masks, sanitiser and other such necessities in stock beforehand.
Preiser has noticed the Covid fatigue around him, and he gets it — he is also tired.
But he is urging the world and the country to hold on to the lessons learnt.
“At the moment my impression is that people want to move on. We have to, of course, but we must learn from it to cope better the next time. I am not confident that I am seeing much of that happening,” he says.
He also laments the fact that our vaccine rollout has all but ground to a halt.
“I deplore that the Covid-19 vaccine rollout has not made much progress and fear that it will soon come to a standstill almost, as people perceive the risk to be gone. Currently, transmission intensity is low, and it is true that the vast majority of people have been infected and/or vaccinated, resulting in a degree of protective immunity,” he says, but points out that it is not as simple as that.
Immunity wanes with time.
This is even more true of natural immunity — especially when it already starts off on a poor footing because the person only had a mild or asymptomatic infection.
On top of that, Omicron sub-variants can already escape immunity, and next variants are very likely to be even more adept at doing that.
Preiser feels anxious for those with underlying conditions and says: “With all measures being abolished, daily life is becoming riskier for them. Here in SA this issue is not mitigated by the availability of antiviral drugs, unlike in many industrialised countries.”
On the upside, he says “human resilience and resourcefulness proved indispensable”, and the criminal networks that sprang up notwithstanding, “SA does not need to hide”.
He says: “I am talking of people who mustered enormous strength and came up with great ideas and resolve to overcome the challenges. It was amazing.”
On a much sadder note, the pandemic uncovered or magnified many issues in the country, ranging from the social to the economic, political and medical.
He highlights diabetes and hypertension in particular: “One wishes they would now be recognised and remediated, but I fear a lot of these may be allowed to disappear from sight again ... until next time.”
Regarding vaccination, Preiser says he was “delighted how quickly several well-working and very safe vaccines could be developed and manufactured, and how they saved numerous lives”.
A big lesson, however, was how the rapid emergence of several variants over a short space of time revealed that “evolution has tricks up its sleeves”.
So have those who’ve tried to derail the vaccination programme.
“While I don’t want to ‘blame the victims’ of Covid-related disinformation, I have spent my gunpowder trying to debunk myths and outright falsehoods and cannot do more than what I have tried. All too many remain misled and misguided,” he says.
His last salvo is about flexibility as evidence changes: “We must acknowledge that decisions were made on the basis of limited and oftentimes fast-changing evidence. This is a challenge. Apparently some people have still, more than two years later, not come to terms with the fact that at the very beginning, the public were advised against using face masks [so as not to deprive medical staff of them] but soon thereafter were asked or required to use them.”
He says: “There is nothing wrong with the former nor the latter. It is disingenuous to construct this as some form of conspiracy.”
If the pandemic was, as Preiser says, a “crude wake-up call” in a world where more zoonotic diseases will proliferate because of how we treat animals, then we only have ourselves to blame if we do not try to stave off, or prepare properly for, the next one.
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