Race to vaccinate as third wave of Covid infections takes hold

The third wave of Covid-19 has taken hold and could be significantly worse than the second, experts told the Sunday Times.

Vaccinations started too late to protect most South Africans from this wave.

"I'm concerned we are sitting on a potential third wave which is 25% higher than the second wave," said Covid-19 ministerial advisory committee member professor Ian Sanne, an infectious diseases specialist who heads Right to Care, a health organisation at the Covid frontline.

Wits University infectious diseases specialist professor Francois Venter said: "I think it is clear we are in the midst of a third wave, with huge differences by provinces. We need to accelerate vaccinations hugely."

This was echoed by Dr Gesine Meyer-Rath from the South African Covid-19 Modelling Consortium, who said: "We need to get vaccinating faster to possibly see an impact on the third wave."

Council for Scientific and Industrial Research senior researcher Ridhwaan Suliman said all indicators show sustained increases in infections. "That's likely to continue now for the next few weeks at least," he said.

The number of confirmed new cases is up, averaging 3,500 daily over the past week, 26% higher than the previous week.

The warnings come as ANC President Cyril Ramaphosa on Saturday confirmed that tighter restrictions were on the cards.

Ramaphosa, who was delivering a virtual address at the ANC's ninth Northern Cape provincial conference, is expected to address the nation on how the government intends to manage the pandemic as the winter season enters full swing.

"Indications are that our country is entering a third wave as the Covid-19 infections are just going up and we must do everything in our power to mitigate this. We once again have to remind South Africans to be vigilant and protect themselves and each other," said Ramaphosa.

Ramaphosa also expressed concern over the rising number of infections in the Northern Cape saying the province has shown the highest infections per capita in the country at nearly 34 to 100,000 followed by the Free State with nearly 15 per 100,000 infections.

A test positivity rate above 10% "shows that South Africa is well into its third wave", said Suliman, adding that Gauteng's sharp rise in cases is driving up the national numbers. "It is the province that is increasing most sharply", with numbers up 40% compared to a week ago.

Hospital admissions are another indicator of increasing infections. There were 3,200 new admissions nationally last week, up 16% on the previous week. Gauteng has seen the biggest increase, with admissions up almost 40% on the week before.

Sanne said: "The rate at which new cases and hospitalisations are increasing in Johannesburg and Pretoria - in Gauteng in general - is quite frightening."

Professor Alex van der Heever of the Wits University School of Governance said Gauteng's "upward surge" needs to be addressed.

"The second wave in Gauteng was curtailed by the December restrictions," he said. "There is therefore a large population still susceptible to infection."

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Admissions are also rising in the Free State, North West, Mpumalanga and the Western Cape. The Free State and Northern Cape have never officially come out of their second wave, based on reported numbers. The Free State, said Sanne, "is a tinderbox".

Professor Barry Schoub, a member of the vaccines ministerial advisory committee, said the Northern Cape is certainly well into a third wave and reporting 33.8 cases per 100,000 people daily.

"We always thought that when the weather gets cold and people misbehave that we were going to get a third wave, and both of those have happened," he said.

However, he said it is too early to tell if the third wave will be more severe than the second. There is some hope that it will be less severe as there are currently no new variants to contend with, he said.

"There's quite a lot of immunity in the population, which might also ameliorate it. But it's too early to be confident about it."

More than 440 vaccination sites were open by Friday and about three times more people were being vaccinated on average per day this week than in the first week, when daily vaccinations averaged more than 22,000.

Sanne said the number of vaccinations is starting to catch up to the volume of doses available. "If the activation of sites continues as anticipated, we will reach 800 to 1,000 vaccination sites by the beginning of July."

About 10% of sites have been allowing people to walk in without first being registered and scheduled electronically, and some - though less than 10% - have been recording the vaccinations on paper-based systems instead of using the electronic vaccine data system (EVDS), Sanne said.

"This will cause major complications down the line," he said of the paper records.

Sites using the EVDS are capturing data smoothly and will be automatically restocked with doses.

Professor Glenda Gray, co-principal investigator of the Sisonke implementation study that vaccinated health workers, said: "Eventually the EVDS is going to be the instrument that saves us with scheduling and supplies, and paper-based systems will let us down. But we have to be pragmatic at this stage, while the systems are getting sorted, and allow people to walk in, especially in rural areas."

By Thursday, 3.2-million people aged 60 and older were registered on the system, but a vast discrepancy has emerged between privileged and disadvantaged citizens. Sanne called for a massive registration outreach drive in locations such as shops and social grant payment points. Deserted vaccination sites have raised concerns about hesitancy, which worsened following reports of very rare blood clots linked to vaccines.

Sanne said: "Even at Right to Care, about 30% of our 1,400 staff members refused to have the vaccine. Once people have learnt to trust the vaccines, I think that hesitancy will decline. That is what we experienced with HIV." He said one of the improvements nationally has been the scaling up of liquid oxygen production after shortages compromised the treatment of critically ill Covid patients in the second wave.