Israel offers glimpse of life after Covid-19 pandemic

The hospitalisation of elderly vaccinated Israelis is no reason for alarm, say top infectious diseases experts, because growing evidence confirms that Covid-19 vaccines prevent 90% of deaths in the real world.

Professor Jeremy Nel, an infectious diseases specialist at Wits University, said: “Israel’s experience actually shows the enormous benefits of vaccination — the rate of severe disease in the vaccinated is about 10% of the rate in the unvaccinated.”

With few restrictions left, Israel offers a glimpse of post-pandemic life: a new norm in which coronavirus infections may surge, possibly triggered by new variants, but deaths are rare among those who have been inoculated.

Professor Shabir Madhi, a vaccinology expert at Wits University, said: “In Israel, 90% of the adult population is vaccinated, so it is unsurprising that proportionally more of hospitalised cases will have been fully vaccinated. However, the attack rate in vaccinated per capita is drastically lower than in unvaccinated.”

A major US study published on Wednesday in the New England Journal of Medicine, using data from 45 000 medical encounters, found that mRNA vaccines offered 89% protection against hospitalisations and 90% protection against ICU admissions.

The future of Covid-19 resurgences in SA will be shaped by the population’s vaccine coverage, its natural immunity after being infected (estimated at 60% to 70%) and the evolution of the virus, said Madhi.

“Over time it is very likely that Covid-19 will become endemic, with occasional flare-ups,” he said, noting that lockdown restrictions do not prevent infections but spread them out.

The Western Cape released data on Thursday showing that 98% of deaths in over-60s were among the unvaccinated and 96% of hospital admissions in that age group were unvaccinated.

Professor Graeme Meintjes, an infectious diseases expert at the University of Cape Town, said: “This is reflected in our daily experience in the Covid-19 high-care wards at Groote Schuur. Every day there are many patients who are desperately ill with Covid-19 pneumonia being admitted for high-level oxygen support. Almost all of them have not been vaccinated.

“Among the small percentage who have been vaccinated, it has usually been in the past few days so the vaccine has not yet been able to exert its protective effects on the immune system.”

Cape Town’s other adult tertiary hospital mirrors this experience. Professor Jantjie Taljaard, an infectious diseases specialist at Stellenbosch University, said: “During the third wave of infection, we have not admitted any vaccinated people to the ICU at Tygerberg Hospital. Although a small number of vaccinated people were admitted for oxygen therapy, they responded well and were discharged without complications.”

Similar patterns were observed at private hospitals in Cape Town. But Johannesburg pulmonologist Dr Frans Skosana, of Netcare Olivedale Hospital, said: “Unfortunately we had the third wave before vaccine rollout.” The experts underlined that vaccines reduce the risk of hospitalisations and deaths massively, but not to zero.

Meintjes said: “The reasons some individuals develop severe Covid-19 despite vaccination are because they have not had a sufficiently robust immune response to the vaccine. This may be related to old age or medical conditions or therapies that reduce immune responses.”

The reduced risk of hospitalisation varies depending on variants circulating and the type of vaccine given — ranging from 70% reduction (Johnson & Johnson) to Pfizer (80%-100% depending on age) — but every vaccine in widespread use, including Sinovac and Moderna, shows about 90% protection against death.

Professor Glenda Gray, co-principal investigator of the Sisonke implementation study in SA, which inoculated nearly half a million health-care workers, said breakthrough infections among the vaccinated were to be expected.

“They are usually mild, and we do see a lot of reinfection. Some health-care workers have been infected [during] every wave. The vaccine protects against severe disease and death, not infection,” she said.

The New England Journal of Medicine study finds the J&J vaccine offers 73% protection against emergency department visits. “The numbers are small but this is a great finding,” said Gray.

The Sisonke study showed that 94% of breakthrough infections were mild, 4% moderate and 2% severe.

Medicine professor at Wits University Francois Venter said: “While people with breakthroughs are less transmissible, they can still infect and harm unvaccinated people. It’s the reason vaccinated people need to wear masks for now — to protect others.”

The experts were clear that the priority is to get at least a single dose into the over-35s before considering booster shots for SA.

Nel forecast, as his best guess, that “Covid-19 will gradually start to resemble influenza [albeit with less seasonality], in that infection will remain common but severe cases will gradually become much rarer. This will be thanks to immunity both from natural infection and vaccination.”

High rates of hospitalisation and death should wane with the rollout of vaccines and natural immunity, said Madhi.

“It would be surprising for Covid-19 resurgences to result in high hospitalisation and deaths, compared to the first three waves.”

In most countries people can expect to live with Covid-19, said Skosana. “In my view, the most likely endgame is cohabitation ... perhaps with selected pockets of conflagration. It is unlikely that we would eliminate or eradicate it.”

Venter outlined the best and worst scenarios, noting there were shades of grey in between.

“There is a nightmare one where we have continual variants and continual new vaccination programmes every year or two for the vulnerable, where we have to reconfigure our society around repeated waves and lockdowns,” he said.

“The other extreme is the current vaccines and old infections give amazing immunity and we never need another vaccine, except maybe for the most severely vulnerable, and we’re all back to normal once we have everyone jabbed.”