I’m a huge fan of experiential writing; pieces from those who share real-life engagement through the stories they share with the rest of us. Dr Sheri Fanaroff is a self-employed Wits educated GP with a family practice in Johannesburg. That means a close connection with her patients, many of whom have relied on her for decades. Sheri is a lifelong learner, and to advise and treat her patients, has invested hugely in understanding Covid-19. Here’s her latest update; on Omicron, the practicalities of SA’s new regulations and how we can live with the virus. – Alec Hogg
Nearly two years into the pandemic, what has become clear is the constant need to change and adapt our responses as the virus continually modifies itself. Going forward into the third year of learning to live with Covid-19, our fight against the virus needs to remain relevant and appropriate to the current situation.
Read also: GP shares everything you need to know about Omicron, Covid’s new “Variant of Concern”. BRILLIANT.
In South Africa, while more than two-thirds of the population show some immunity to Covid-19 (either through vaccination or prior infection or both), and Omicron does not threaten the same severity as prior strains, the following recommendations are applicable:
1. Isolation for mild infections
- People who test positive or have mild symptoms of Covid-19 now need to isolate for seven days from the onset of symptoms.
- First day of symptoms = Day 0
- Common symptoms we are seeing with Omicron include sore throats, congestion, cough, headaches, body pains, sometimes loss of smell and taste, and fevers.
- The CDC recommendation for isolation is now five days, followed by five days wearing an N95 mask to prevent transmission, and completing the 10-day period wearing an effective mask is a reasonable suggestion in order to limit transmission.
- If fever persists beyond seven days or disease is more severe, isolation should continue until the fever is resolved.
- The length of isolation following severe infections or hospitalisation should be advised by the doctor on an individual basis.
2. Isolation for people who test positive but are asymptomatic
- Asymptomatic means absolutely no symptoms whatsoever, i.e. you tested positive on a screening travel test or a pre-hospital admission test and feel completely well.
- A scratchy throat or ‘sinus’ or ‘allergy’ symptoms or ‘just a bit headachey’ or ‘a mild fever but only for one day’ does not equate to asymptomatic and in the context of a positive test, should be regarded as a mild infection; you should isolate for seven days from symptom onset.
- If you went for a test because of any mild symptom and the test (either PCR or rapid antigen) comes back positive, please be responsible and isolate for seven days so as not to transmit the virus to someone who may be vulnerable to severe infection.
- The ‘no isolation for asymptomatic positives’ was introduced because of the highly contagious Omicron variant. There are many, many people walking around with undiagnosed asymptomatic infections; it’s estimated that for every diagnosed Covid-19 infection, there are 10 more undiagnosed ones. It thus doesn’t impact the spread of the pandemic to force those who are diagnosed by chance to isolate when so many more are out and about anyway.
3. Quarantine for contacts
- Contacts of infected patients are no longer required to isolate at all. However, they are encouraged to remain cautious and monitor themselves for symptoms. Should they develop ANY symptoms, they should isolate for seven days.
- Quarantine and contact tracing have been scrapped as the volumes of infected people and thus positive contacts are just too enormous to justify the impact on the economy, the workplace and schooling. With a mild variant circulating, the end of the fourth wave and the majority of the population having some form of immunity, at this time it cannot be justified.
- Those who have been in contact with an infected person need to be responsible about mask-wearing, avoiding crowded places and avoiding vulnerable individuals, as they are still at risk of developing Covid-19 and transmitting the virus.
4. Masks
- A common query, after the quarantine and isolation rules changed last week, was whether people needed to continue wearing masks. Some have interpreted the reduced restrictions as the end of any danger from the virus.
- I would argue the wearing of masks indoors – particularly for vulnerable and at-risk individuals – is now even more important, as with the laxity of restrictions, there are far more infected people walking around spreading the virus.
- A recent systematic meta-analysis of studies published in the BMJ showed in general that masks are effective at reducing the risk of transmission by 56%. Wearing an N95 mask reduces transmission up to 95%.
- Mask-wearing remains important, particularly indoors, including at schools.
5. Sanitising and distancing
- Good hand hygiene (hand washing or sanitising) remains essential to prevent the spread of the virus between people.
- Gloves are not recommended as they become contaminated as easily as hands and should be washed just as often.
- Sanitising of groceries and fogging are completely unnecessary.
- Wiping down surfaces that are commonly or communally used, remains worthwhile.
- The social distance rule of 1.5 metres has become redundant as we understand the virus is airborne (not droplet spread as originally thought) and can travel beyond this distance. However, if standing in close proximity to others, it would be wise to keep masks on, covering noses and mouths.
- Good ventilation is crucial to allow air to circulate so that high viral loads do not accumulate within an enclosed space.
- Taking temperatures outside venues is really a waste of time and unlikely to pick up anyone carrying the virus.
6. Social interactions
- After two years of lockdown, we are seeing a pandemic of social isolation and mental illness (including depression, anxiety and social phobias) across the spectrum of children, adolescents, adults and the elderly.
- While the case numbers are low at the end of the fourth wave and immunity is high from vaccines and prior illness, I believe people should be encouraged to venture out again and meet up with friends and family with whom they may not have been able to connect for many months.
- Ideally, larger gatherings should be planned outdoors or at least in well-ventilated spaces.
- Travel, both locally and internationally, should be assessed and decided on by doing an individual risk: benefit analysis. This needs to include the financial and other impacts of potentially being stuck in a foreign country having tested positive.
- Families having gatherings when vulnerable members will be present, should consider everyone undergoing rapid antigen tests on the day of the gathering.
- Unfortunately, rapid tests are not yet widely available for home use in South Africa and are still expensive. Ideally, rapid tests should be done by everyone attending communal events and those with a positive test should not attend.
- Anyone who has symptoms of illness should stay home from social events!
7. School and work
- Restrictions on distancing at schools have been lifted, so hopefully in-person schooling can resume.
- While we can expect to see Covid-19 cases rise in schools, this is generally not a high-risk population and the benefits of attending school far outweigh the risks.
- By vaccinating adolescents, we dramatically reduce their risk of severe illness should they become infected, as well as their risk of developing ‘long Covid’; vaccinating this age group will lead to far less disrupted schooling, with less risk to both teachers and scholars.
- Universities have also been severely impacted by lockdown restrictions but most are planning to bring students back on campus for at least part of their learning. Most are implementing vaccine mandates for students wanting to attend public lectures.
- Many workplaces adapted well to functioning online and some will continue in this way, or will adopt blended working environments. Many workplaces are navigating introducing vaccine mandates to provide safe workspaces for employees and thus far, the law seems to be supporting this practice.
- Some private and public hospitals are also enforcing vaccine mandates to protect staff and patients seeking healthcare.
8. Vaccines
- An overwhelming body of scientific evidence shows Covid-19 vaccines to be safe and effective against preventing severe illness and death. Immunity wanes with time and booster doses are strongly recommended.
- A reminder of the recommended vaccine schedule in South Africa:
Pfizer: Age 12 years and over
First dose
Second dose – six weeks (42 days) later
Booster dose – six months (180 days) after second dose
J&J: Age 18 years and older
First dose
Second dose (booster) – at least two months (60 days) after first dose
Immunocompromised patients:
Extra dose > 30 days after first J&J or second Pfizer.
If they have had an extra immunocompromised dose, then eligible for a booster dose six months after this extra dose.
Only homologous boosters are allowed, i.e can do a Pfizer booster only if you have had two initial Pfizer vaccinations; and can only do a J&J booster if you have had initial J&J vaccination.
9. New variants
- A sub-variant of Omicron, called BA.2, is circulating widely in some countries and may soon take over as the dominant strain. This is also a possibility in South Africa and it may be responsible for the plateau in the decline of case numbers we have seen over the last two weeks.
- BA.2 will be watched closely, but so far, although it may be more transmissible than the original Omicron (BA.1), it is not causing more severe illness and is not evading immunity (in fact, vaccine effectiveness against symptomatic disease is slightly higher at 70% for BA.2, compared with 63% against BA.1).
- We expect to see new mutations of SARS-COV-2 in the coming months. While we hope each variant continues to become less virulent as we continue to build immunity against the virus, this is impossible to predict with any certainty.
- We are likely to experience a fifth wave before winter in South Africa and following on from prior waves, this may be driven by a new mutation causing a new variant. The greater the proportion of the population that has vaccine immunity before then, the smaller the impact will be on the country’s healthcare systems.
Conclusion
The WHO recently warned against complacency with respect to the SARS-COV-2 virus, stating that Covid-19 remains a considerable threat and poses a risk of serious infection or death. We are learning to live with Covid-19 and, correctly, are returning to some kind of normalcy. We must, however, not lose sight of the fact that Covid-19 remains a peril, is unpredictable and constantly changing. Therefore, we need to be vigilant, remain cautious and endure some inconvenience in order to protect ourselves and our loved ones.
Read also:
