A recent weekly press briefing by the Western Cape Premier Alan Winde to update the province on the COVID pandemic set me thinking and asking myself some difficult questions.
With the advent of the Omicron COVID variant, countries around the world have reacted with further restrictions placed on their citizens. International travel for the average citizen has ground almost to a halt with disastrous consequences for the hospitality industry and the many other commercial entities dependent on this sector. Despite these new and draconian restrictions, almost impulsively implemented, the numbers of Omicron infections across the globe continue to rise.
In South Africa where the Omicron variant was first identified, the impact on the travel and hospitality industry has been severe with many guesthouses and hotels seeing almost total cancellation of bookings for the festive season which is under normal circumstances the period when they are at their busiest. In Cape Town in the Western Cape, where I live, this has assumed dire proportions despite efforts to promote local tourism as in many instances there was a heavy dependence on foreign tourists. This has now occurred in addition to the broader damage to lives and livelihoods of similar even harsher restrictions over the last two years during the previous “waves” of COVID infections.
On 21st December 2021, the Western Cape Government in its weekly press briefing confirmed that the number of COVID cases, predominantly of the Omicron variant, have risen sharply in the province but “with caution” noting that hospital admissions and oxygen usage for those admitted has not followed the steep increase in infections as was the case in the previous three “waves”. This should be good news! The response from government however remains unchanged, that is, “vaccinate, wear a mask, avoid closed spaces and gather outdoors”. Sound advice but repetitive after two years of living with the virus and almost a year with vaccines available to the South African population. So where do we stand? As of 21st December 2021 it is reported that only 39% of the South African adult population is fully vaccinated with a somewhat higher figure of 46% in the Western Cape. Nationally the target of vaccinating 300 000 people a day has not been achieved with a reported dismal 55 989 vaccinated country-wide in the 24 hours prior to the press briefing of whom 7327 were in the Western Cape. It certainly seems that something is very wrong.
The “Stay safe Christmas message” from the Western Cape Government exhorts citizens to “work together to beat the fourth wave” and again indicates that to do this people must vaccinate and “keep up the good habits.” The message continues, “Don’t hesitate vaccinate”; “Mask up” and “Avoid crowds” encouraging people to postpone parties, keep gatherings short and outside, and ensure physical distance from others. However, given the demonstrated rapid rise in the number of infections it is clear that this messaging has failed and is failing to influence behaviour and the question is why?
Does it indicate a need for more draconian restrictions? Clearly these failed in the past to influence the inevitable progress of the three previous waves of infections. In fact what has occurred is a building resistance to the limitation of personal freedoms across the world, exemplified by the recent revolt experienced by the British Prime Minister from 100 of his own Tory backbenchers in the British Parliament to increased restrictions and incidents of civil unrest as a result in other countries. The stated aim of the so-called “lockdowns” was to allow time for health services to prepare for the influx of seriously ill patients into hospitals, which should after two years have been achieved and thereafter to prevent them being overwhelmed. And other than in the initial phases of the pandemic in Europe, India and a few other countries this did not happen elsewhere or in South Africa. In fact, in countries including South Africa, facilities constructed specifically to manage COVID patients were under utilised and subsequently decommissioned. The repeated and often injudicious nature of the restrictions based on this premise have resulted in the frustration and anger of communities with government.
Vaccination in the Western Cape Government press release is indicated as the “biggest weapon against the impact of the fourth wave” and a call is made for a “massive whole of society effort to generate increased targeted demand”. What is this “massive whole of society effort”? It seems strange that with the vaccine freely available across the country that people are not streaming to vaccination sites and that there is a need to “generate vaccine demand”. While those opposed to vaccination, some prominent individuals with societal credibility, have expressed their views widely on social media and may well have affected vaccine demand to a limited extent it is unlikely that this alone is the reason for vaccine hesitancy or resistance. Rather it seems to me to possibly speak of a more general distrust and disillusionment in governments by their citizenry that fragments the call for the “massive whole of society effort”.
The case for vaccination, which I unequivocally support, has not been helped by statement from “experts” that the Omicron variant is “resistant to vaccines” and further that vaccination has not prevented infections. Reports of the value of what is termed “natural immunity” that in a recent report from the National Institute for Communicable Diseases (NICD) has possibly reached levels of 70% in the general population, in reducing the severity of infections in the current wave, have weakened the argument for vaccination in the minds of some and strengthened the hand of those who outrightly oppose vaccination. While transparency is laudable I wonder if this “transparency” reflected by numerous appearances on our television screens and interviews reported in the print media by “experts”, never previously granted such a wide audience, discussing their latest research results, even when not yet published in reputable peer-reviewed scientific journals have only served to confuse. As an example, a report from the Imperial College of London in the past week states that “the Omicron variant largely evades immunity from past infection or two vaccine doses” and that “the level of immune evasion means that Omicron poses a major imminent threat to public health”. However, the report has a footnote that the work is not yet peer reviewed and that the Imperial College Response Team “has adopted a policy of sharing research findings on the developing pandemic”! Yet governments across the globe are indicating that booster vaccination doses are how the pandemic will be defeated.
Even more concerning is a report that “bad research has clouded understanding of COVID-19”. In this report a group “Retraction Watch” reports that 200 COVID-19 papers have been retracted or withdrawn since the start of the pandemic for a range of reasons although the majority of these retractions related to retractions of papers focused on therapeutic interventions for COVID-19 infections.
I am left to wonder if the consequence of the prolonged nature of the “pandemic”, the confusing and at times ill-informed messaging from a multitude of sources, the unfortunate fraud and corruption that accompanied the initial waves of infection in this country and the question as to whether the current vaccines remain effective has not weakened the thrust of government communication. As a result simply repeating the same message again and again will not in itself alter the response of citizens to the rising numbers of the latest and subsequent variants.
A very recent advisory of the South African COVID-19 Ministerial Advisory Committee (MAC) accepted by the National Department of Health appears to take the first steps in changing the direction of the country’s approach to the COVID-19 pandemic. There is recognition that the proportion of people with a degree of immunity from either vaccination or past infection in the South African population is high with evidence of past infection in 60-80% in serological surveys, as alluded to above. The previous “containment policy” is thus deemed no longer appropriate. Further it is stated that there is a high degree of asymptomatic disease with as a result a high degree of spread and that only a small proportion of cases are diagnosed. It is concluded that quarantine “has been costly to essential services and society” as “people stay away from work and lose their income”. Contact tracing has been stopped unless associated with cluster outbreaks. Of cardinal importance is that contacts should now continue with normal activities and only if symptomatic should testing for COVID-19 be undertaken. Isolation is only required for contacts if symptomatic and return to work is allowed after a period of 8 to 10 days depending on the severity of symptoms with no requirement for further testing.
In the light of the latest developments and the failure of the communication strategy to date what if governments and policy makers altered their approach and messaging to state that:
The COVID-19 pandemic has now become an endemic world-wide infection which will persist;
The majority of infections are now either asymptomatic or mildly so and require minimal if any treatment;
The Omicron variant is just one of the many variants of the coronavirus that will occur in the future;
Current vaccines provide protection against severe infection and death but not necessarily infection by the prevalent variant;
Enforced restrictions of civil liberties related to the pandemic will end, and that
Personal responsibility for behaviour, as with other illnesses, including vaccination will replace enforced restrictions?
With this approach possibly the media hysteria of daily tallies of infections, hospitalisations and deaths, which are not seen with other illnesses, some currently more prevalent than COVID-19, would end. Researchers would return to their laboratories and publish their results in peer-reviewed scientific journals. Health services would return to managing the broad spectrum of diseases that affect the populations of the world, including viral infections such as COVID. Governments would ideally return to facilitating growth of economies and improving the lives of their citizens. Citizens would return to lives without restrictions but accept responsibility for their actions. And finally we could all work together to make make the World a better place for those whose lives are characterised by poverty and despair.
