Tag: South Africa

NICD Warns of Malaria Being Misdiagnosed as COVID

Mosquito
Photo by Егор Камелев on Unsplash

The National Institute for Communicable Diseases has warned that, as South Africa enters its peak malaria season, cases of malaria are being misdiagnosed as COVID. Both malaria and COVID have similar non-specific early symptoms such as fever, chills, headaches, fatigue and muscle pain. Undiagnosed and untreated malaria rapidly progresses to severe illness and can be fatal.

Speaking at a media briefing on Wednesday, principal NICD medical scientist Dr Jaishree Raman said that Gauteng has seen a slight increase of malaria cases recently. 

Dr Raman noted that COVID “has pulled resources from the malaria programmes, reducing active surveillance and case investigation, which is reducing the ability [to] classify cases accurately.”

However, the NICD does not know the exact source of the malaria. “Data cleaning and case classification is ongoing, so at the moment, we cannot say whether the uptick in cases is due to locally-acquired or imported malaria,” she said.

The NICD advises that any individual that prevents with fever or ‘flu-like illness, if they reside in a malaria-risk area in Limpopo, KwaZulu-Natal and Mpumalanga or have travelled to a malaria-risk area, especially Mozambique, in the past six weeks, must be tested for malaria by blood smear microscopy or malaria rapid diagnostic test. If they test positive for malaria, the patient must be started on malaria treatment, immediately.

The NICD also advises patients to remember to inform their healthcare provider of their recent travel, especially to neighbouring countries and malaria risk areas in South Africa.  

‘Taxi malaria’, transmitted by hitch-hiking mosquitoes, should be considered in a patient with unexplained fever who has not travelled to a malaria-endemic area, but is getting progressively sicker, with a low platelet count.

Source: NICD

SA Healthcare Bolstered With Vaccine Lab Investment and Loans

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Last week, South African healthcare received a double shot in the arm with the opening of a local vaccine manufacturing facility and the approval of a World Bank loan to bolster social safety nets and health systems.

On Wednesday, President Cyril Ramaphosa and health technology billionaire Dr Patrick Soon-Shiong officially opened a new vaccine manufacturing facility in Brackenfell, Western Cape.

The South African-born entrepreneur has been strongly supporting local healthcare, with R3 billion invested to help SA share vaccine technology with the rest of Africa. His company, ImmunityBio, is developing a T-cell based universal COVID vaccine, currently in Phase III trials in SA. The same adenovirus vector technology it uses is also being tested in cancer vaccines.

“It has been a dream of mine, since I left the country as a young physician, to bring state-of-the-art, 21st century medical care to SA and to enable the country to serve as a scientific hub for the continent,” Dr Shoon-Siong had previously said. The technology transfer will help “establish much-needed capacity and self-sufficiency.”

The hub will transfer technology, know-how and materials for DNA, RNA, adjuvant vaccine platforms and cell therapies to SA.

“There is no reason we couldn’t make 500 million doses a year,” said Dr Soon-Shiong, who is also a Wits alumnus. “Subject to the raw material being available.”

He said he wants to tap the country’s expertise on prevalent diseases such as HIV and cervical cancer. “There are fantastic scientists with deep knowledge about these diseases,” he said. “More so than in America because they see these patients every day.”

President Ramaphosa and Dr Soon-Shiong also launched the Coalition to Accelerate Africa’s Access to Advanced Healthcare, which aims to drive the development of innovative therapeutics and ensure the continent is prepared for future pandemics.

The coalition aims to manufacture a billion doses of the COVID vaccine by 2025 and to develop treatments for conditions including cancer, COVID, tuberculosis and HIV.

South Africa also received approval from the World Bank for a US$750 million COVID relief loan aimed at reducing the worst of the pandemic’s impact on the poor.

“The World Bank budget support is coming at a critical time for us and will contribute towards addressing the financing gap stemming from additional spending in response to the COVID crisis,” said Dondo Mogajane, Director General of the National Treasury. “It will assist in addressing the immediate challenge of financing critical health and social safety net programs whilst also continuing to develop our economic reform agenda to build back better.”

Meanwhile, Health Minister Dr Joe Phaahla warned that South Africa will likely enter a fifth wave when cold temperatures in May, though what COVID variants may drive it remain to be seen.

SA Scientists Criticise Developed Nations’ ‘Scepticism’ over Omicron

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South African scientists have criticised developed nations for ignoring early evidence that Omicron was “dramatically” milder than the previous strains of the coronavirus, an attitude which could be construed as “racism”.

“It seems like high-income countries are much more able to absorb bad news that comes from countries like South Africa,” said Prof Shabir Madhi, vaccinologist at Wits University.

“When we’re providing good news, all of a sudden there’s a whole lot of scepticism. I would call that racism.”

Prof Salim Karim, former head of the South African government’s COVID advisory committee and vice-president of the International Science Council concurs.

“We need to learn from each other. Our research is rigorous. Everyone was expecting the worst and when they weren’t seeing it, they were questioning whether our observations were sufficiently scientifically rigorous,” he said, though he acknowledged that Omicron’s high number of mutations may have led to an overabundance of caution.

But by early December, anecdotal evidence was already indicating that Omicron caused far fewer hospitalisations than the Delta Wave, despite being more transmissible.

“The predictions we made at the start of December still hold. Omicron was less severe. Dramatically. The virus is evolving to adapt to the human host, to become like a seasonal virus,” said Prof Marta Nunes, senior researcher at the Vaccines and Infectious Diseases Analytics department at Wits

“It didn’t take even two weeks before the first evidence started coming out that this is a much milder condition. And when we shared that with the world there was some scepticism,” Prof Karim added.

While some have argued that Africa’s pandemic experience is different due to factors such as its younger population, any advantage South Africa has is outweighed by poor health, with excess deaths during COVID at 480 per 100 000, one of the highest in the world. Prof Madhi points out a high prevalence of comorbidities such as obesity and HIV.

A majority of those excess deaths are probably due to the pandemic, many SA scientists believe. Half occurred during the Delta wave, but only 3% transpired during the Omicron wave so far, Prof Madhi pointed out.

The government chose not to tighten restrictions during the fourth wave, and criticised the reimposition of travel bans coming from South Africa. South African scientists have mostly welcomed this, even though the WHO continues to warn that Omicron should not be considered “mild”.

“We believe the virus is not going to be eradicated from the human population. We must now learn how to live with this virus and it will learn how to live with us,” said Prof Nunes.

The low death rate from Omicron indicates a different phase of the pandemic. “I’d refer to it as a convalescent phase,” said Prof Madhi. The government has already effectively stopped quarantining and contact tracing.

Source: BBC News

SA’s Top 10 Health Topics to Watch in 2022

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Spotlight highlights the country’s top 10 health topics to keep an eye on in 2022.

1. COVID prosecutions
Former health minister Dr Zweli Mkhize resigned amid allegations of wrongdoing in the Digital Vibes scandal, and hit back at the findings of the Special Investigations Unit, which had also implicated a number of top health department officials. Whether Health Minister Dr Joe Phaahla  will take decisive action against those found guilty will be an important litmus test. Last year, Dr Phaahla assured the public that the department “is going to thoroughly and decisively act to ensure nothing is swept under the carpet”.

2. The NHI Bill
Public hearings on the National Health Insurance Bill will be done by the end of January, with feedback in February and final report by April 1. It then goes to the National Council of Provinces for a similar stakeholder process, and before the end of 2022 it could be signed into law.
To date, public inputs on the Bill were mostly on governance issues. A critical point this year is whether MPs will take these inputs on board and make significant changes to the bill, or whether they will simply force through the bill largely unchanged.

3. Medico-legal claims
With R74 billion in medico-legal claims against the state, the State Liability Bill is back on Parliament’s agenda. Instead of government departments paying a lump sum for successful medical negligence claims, the Bill proposes a new settlement structure of separate payments to relieve budgetary pressure on hospitals. Since the necessary final report from the South African Law Reform Commission is months away, Spotlight does not think the Bill will be passed this year – and first prize would be to prevent medico-legal claims from happening.

4. Healthcare budget cuts
Unfortunately, there is still no end in sight to continued budget cuts to healthcare. Employing more nurses could reduce medico-legal claims, but in fact there is a growing shortage of nurses. Even th Office of Health Standards Compliance is also hamstrung by inadequate funding, with only 61 inspectors to cover more than 5000 public healthcare facilities, putting off private sector inspections until next year.

5. HIV prophylaxis
With the extremely promising results of injectable pre-exposure prophylaxis (PrEP) for HIV, there is still a process to go through before it will be made available in South Africa this year. COVID has shown that processes can be sped up if there is the will, but whether there is the same drive to treat HIV remains to be seen. As such, PrEP will most likely only be available in public healthcare facilities by the end of 2023.

6. An end to the COVID pandemic
While South Africa is heading towards living with COVID as an endemic disease, it is impossible to predict what surprises the coronavirus will have in store for the world this year in the form of new variants. However, according to Director of the Medical Research Council, Professor Glenda Gray, the winter months will give us an idea of the direction the pandemic will take with a fifth wave. Vaccination will remain key to reducing its severity.

7. SA’s TB programme
COVID severely set back SA’s TB programme, but 2022 should see the arrival of a number of delayed initiatives. These include rollout of the relatively new 3HP prevention pills, the results of new X-ray detection technology and  consequent possible changes to screening and testing, and an update to the Thembisa HIV model which will now include TB.

8. The National Mental Health Policy Framework
The new National Mental Health Policy Framework and Strategic Plan are expected to be finalised this year. However, as with the NHI, funding remains a problem. Only 5% of the current health budget goes to mental health services, and it only provides for one in 10 of those in need.

9. Improved procurement legislation
As illustrated by the government’s COVID procurement debacle, an overhaul is needed. Draft Public Procurement Bill proposes a single regulatory framework for all goods and services procured by government departments and has the potential to strengthen and streamline procurement processes. However, Spotlight notes that critically important pieces of legislation can simply vanish, as did the Medical Schemes Amendment Bill of 2018.

10. No-fault compensation fund
The COVID vaccine injury no-fault compensation fund has quietly fallen off the radar, with no payouts made to date. However, the NICD again urged people to report adverse events with the vaccine.

Source: Spotlight

‘No NGOs Were Ready’, Life Esidimeni Inquest Reveals

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The former Gauteng deputy director-general for mental health services, Hannah Jacobus, has the process to move Life Esidimeni patients was rushed. She was being cross-examined by the State’s Advocate Willem Pienaar.

The much-delayed inquest meant to determine any criminal liability for the deaths of 144 mental health patients in the 2016 Life Esidimeni disaster continued virtually on Monday.

Jacobus’ role was in downscaling of patients at Life Esidimeni for cost savings, and says there was no indication of it closing at the time. When its closure was announced, these downscaling plans were not implemented and there was no timeframe given for when patients were to move out.

The former deputy DG admitted to writing false licences for NGOs, under pressure from then head of Gauteng mental health services, Dr Makgoba Manamelashe. However, Jacobus maintained that while she assessed their suitability, she ultimately did not issue any licences.

Dr Manamela signed licences authorising inexperienced‚ underfunded‚ poorly equipped NGOs to look after patients with profound mental illnesses.

After the Gauteng health department terminated the contract with Life Esidimeni, NGOs were used to care for the 1712 patients.

Dr Manamela admitted to Solidarity advocate Dirk Groenewald that the NGOs to which she gave authority did not comply with the legal requirements. In 2017,  it was found that patients were transferred to NGOs that had been issued “unlawful and knowingly fraudulent” licences.

Many NGOs were subsequently found to be entirely unprepared for the patients they received, some lacking sufficient food, water, medication, staff or blankets.  According to Jacobus, the process have only been completed by 2020 according to the downscaling schedule.

“From December 2015 to the end of March 2016 [is not] a sufficient period to determine and appoint suitable NGOs to receive mental healthcare [patients]. No NGOs were ready by the end of March. We needed more time,” she said.

Source: Times Live

Fourth Wave Ending as COVID Becomes Endemic

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Speaking to  the media on Friday, Dr Joe Phaahla said that vaccinations had “uncontestably” lowered the rate of hospitalisations as seen by reduced hospital admissions in the fourth wave. saying that there has been a decoupling between new infections and hospital admissions and deaths. An article awaiting peer review on the medRxiv preprint server shows evidence of this in Cape Town.

Vaccinations were still lower than expected, despite a renewed vaccination drive from 17 December, a situation he attributed to people focussing on their festivities. As of Thursday, 45.5% of all SA adults had received at least one dose, with just under 40% being fully vaccinated. However, only 31.6% of 18–34 year olds have been vaccinated. About one million doses have been administered to the newly opened 12–17 year age group.

In an interview with eNCA, Dr Phaahla said that he concurs with experts that COVID is heading towards becoming an endemic disease, emphasising that South Africa is prepared for this. A new dashboard is to be unveiled which will show the number of vaccinated and unvaccinated in hospitals.

Dr Phaahla has also said that the issue of mandatory vaccinations is currently being deliberated by the government and that an announcement will be made in due course. In the US, the Supreme Court blocked President Biden’s vaccine mandate for large companies, which is seen as a significant blow to his administration’s COVID response plan.

The NICD’s Dr Michelle Groome said that almost 99% of all COVID cases sequenced are caused by Omicron. Gauteng, has exited the fourth wave with a low rate of new cases (1.4 cases per 100 000) and slight (2.2%) increase, likely attributable to increased testing. All other provinces had observed a decrease in weekly incidence of new cases, save Northern Cape (21.9 per 100 000, 18.3% increase). A 14.3% positivity rate was seen as of 13 January, down from highs above 35% in mid-December.

Test positivity rate had fallen from 25–30% in the last week of 2022 to 14% on Thursday.

Living with COVID: SA’s New Approach

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South Africa’s easing of COVID regulations at the end of 2021 set a new trend in how countries are choosing to manage the pandemic. In an article for The Conversation, Wits University’s Professor Shabir Madhi and colleagues reflect on the boldness – and the risks.

In a significant departure, the government is choosing a new, more pragmatic approach while keeping an eye on severe COVID and threats to health systems. This reflects a willingness to “live with the virus” without causing further damage to the economy and livelihoods, especially in a resource-constrained country.

Prof Madhi and colleagues hope that “the government continues to pursue this approach and doesn’t blindly follow policies that are not feasible in the local context, and ultimately yield nominal benefit.”

This more nuanced approach is a stark contrast to reflexive restrictions in response to rising case rates, suggesting the government has listened to commentary saying that the focus should be on whether health systems are under threat.

A high level of population immunity guides this approach. A sero-survey in Gauteng, just prior to the onset of the Omicron wave indicated that 72% of people had been infected over the course of the first three waves. Sero-positivity was 79% and 93% in COVID unvaccinated and vaccinated people aged over 50: a group that had previously made up a high percentage of hospitalisations and deaths.

The sero-survey data show that immunity against severe COVID in the country has largely evolved through natural infection over the course of the first three waves and prior to the advent of vaccination. This has, however, come at the massive cost of 268 813 deaths based on excess mortality attributable to COVID

Antibody presence is a proxy for underlying T-cell immunity which appears to play an important role in reducing the risk of infection progressing to severe COVID. Current evidence indicates that such T cell immunity, which has multiple targets and even more so when induced by natural infection, is relatively unaffected even by Omicron’s many mutations and likely lasts more than a year. This sort of underpinning T-cell immunity protecting against severe disease should provide breathing space for at least the next 6–12 months, and possibly further.

Despite Omicron’s anti-spike evasion, vaccine and natural infection induced T-cell immunity has been relatively preserved. This could explain the uncoupling of case rate to hospitalisation and death rates. Omicron’s mutations also appear to make it predisposed to infecting the upper rather than the lower airway, reducing the likelihood of progressing to severe disease.

In the meantime, they stress that greater vaccine uptake is ensured, along with boosters for high-risk groups.

Additionally, since low test rates mean only 10% of infections are actually documented in SA , isolation and quarantine are ineffective and a more pragmatic approach is necessary, the authors argued.

As the average person in South Africa could have 20 close contacts per day, contact tracing is of little value, and even symptomatic cases are most infectious in the pre-symptomatic and early symptomatic phase. The fact that three quarters of the SA population were infected over the course of the first three waves demonstrates how ineffective contact tracing and quarantine is.
They recommend that certain non-pharmacological interventions should be gradually dropped, especially hand hygiene and superficial thermal screening, while outdoor events should be allowed. Rather, government focus should remain on masking in poorly ventilated spaces and ensuring proper ventilation.

Mandatory vaccinations are still on the radar, since as well as the added risk to others that unvaccinated pose, there is the greater pressure they place on the health systems when they are hospitalised for COVID.

Attention also needs to be given to the management of incidental COVID infections in hospitals. The Department of Health guidance needs to be adapted to manage these patients with the appropriate level of care for the primary reason they were admitted. And patients with severe COVID disease require additional care and expertise to improve their outcomes.

Finally, an evaluation of both vaccination status and underlying immune deficiency needs to become a key element of the workup of hospitalised patients with severe COVID.

The authors stressed the need to minimise hospitalisations and deaths, without damaging livelihoods. SA’s Omicron wave death rate is about a tenth that of Delta, on par with pre-COVID seasonal influenza deaths – 10 000 to 11 000 per annum. TB caused an estimated 58 000 deaths in 2019.

While future variants are unpredictable, there is a trend towards lower rates of hospitalisation and death, especially if vaccine coverage can be increased to 90%, particularly in the over-50 age group. Omicron’s high infection rate will likely also contribute to future protection against COVID.

They note that while there is a risk of new variants, failure to change the pandemic mindset is another risk, as Omicron signals the end of COVID’s epidemic phase.

Past practices have had little effect, the authors concluded, and it is something that the SA government appears to have realised. Despite all the severe lockdowns, SA still suffered a high COVID death rate of 481 per 100 000.

Source: The Conversation

Why Omicron May Hit Other Countries Harder

COVID heat map. Photo by Giacomo Carra on Unsplash

South Africa may have gotten off more lightly from Omicron due to widespread immunity from previous infection combined with vaccine coverage, researchers think, which may not bode well for other countries which have not completed their vaccination nor seen the worst COVID surges.

The South African Medical Research Council in collaboration with Discovery Health on Tuesday last week presented data from a large study showing  that South Africans infected with Omicron are, on average, less likely to be hospitalised, and recover faster, compared to the other variants.

Their study looked at more than 200 000 COVID cases in South Africa during a Delta-driven surge in September and October, and the start of the Omicron-driven surge in November, as that variant began increasing rapidly. About a quarter of the people in the study already have a chronic illness, putting them at higher risk of severe COVID.

The researchers found a hopeful trend: The risk of hospitalisation for adults dropped 30% during the early days of the Omicron surge from the levels seen there in September and October.

“The hospital admissions during omicron, standing at 58 per 1000 infections, are the lowest of the four COVID waves, and one-third of what we experienced during the delta surge,” said Discovery Health CEO Ryan Noach.

Why was this so? One explanation could be the immunity from COVID recovery present in the population. South Africa had experienced three huge COVID surges with low vaccination rates compared to the US and Europe.

When the Omicron variant appeared, only about a quarter of the population were vaccinated but the vast majority of residents had likely already been infected with previous variants of SARS-CoV-2. This was based on the excess mortality rate observed in the country through the pandemic, and so it is thought that South Africans likely had some immunity granted by infection.

“Thus, Omicron enters a South African population with considerably more immunity than any prior SARS-CoV-2 variant,” concluded Dr Roby Bhattacharyya, an infectious disease specialist, and epidemiologist William Hanage in a recent working paper. This means that most Omicron cases are likely to be reinfections, rather than first infections.
Other countries will not have as broad a ‘coverage’ of vaccination and previous infection as South Africa. Around 125 million Americans are unvaccinated, and a recent study estimated that about 20% of Americans had been infected with COVID from the start of the pandemic, up to August, 2021.

The data therefore suggest that a minimum of 20% of Americans who are completely ‘naive’, as scientists term it, when it comes to exposure to SARS-CoV-2.

Source: NPR

Gauteng Peak Passes but WHO Warns not to Underestimate Omicron

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Wastewater monitoring has shown that COVID  infections are falling in Gauteng, indicating that the Omicron wave may have peaked, while the World Health Organization warns that the variant should not be taken lightly despite its mildness.

The findings align with comments by Health Minister Joe Phaahla on Friday that the Omicron-driven wave may be peaking in the province.

Despite Gauteng’s peaking, cases are on the rise in seven of the nine provinces and last week the country saw a new high in cases. Of the infections confirmed on Thursday, Gauteng accounted for 27%, down from 72% of new infections on December 3.

However, the surge of Omicron will likely not be confined to Gauteng. “Early indications are that we might have reached the peak in Gauteng,” Dr Phaahla said in an online media briefing. “But there is a corresponding, rapid increase of cases in the other big provinces.”

He also noted a 70% increase in hospitalisations, though he stressed that this was off of a low base rate. Meanwhile, the WHO has warned that countries should not take the Omicron variant likely in spite of its apparent low severity.

“Countries can – and must – prevent the spread of Omicron with the proven health and social measures.  Our focus must continue to be to protect the least protected and those at high risk,” said Dr Poonam Khetrapal Singh, Regional Director of the WHO South-East Asia Region.

Omicron should not be dismissed as mild, she cautioned, adding that even if it does cause less severe disease, the sheer number of cases could once again overwhelm health systems. Hence, health care capacity including ICU beds, oxygen availability, adequate health care staff and surge capacity need to be reviewed and strengthened at all levels. 

The overall threat posed by Omicron largely depends on three key questions – its transmissibility; how well the vaccines and prior SARS-CoV-2 infection protect against  it, and how virulent the variant is as compared to other variants.

From what we know so far, Omicron appears to spread faster than the Delta variant which has been attributed to the surge in cases across the world in the last several months, Dr Singh said.

She added that emerging data from South Africa suggests increased risk of re-infection with Omicron, and said that there is still limited data on Omicron’s limited severity. Further information is needed to fully understand the clinical picture of those infected with Omicron, and more information is expected in the coming weeks.

Her statements echo those of WHO chief Tedros Adhanom Ghebreyesus, who earlier last week warned that health systems could still be overwhelmed by cases.

Alcohol Curbs may Return while UK Red List may be Scrapped

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With the COVID test positivity rate climbing above 30%, President Cyril Ramaphosa is widely expected to address the nation in the coming days. Health Minister Dr Joe Phaahla said on Friday that the National Coronavirus Command Council would be meeting on Tuesday or Wednesday to discuss new restrictions in the face of surging infections.

The main concern is centred around the large number of gatherings that will take place over the festive period: under Level 1 lockdown rules, gatherings of up to 750 individuals are permitted indoors. The Bureau for Economic Research issued a report saying that data so far indicates that there are fewer hospitalisations and less severe disease with the Omicron variant, in line with observations made since the start of the variant’s outbreak.

A partial ban on alcohol sales seems likely, according to a source cited by City Press: “He is considering proposing to the NCCC and cabinet a few adjustments, which include banning the sale of alcohol on weekends and public holidays until mid-January. Don’t be surprised when we have a family meeting before Thursday. He is serious about protecting the country.”

He initially had no plans to address the nation, sources said, but was motivated to change his view in light of the increasing rate of transmission.

Meanwhile, the UK appears set to scrap its controversial red list, which had been widely viewed as unfairly targeting South Africa. The red list amounted to a virtual travel ban, with travellers forced to pay £2285 (R48 400) per person for a ten day stay in often substandard quarantine accommodation. However, it will come too late for many people who have cancelled travel plans.

In a windfall for South Africans, the cost of PCR testing has been revised downward to R500 from R850 as of Sunday following a complaint lodged with the Council for Medical Schemes against private pathology laboratories, alleging the pricing for COVID PCR tests was unfairly inflated. Pricing for rapid antigen tests is said to be next on the list for the Competition Commission. 

On Sunday, a technical glitch caused the National Health Laboratory Service to delay release of a large portion of test results. The glitch meant that initially 18 035 cases were released initially, which rose to over 37 000 after the correction.

The cause was put down to IT difficulties with various laboratories.