Even though the decline in COVID-19 cases is a promising sign for South Africa, there are concerns about a second surge.

This was the opinion of the three experts who took part in the first Though-Leader webinar presented by the University of the Free State (UFS) on Thursday. The 2020 UFS Thought-Leader Webinar Series, themed 'Post-COVID-19, Post-Crisis', is taking place in collaboration with Vrye Weekblad as part of the Vrystaat Literature Festival’s online initiative, VrySpraak-digitaal.

The panellists included top experts such as Prof Salim Abdool Karim, Director: Centre for the AIDS Programme of Research in South Africa (CAPRISA) and Chair: South African Ministerial Advisory Committee on COVID-19; Prof Glenda Gray, President and CEO: South African Medical Research Council (SAMRC); and the UFS’ Prof Felicity Burt, NRF-DST South African Research Chair in Vector-borne and Zoonotic Pathogens Research.

Prof Karim said the downward decline is consistent and the number of patients presenting at hospitals is also declining.

Promising trend of decline
“What we are seeing is a promising trend, and it looks like we are on the decline. A question that I am often asked is – is the worst over? The answer is not clear cut. We are concerned about the risk of a second surge. If anything – what really concerns me at this stage is a second surge, as I think about how the pandemic may play out over the next few weeks,” said Prof Karim.

He also referred to other countries, such as the US, Spain, New Zeeland, Vietnam, and South Korea, which are now facing a second surge.

“We need to be very careful; this is not the time for complacency. We need to maintain all our efforts. If we look at one of the key drivers, it is the need for our economy to restart. We need to get people back to work,” said Prof Karim.

According to him, we have to look at COVID-19 not as a sprint, but as a marathon. “As we learn to co-exist with this virus, aim for containment; we need to plan for the long term. Even if we get a vaccine, it is unlikely that we will be able to vaccinate a substantial part of our population before the end of next year.”

“We need to transition from being scared to a situation where we can control our risk; when we know that we can control the risk and then influence the risk, we influence the risk of everyone around us. Part of the new normal is the strategy of mitigation with prevention, plus preventing outbreaks.”

Schools and vaccine development

Prof Gray spoke about whether schools should be open and the role that children play in transmission, how to avoid the second wave, how to adjust our testing, and the exciting news around vaccine development.

As a paediatrician and a parent, Prof Gray said she believes schools should open. “Children have a different immune response to COVID-19 and probably have less viral load copies, causing them to have a milder form of the disease. They are lucky to have been spared the symptomatic or severe form of the disease,” said Prof Gray.

According to her, schools need to be de-risked as much as possible, with children and teachers wearing masks, washing hands, making sure that there is good ventilation in the school, and that windows are wide open.

“We also need to know about the comorbidity and ages of teachers, so that we can keep the sick and older teachers out of direct contact. The younger teachers with no comorbidities should be teaching.”

“We also know from our experiences with health workers that transmissions happen in the tearoom where teachers take off their masks and talk. We need to minimise the transmissions in tearooms and protect teachers and parents who are old and have comorbidities.”

Prof Gray said from data she has seen, schools play a very small role in the transmission of COVID-19; a lot more (transmissions) happen in the community, by commuting, and overcrowded taxis.

Prof Gray agreed with Prof Karim that we should be concerned about a second wave, and that we need to make sure that community transmissions are minimised.

Regarding a vaccine, Prof Gray said that a global race is on to find a vaccine. “The more vaccines the better, we want more vaccines to work. The more vaccines, the more affordable they are, and the more doses are available.”

One health approach

During her presentation, Prof Burt said that the current response to outbreaks is largely reactive rather than proactive, and “if we have more of a one-health approach, with forecasting, early detection, and a more rapid respond, we could have an impact on public health in the future”.