Despite slipping out of the headlines recently, amid floods, war and other natural and man-made disasters, the Covid-19 pandemic is not yet over – and South Africa is preparing to endure a fifth round of infections as winter sets in.
Recent reporting by the National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), has been alarming: of 19,325 tests conducted, 3,222 new cases were detected late last week – that represents a 16.7 percent positivity rate.
For three consecutive days last week, South Africa recorded more than 4,000 new daily infections, with positivity rates (for those tested) of around 20 percent, following a period of significantly fewer fatal cases, often in the single digits for the last two months or so.
In the latest reporting cycle, however, the death figure has jumped by 30, for a national toll of 100,333, with another 1,954 new cases also confirmed.
The marked jumps in new infections, infection rates and even deaths – the latter at least partly accounted for by a lag in reporting, now being caught up on – have health authorities on the alert.
But, says the national Department of Health, there is no reason for alarm as yet – the department's experts in consultation with academic and other collaborating virologists and epidemiologists are "closely monitoring" the situation to see if the expected fifth wave of Covid will sweep through the country, much as its predecessors have done.
Already several European countries have experienced a 5th wave of infections, mainly driven by the currently dominant Omicron variant and some sub-variants.
This version of the original virus behind Covid-19 is much more infectious but also apparently less virulent and therefore less lethal than the original and some of the subsequent variants such as Beta and Delta, both of which claimed many lives in South Africa and elsewhere.
The concern of South African health authorities is that there are at least 20 percent of eligible people in the country who are refusing any vaccine at all, even though it is free, even to undocumented foreigners.
Much of the messaging from those refusing vaccination is infused with false pandemic information, as pushed by those actively sowing dissension and divisions through the use of “fake Covid news”.
Around 80 percent of adult and school-going South Africans have either been vaccinated fully – some also having had booster shots – or have relatively recently been infected.
But, with the latest versions of the SARS-CoV-2 virus which has caused the pandemic, including Omicron BA.1 and mostly BA.2 sub-variants, being apparently yet-more infectious, South Africa's recent further 'normalisation' of work, school and other activities has also set the country up for another wave of infections.
Even at much lower levels of serious disease, as expected with 80 percent of the population at least somewhat protected, the 20 percent refusing vaccination and those for whom infection was too long ago to provide meaningful protection from new variants, could "still create a crisis" in the handling of a surge of hospitalisations and serious disease.
There is also public exhaustion with constant masking and related protection measures, increasing risk even as the general view among 'ordinary' South Africans is that the 'worst of Covid is over'.
That view has been warned against by health authorities assessing the prospects for the country's heavily constrained health sector.
Data from Denmark and Sweden, the two countries where the Omicron BA.2 sub-variant has obtained an early grip, suggest that waning immunity is less of a driver in the rise in infections, with BA.2’s much-increased infectiousness the likely cause.
In both instances, health authorities would have expected the 'infection curve' to have looked "very different" if waning immunity was the issue.
The implications for countries in Africa and elsewhere, following in the wake of European and other regions where the latest super-infectious Omicron BA.2 sub-variant has quickly become dominant in new infections, are serious.
Even if the latest versions of the Covid-causing virus are much less aggressive in the infected, the sheer numbers of people likely to become infected under much relaxed regulations for public engagements, events and activities, may, yet again, see emergency and dedicated Covid wards being overwhelmed.
Although UK hospitalisations are rising in its 5th wave, along with other countries where the BA.2 sub-variant has spread rapidly, the rate of hospitalisations and ICU admissions per case remains low – and there is no evidence so far that the BA.2 sub-variant is leading to any increased severity of illness.
In the UK, 60 percent of those in hospital with Covid had not been hospitalised for Covid, indicating that many are incidental cases and likely too mild to have been necessarily picked up without routine Covid testing of all admitted patients.
It is expected that the yet-more transmissible BA.2 sub-variant will also be better at finding pockets of unvaccinated people.
Together with the highly vulnerable, this pool of potential new infections is expected to put pressure on health systems and workers as the next wave, expected to be in full swing by mid-May, peaks.
While South Africa's health authorities have noted a sharp increase in the number of daily Covid-19 infections, the Health Department said that the trend needed to be observed a little longer before determining if this was the onset of the expected fifth wave.
The Health Department’s deputy director-general, Dr Nicholas Crisp, said that there could be a number of reasons for the recent uptick in new infections and even deaths.
"It may be associated with one of the sub-variants of Omicron (BA.2), certainly that is what’s dominant, but it also might be just because we are all a bit lax at the moment, we don’t wear our masks so diligently," said Dr Crisp.
"What we are seeing is what we call a flare-up," he added, but warned that while the highly infectious sub-variant doing the rounds was apparently less severe in its effects in most people, it was not so with all, especially the unvaccinated.
South African officials have, therefore, renewed efforts to get the more vaccine-sceptical to accept vaccination as the fastest way to 'return to normal', though all the indications are that few who have so far adamantly refused vaccination will be successfully persuaded.