Shabir Madhi. Picture: SUPPLIED/WITS
Shabir Madhi. Picture: SUPPLIED/WITS

The borders can open, the curfew can be lifted and international travel can resume, according to Wits vaccinology professor Shabir Madhi, a member of the Medical Advisory Council, which is advising the government on its response to Covid-19. “There is ample opportunity to be a bit more aggressive in opening up society,” Madhi tells the FM.

This comes as consensus builds that SA could move to a level 1 lockdown this week, which would entail exactly these measures.

But despite the recommendations mentioned above, Madhi believes restrictions on mass gatherings should remain in place.

Such a limitation shouldn’t be an arbitrary number, such as 50 people per venue, for example, but rather a limit on a large number of people in a small space – if you have “1,000 people attending a church service at the FNB stadium, all spaced apart in the open air”, that wouldn’t be a problem, he says. But the same number of attendees in a 200m² church or mosque that has poor ventilation could lead to “super-spreader” events, where a large number of people could get infected at one time.

“I don’t think we are in any position right now to take that sort of a gamble,” he says.

Even though fears of a new surge of infections are rising in Europe, some scientists believe that if SA experiences any “second wave”, it’ll be orders of magnitude lower than its first. Which is why they believe life can begin to return to normal.

Madhi doesn’t believe we should “dismiss the second wave idea out of hand”, but says that if this happens, we’re likely to see far fewer deaths.

He cites two reasons: first, the progression towards herd immunity, where enough people have already had the virus, which impedes its spread; and second, many of those most vulnerable to Covid-19 have already passed away.

A study by UCT and National Health Laboratory Service virologist Martin Hsiao found that up to 40% of pregnant women and people having routine HIV testing in Cape Town townships had antibodies for the virus.

This seems to explain why even as the economy was opening up in June there wasn’t an increase in infections in the Western Cape, but rather a decrease — something Hsiao explained on Cape Talk radio last week.

But Madhi also points out that people in the “middle class and affluent areas” in SA are still susceptible to the virus, as they were able to socially distance and use private transport in lockdown.

So there are still people very susceptible to coronavirus, but “the rate of mortality is lower this time round” in Europe, he says, and is likely to be so in SA as well.

The odds of reinfection

One question the scientific community is still grappling with is how long immunity lasts once a person has been infected. Madhi says that the experts’ figures differ radically — anything from 40 weeks to three years.

UCT emeritus professor Robin Wood, presenting a MedicalBrief webinar on pandemics in the 20th century last month, said he didn’t believe the Western Cape would have a second wave. (He added, however, that any prediction that is made must be moderated with humility.)

He said that places with effective hard lockdowns, where Covid-19 disease did not spread much, such as Japan, did have a second wave. He says that during the 1918 Spanish Flu, when people chose lockdown voluntarily, places that closed down “a little bit more aggressively or particularly early on in the epidemic suffered from second waves”.

But even these experiences differed between hemispheres, and, he added, “there is an awful lot we don’t know”.

Wood said history shows that nonpharmaceutical interventions – social distancing and handwashing – didn’t prevent the Spanish flu from spreading across the world but just slowed the disease.

Still, some countries today have moved from using lockdowns to slow infections to trying to prevent infections in young people altogether, something science suggests won’t work.

To date, Covid-19 has killed 927,408 people, while the Spanish flu killed 50-million people. Wood points out that not long after the Spanish flu, life went back to normal, and it was soon followed by the “Roaring 20s”.

Madhi is equally optimistic. Not only will the “second wave be less severe” than the first wave, but, he points out, “what we experienced this time was less severe” than the initial models predicted.

The reason the models forecast far higher fatalities, he says, is because they assumed everyone was susceptible to the disease. But one hypothesis is that a large percentage of South Africans have been exposed to the common cold – also caused by a coronavirus – which helped build immunity and prevented more severe Covid-19 symptoms.

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