First published in the Daily Maverick 168 weekly newspaper.

South Africa is still under lockdown Level 1, but fears remain that the Easter weekend will catapult the country into the third wave of Covid-19 infections.

A third wave was not imminent, warned health experts, but “rumbling” Covid-19 transmission across the country could accelerate over Easter. This could bring the third wave forward by months. But it’s not inevitable.

There is currently no indication of an impending third wave, says Dr Harry Moultrie, a senior epidemiologist leading the National Institute of Communicable Disease’s Covid-19 modelling.

The current seven-day moving average of new infections was just below 1,000 cases a day – the lowest since mid-May 2020, and lower than the period between the first and second waves, he said. Although there had been an increase in infections in the Northern Cape, Free State and North West, these seemed to be plateauing, he said. The Eastern Cape has had a recent rise in infections.

The Easter weekend poses the risk of rising transmission. Still, a lot was unknown about how it will play out, experts agreed.

More than 3,000 University of Pretoria (UP) students are being traced and tested after 55 students tested positive for Covid-19. This is being seen as a small “cluster” outbreak, which probably began at a nightspot frequented by students. UP has had a hybrid of online and in-person teaching since 15 March. There are fears similar clusters could develop at other universities.

Many people are still susceptible to Covid-19, public health specialist Dr Helen Schneider said. The extent and distribution of population immunity, the possible emergence of new variants and how faithfully mask-wearing and hand-washing will be adhered to are unknown.

Human behaviour will play a role, as will biology and climate, says Dr Francois Venter, an infectious diseases expert. “We don’t fully understand yet how they impact the trajectory of the pandemic,” he said, but it was certain that indoor gatherings had been super-spreader events in the past.

“Large gatherings are exponentially worse for spreading diseases than small ones. A 1,000-person gathering is about several thousand times worse for spreading Covid-19 than a 10-person gathering, all other things being equal,” explained Dr Jeremy Nel, the head of the department of infectious diseases at Helen Joseph Hospital in Johannesburg.

Transmission does not end at the event. “When events with crowding, poor ventilation and lots of people in close contact occur, that risk may be multiplied and lead to many onward transmissions,” said Dr Linda-Gail Bekker, the director of the Desmond Tutu HIV Centre and the co-lead investigator of the Sisonke Covid-19 Study.

The priority must be to protect this period of low transmission, said Prof Salim Abdool Karim, an infectious disease expert who until 23 March was co-chair of the Ministerial Advisory Committee on Covid-19. Before his departure he advised the minister of health on how to approach the safety risks over Easter.

South Africa’s present “very, very good position” in the pandemic could not be jeopardised by super-spreader gatherings, which played a significant role in bringing forward the second wave by about four weeks, he explained.

He believes that, on the whole, SA’s healthcare system is “far, far better prepared” for the third wave than it was for the second. Now there was better planning, and systems were in sync, he said.

“At this time, when the Easter message of hope, rebirth and renewal finds expression in the lives of so many of us, let us please take care,” Ramaphosa said.

“I’m quite comfortable and confident that most of the provinces will cope, but the Eastern Cape is a difficult situation,” he said. In the first and second wave it was already collapsing because it does not have a “well-functioning healthcare system”. Years of corruption and mismanagement had “left it literally in tatters”, he said.

The healthcare system did not seem to be weaker, but it wasn’t stronger either, said Lynne Wilkinson, a public health expert who has worked on the pandemic frontline in Johannesburg and the rural Eastern Cape. “It doesn’t appear that there are efforts to ensure we manage better each time,” she said. There may be a hope that vaccination would lessen the load, she concluded.

The second wave “severely traumatised” SA society and its healthcare system, said Schneider. “The reserves of coping and resilience are very low and in some provinces, notably the Eastern Cape, dangerously depleted,” she said.

Healthcare workers are hoping for the best but bracing for the worst.

More than 230,000 healthcare workers have been vaccinated and it is hoped that most will be reached before the third wave, she added. Know-ledge on how to treat Covid-19 is also improving.

Better government communication could push back the third wave, said Schneider, Moultrie and Venter. Messaging on physical distancing, mask- wearing, hand sanitising and avoiding large gatherings should be intensified, they agreed. A third wave is not inevitable right now, said Moultrie.

Schneider said transparent communication on the vaccine roll-out would inspire hope.

The science behind changing restrictions needed to be explained, said Venter. “Taxi drivers, restaurant owners, church leaders don’t want to kill their clientele, but if you don’t explain … how they will save people then the other stuff [tightened restrictions] is wrong,” he said.

President Cyril Ramaphosa said in his newsletter on 29 March that religious leaders had asked that restrictions on the size of congregations be eased for Easter and Ramadan.

A day later, he said SA would remain on Level 1 because of the relatively low transmission of Covid-19 at present, but there would be restrictions such as limited alcohol sales.

The maximum number of people allowed at a gathering was upped from 100 to 250 indoors and 250 to 500 outdoors. If the venue is too small to accommodate such numbers with physical distancing, it could use 50% of its capacity.

Ramaphosa said this decision followed weeks of consultations “to find mutually beneficial solutions to the challenges of managing large crowds at religious services”. “There is a common appreciation that we must do all we can to support our people to exercise their religious freedom and keep our country safe,” he said.

“At this time, when the Easter message of hope, rebirth and renewal finds expression in the lives of so many of us, let us please take care,” he said.

According to the Catholic Archbishop of Durban, Cardinal Wilfred Napier, the SA Council of Churches (SACC) asked that churches be allowed to accommodate 50% of a venue’s capacity for Easter services. “I’m quite confident that all our churches are observing safety measures,” said Napier.

In October last year, the government issued special regulations for religious gatherings, including general screening, sanitising and physical distancing, as well as barring rituals that require physical contact. Faith groups were urged to conduct services virtually when possible.

Catholic churches have been advised to omit Easter rituals that lead to close physical contact, such as processions and ceremonial foot-washing.

The Anglican church has urged that there be no foot-washing, and that Maundy Thursday services the day before Easter be kept to a maximum of one hour. Wine has been omitted from holy communion. Only bread will be used.

Anglican Archbishop of Cape Town Thabo Makgoba said he was “anxious” about his congregants’ safety and general precautions should be taken, especially during funerals.

SA’s largest religious grouping, the Zion Christian Church (ZCC), has cancelled the annual Moria pilgrimage, the annual Easter gathering noted for being Africa’s biggest Christian congregation.

Last year, a ban on gatherings meant congregants could not celebrate Easter in physical fellowship. Some churches have since reopened, but others remain shut. Rivers, a megachurch with campuses in Gauteng and Durban, has relied on livestream and television broadcasts for Sunday meetings, including its upcoming Easter services. Devon Fugard-Gous, a pastor at the church’s Sandton campus in Johannesburg, said they would only consider returning to in-person services “when the government has eased restrictions to the point that we’re able to safely accommodate our congregation”.

Similarly, Rhema, another megachurch, has used online and broadcast media for services. Napier said cancelling Easter celebrations would be a mistake: “People are under great distress. They need the Easter services.” He acknowledged, however, that rural churches may have difficulties adhering to health protocols because running water and personal protective equipment (PPE) may be scarce. Limiting congregation size would be hard for congregants who often travel a long way to attend and refuse to be turned away.

The Jewish community is currently celebrating Passover. “We are acutely aware of the danger of gatherings and our synagogues are putting great emphasis on observance of the protocols … to ensure that religious services do not lead to … increased infections,” said Prof Karen Milner, the Gauteng chairperson of the SA Jewish Board of Deputies.

Last year, synagogues were closed and Pesach seders (dinners) could not take place because of lockdown Level 5 restrictions. “It was heart-breaking that many in our community were alone during this festive time,” she said.

This year’s eased restrictions meant that synagogue services could take place and seders could be shared with family, she said. Still, synagogues have developed protocols on the numbers of attendees, physical distancing, mask-wearing and sanitising. “Many of our services are held outside and this is encouraged as much as possible.

“The seder nights, which previously were large joyous family events, have been severely curtailed and communal leadership have expressed pleas to the community to keep these to close family members as much as possible.”

The Muslim community will observe Ramadan in mid-April. Maulana Siraj Girie from the Muslim Judicial Council said guidelines are yet to be issued regarding Ramadan as disaster management regulations are constantly changing. “We’re only going to issue certain guidelines a few days before Ramadan,” said Girie.

“For example, the masjids, the mosques. Should the congregants go pray at the mosque, yes or no? We can’t really give an answer now because we don’t know what the situation is going to be like in two or three weeks.”

Fasting, however, will go on as per usual. Concessions are ordinarily made for persons who are unable to fast for reasons such as being elderly or ill.

The long-term effects of lockdown have taken their toll on faith communities. “People, particularly the elderly, have not been able to get the kind of service they need because many of them are housebound, though in many cases the priests are making special visits to see them,” said Napier.

Churches have lost significant revenue because donations and collections have decreased. “When the services are online it’s okay, you get the message, you feel you’re part of a community, but it’s not the same as actually being there with a live person … who you know is suffering together with you.” DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick n Pay Smart Shoppers at these Pick n Pay stores.

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