Covid-19

PANDEMIC OP-ED

SA Covid situation in 2022 is unpredictable — poor information clouds our understanding

The public is routinely fed unhelpful figures on the Covid-19 pandemic without being told how problematic they are. What is worse, they are not given the information that would be informative and predictive, for themselves, for their communities and for the nation at large. (Photo: sciencenews.org / Wikipedia)

The information we are being given about Covid-19 infections and deaths does not permit us to make really meaningful assessments and predictions. That is a real problem as we enter the third year of the Covid-19 pandemic.

Few people can be sure what the next year holds in terms of the Covid-19 pandemic and its broad range of effects on individuals, families and society at large. Governments and the media in most countries seem to be at their wits’ end as the highly transmissible Omicron variant spreads like wildfire across the globe.

Encouraging noises are now being made about a generally milder infection (probably related to a high prevalence of partial immunity in some populations combined with a decreased ability of the variant to infect the lungs as opposed to the upper respiratory tract). This is especially the case in South Africa with its waning “fourth wave” in advance of most other countries.

These welcome noises come with quite a few caveats, however, as the WHO keeps on emphasising — vaccination rates and previous population infection levels vary widely among regions for a number of reasons, of which the local public health infrastructure and the prevalence of poverty are the most crucial.

Let’s be clear as to what we now need to assess, and by “we” I mean every citizen and community, as well as the authorities in the health and general government sectors. We need to be able to predict whether we are individually at risk of getting reasonably sick from an Omicron infection (say, a flu-like episode with several days in bed at home and some rather unpleasant symptoms) or of being so ill that we need hospitalisation for a few days, or of going into an ICU and then dying.

This must be assessed by vaccinated and unvaccinated people, by young people and by those in higher age brackets up to the over 80s, and by those with the comorbidities known to be associated with poor outcomes in Covid-19 infections. Then we have to be able to widen the assessment to our communities and by extrapolation to the nation at large.

I contend that the information we are being given does not permit us to make any of these assessments. That is a real problem as we enter the third year of the Covid-19 pandemic in this country. The question is: Does the necessary information actually exist, or at least most of it? Could we readily be provided with it?

In these circumstances, it is astonishing that the provision of information about the pandemic, here and more widely, continues to be uninformed and uninformative. It is not so much information about the underlying scientific progress being made in relation to the currently dominant Omicron variant (which is technically quite complicated although the main findings can easily be summarised in lay terms) but constant consideration of the many things that have become known as consistently true about Covid-19 since the start of the pandemic more than two years ago.

We have every reason to have become frustrated by the endless flow of irrelevant, incomplete and uninterpretable data in news item after news item, whether from local news media or the BBC or The New York Times.

The figure for “deaths” is also subject to the testing regimen, as a “Covid-19 death” is defined in terms of a positive test within the last 30 days before death. This figure is also affected by the inclusion of admitted patients who die from unrelated causes, but had a positive test for screening purposes. The figures for “active cases” is also affected by the testing regimen, but fails to include the many patients who suffer from “long Covid” long after their primary infection.

For example, we have been hearing almost every day from Europe and North America that “hospital admissions and deaths related to Covid-19 are rapidly increasing”, without any attempt to differentiate between patients admitted to a hospital who only incidentally test positive for the virus, but are in fact being admitted for other reasons (when you live in a country like the US, with 1.35 million positive tests on one recent day, and many more untested multiday infections occurring well above that figure, the chance of an incidental positive test is very high).

Similarly, when a death related to Covid-19 is defined as any death occurring within 30 days of a positive test, then many incidental deaths will be recorded in the present circumstances where the WHO has, for example, predicted that every second person in Europe will be infected by this variant in the next two months.

South Africa is a “laboratory” for Omicron infection and local experts have explained their optimism about the likely outcome of the Omicron-generated “wave” of infection in this country. They have pointed out the relative, but by no means absolute, protection against severe disease afforded by vaccination, as well as the relative “mildness” of the disease in hospitalised patients, even in the case of unvaccinated patients, with shorter hospital stays, lower oxygen requirements, fewer ICU interventions and fewer deaths.

Importantly, the word “few” in the preceding paragraph does not mean “none” — this past week it was finally admitted by an SA Medical Research Council researcher in a TV interview that 14 out of 21 patients who had died in an Omicron-infected, hospitalised cohort died of Covid-19 pneumonia and its complications. Unfortunately, but typically, he didn’t go on to mention whether these unfortunates were vaccinated, old, male, immune-compromised or seriously comorbid — all bits of information of potentially immense value in pointing to the real dangers that still reside in the “mild” Omicron epidemic.

These features are well established worldwide as the major risk factors for severe Covid-19 and fatalities directly resulting from it. I am giving these details to illustrate how even a good interview (and this one was good in other respects) still fails to tell the informed viewer, listener or reader what would immediately provide predictive value at both personal and population levels. It is also information that is urgently needed for public policy regarding vaccination/booster targeting and the prevention of infection in those at maximum risk.

The figures we see every day are the “new cases” (new positive tests over the last day) and the cumulative total for South Africa, numbers of “deaths” on the last day and the cumulative national total, and the number of “active cases” on the day concerned.

These “five favourite figures” are almost meaningless if one examines them closely. The first “new case” figure depends on the testing regimen, which fluctuates across the country and in different kinds of community settings. The only consistent figure is that everybody admitted to any hospital for any reason is tested; the rest are voluntary and depend on how individuals come to decide to be tested or have the decision made for them, both highly variably.

The figure for “deaths” is also subject to the testing regimen, as a “Covid-19 death” is defined in terms of a positive test within the last 30 days before death. This figure is also affected by the inclusion of admitted patients who die from unrelated causes, but had a positive test for screening purposes. The figures for “active cases” is also affected by the testing regimen, but fails to include the many patients who suffer from “long Covid” long after their primary infection.

Thus the public is routinely fed these really quite unhelpful figures, without being told how problematic they are. What is worse, they are not given the information that would in fact be informative and predictive, for themselves, for their communities, and for the nation at large. This information for a particular day or week or month would ideally include:

  • The number of people who have been hospitalised, the proportion of these who have been vaccinated, the proportion of these whose primary reason for admission is Covid-19, as well as their age, gender and comorbidity profiles;
  • The number of people who have been admitted to ICUs or other high-care facilities, the proportion of these who have been vaccinated, as well as their age, gender and comorbidity profiles;
  • The number of people who have died from Covid-19 as a primary cause of death, the proportion of these who have been vaccinated, as well as their age, gender and comorbidity profiles;
  • The Covid-19 test positivity rate in the general population who are admitted to hospital for any reason, as a reasonable and accessible sample of the larger population’s overall likely positivity rate; and
  • Some idea of the incidence of “long Covid” in the country.

I believe this “ideal” information exists or could relatively easily be obtained if the minds of the authorities could be set to get it. If the public information were based on this approach, we would all be much better able to see into the future of the pandemic and plan or act accordingly. Without it, the fog will continue and good luck to everybody and all.

[Note: The above scenario is based on the likelihood that no extremely transmissible “Variant of Concern” with much greater virulence and/or immune-evasive properties will arise in 2022.] DM

Prof Wieland Gevers is Emeritus Professor of Medical Biochemistry at the University of Cape Town, and was the founder and interim director of that university’s Institute of Infectious Disease and Molecular Medicine (IDM). He is a former president of the Royal Society of South Africa and the Academy of Science of South Africa, and a Fellow of The World Academy of Sciences (TWAS).

Gallery

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