Government should explain rationale behind new Covid-19 regulations — public health experts
Public Health experts in South Africa are calling on the South African government to explain and clarify the reasoning behind a new set of regulations issued late on Monday after a Cabinet meeting.
Public Health experts have called on the government to explain the intent behind, and reasons for, a new set of Covid-19 regulations issued and gazetted late on Monday night.
The regulations include measures that will allow for the forced isolation of symptomatic patients who refuse treatment and admission at a health facility, including a provision that they can be held for 48 hours at such a facility before a warrant is obtained to extend their isolation period.
The regulations contain a new form that can be used by magistrates to order people into isolation, and which include an order allowing for the taking of samples from the person’s body.
Doctors, nurses, people that have been delegated by doctors to do so and the police will be able to order someone to isolate. Asymptomatic people who have tested positive for Covid-19 will no longer be required to isolate themselves.
Symptomatic people are still required to isolate themselves for seven days.
The new regulations seem to replace another set that had been issued at the end of December, but were almost immediately withdrawn.
In January, health department spokesperson Foster Mohale said the reason for the revision had been based on several scientific factors, including that most people have been vaccinated with at least one dose and have developed some level of immunity. This has contributed to the current low hospitalisation and high recovery rates.
He said many people do not show any symptoms, and only a small percentage are diagnosed. Many who are in contact with Covid-19 positive people lose their incomes and children lose valuable school time while staying at home without symptoms.
“Thus, in line with the principles of transparency and openness, the department has decided to put the implementation of the revised policy changes on hold, while taking all additional comments and inputs received into consideration,” a statement issued by Mohale said at the time.
The amended regulations for Alert Level 1 appear to be these revised rules.
Earlier in January, a group of eminent public health experts called on the government to implement extensive changes to the way the Covid-19 pandemic was being managed.
The suggestions were offered by a group of public health experts and doctors — Francois Venter, Ezintsha divisional director, Faculty of Health Sciences at Wits University, Marc Mendelson, head of Infectious Diseases and HIV, University of Cape Town, Jeremy Nel, head of department, Infectious Diseases, Wits University, Lucille Blumberg, Right To Care and University of Stellenbosch, Zameer Brey, health systems adviser and Groote Schuur Hospital board member and Shabir Madhi, Dean, Faculty of Health Sciences and Professor of Vaccinology, University of the Witwatersrand.
They suggested that the government should end the state of disaster as “our current understanding of the science, the building of immunity protecting against severe Covid-19, and experience with policy renders most state of disaster measures still in place unfit for purpose and requires tailoring of others”.
“We see no reason for the continued use of this legislation, nor for the National Coronavirus Command Council.
They said the government should be single-mindedly focused on the vaccine programme and protecting health facilities from the impact of large numbers of admissions, in terms of SARS-CoV-2. Their suggestions did not require continued centralised, secretive and unaccountable decision making for this to occur.
“Arguments that the state of disaster is required to enforce interventions like masks or limits on social gatherings are unconvincing, as most restrictions need to be lifted anyway, and conventional legal and social persuasion mechanisms can be used to ensure the very limited number of interventions required, are executed.”
One of their suggestions, to stop school restrictions, was agreed to and legislated in the new regulations.
Other suggestions like ending restrictions on outdoor activities and a rethink of the mask mandate, “given increasing vaccination coverage and a greater understanding of the predominant role of aerosols in transmission”, were not addressed in the new regulations.
Further suggestions included bringing an end to routine temperature taking and symptom screening, fogging, PCR and antigen testing at the border, and routine testing of mild and asymptomatic cases, unless it made a difference to care.
“There is nothing to offer people who are positive that you wouldn’t offer for any mild respiratory infection. Routine testing of asymptomatic patients should stop … Hospitalised symptomatic people should be tested, as we have treatments, but for mild disease, testing really only makes sense for those at high risk…
“You can make a case for testing yourself if visiting granny or someone vulnerable, but understanding that the tests are not perfect, and that unless the person you are visiting is living as a hermit, their risk of exposure to someone else who isn’t testing and infected is very high. Again, vaccines are the best protector of the vulnerable,” their statement read.
The experts were also in favour of ending quarantine and contact tracing.
Reacting to the new regulations, Venter said on Wednesday: “We had clear guidance in late December, that many experts regarded as world-leading, then retracted without explanation days later, and now this new set with no coherent explanation for the changes, in the midst of a vaccination programme that missed every target by a mile. No urgency, no communication, no clear strategy. It really erodes public trust and amplifies the dreadful disinformation we see on social media.”
Madhi said on Wednesday he believed the intention was good in drawing up the new regulations, but they came with “poorly crafted messaging which has created uncertainty as to why and what has changed to bring about [these new rules]. He said the government should have referred to their suggestions published in January.
Following a meeting on 19 January, the World Health Organization issued a list of critical actions for all countries. These included:
- The continued use of evidence-informed public health and social measures, therapeutics, diagnostics, and vaccines for Covid-19;
- Where isolation and quarantine of large numbers of cases and contacts is potentially disrupting critical infrastructure (including healthcare services), the WHO urged countries to modify isolation and quarantine periods with the introduction of testing, to balance the risks with the continuation of key functions, using a risk-based approach;
- A new risk-based approach to mass gathering events by evaluating, mitigating, and communicating risks. Recognising that there are different drivers and risk tolerance for mass gatherings;
- Strengthening systems to collect and publicly share indicators to monitor the burden of Covid-19;
- Continually ensure sufficient surge capacity for critical SARS-CoV-2 clinical care and post Covid-19 conditions, and for the maintenance of essential health services, and should plan for the restoration of health services at all levels with sufficient funding;
- The lifting or easing of international traffic bans;
- Doing away with measures that require proof of vaccination against Covid-19 for international travel as the only pathway or condition permitting international travel given limited global access and inequitable distribution of Covid-19 vaccines; and
- Address community engagement and communications gaps.
Mohale promised to respond soon on questions to clarify the new regulations. DM/MC
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