NEWS
Did we learn anything from
Covid’s first and second waves?
As SA braces for the third wave of Covid-19 infections, will lessons learnt from the first and second wave make any difference? By Nicky Belseck, medical journalist
W
HILE PREDICTIONS IN February had the third wave of Covid-19 infections hitting SA in May/June, by March researchers were warning the third wave could hit parts of SA as early as April. Following the second wave, the National Science and Technology Forum (NSTF) held a discussion Forum on issues of preparedness for human and animal disease outbreaks. The keynote speaker was former National Department of Health acting deputy director-general, Dr Yogan Pillay. Discussing the lessons learnt from SA’s response to the Covid-19 pandemic so far, Dr Pillay identified six key intervention areas: community screening, contact tracing, active and informed use of epidemiological data, community engagement and risk communication, SA’s risk adjusted strategy, and health system strengthening. COMMUNITY SCREENING & CONTACT TRACING “It was fairly clear from the first wave that the Health Department working alone was not going to be able to mitigate transmission or to prevent avoidable mortality. So, it was a major lesson that unless you work intersectorially and across all the spheres of government (local and national) a health sector response alone was not going to be sufficient.” Dr Pillay also stressed the need for community mobilisation at the lowest level. “Adherence to non-pharmaceutical interventions was significantly higher in communities where there was significant community mobilisation and significant involvement by local government councils.”
8 April 2021 | MEDICAL CHRONICLE
ACTIVE AND INFORMED USE OF EPIDEMIOLOGICAL DATA “It’s well known that in some areas we have really good surveillance data, in other areas not. We have to extend the digital platform we have to strengthen the surveillance system. There is some duplication and lack of standardisation across provinces, and there’s inadequate communication in many areas, but I think the Covid response has shown that the public and the private sector have to work more closely together, as should the national and provincial district levels. The only way to get ahead of a pandemic, which grows very fast, is to have electronic data systems.” While it might not be ready in time for the third wave, Dr Pillay said, “I think what’s currently being built in terms of the labbased systems as well as the surveillance systems, including the modelling system through the Covid-19 modelling consortium will stand us in good stead so that if and when we get the next pandemic, we will be better prepared from an EPI (Epidemic Preparedness Index) and surveillance point of view.” COMMUNITY ENGAGEMENT AND RISK COMMUNICATION Dr Pillay believed that from the beginning of the pandemic all mechanisms of communication had been used. “Everything from social media to radio and TV, and in all South African languages.” However, while the president and minister of health were at the forefront, of communication, he admitted that: “We could have had significantly more support in communication
from other government departments, and I think going forward that could increase.” SA’S RISK ADJUSTED STRATEGY “The five-level alert system evolved out of significant consultation across all sectors, including private sector. Notwithstanding the fact that it did cause a significant amount of social and economic pain, because of the lockdowns. So going forward we need to learn lessons from what works and what doesn’t work at each of the levels, and what can be done differently. There’s been suggestions that you need a significant amount more community buy in before you institute an alert level, which means we need to not only balance between what’s done and how it’s done, but also between saving lives and saving livelihoods. While that’s become fairly clear, it’s a difficult balance to achieve.” HEALTH SYSTEM STRENGTHENING “The lesson from the health system strengthening, and the lesson from the vaccines, is that SA has to become more self-sufficient in the production of commodities. Whether they are ventilators,
whether it’s production of oxygen, whether it’s PPEs, whether it’s the selection of drugs, steroids included, or whether it is coffins, regrettably, we’ve got to be able to become more self-sufficient in the production of these commodities because when you have a pandemic everybody in the world is looking for these commodities.” Going forward Dr Pillay stressed the need to invest in public sector workers of all types, provide quality care at an affordable cost, and reduce the cost of inputs like diagnostics, vaccines, and medicines. “It means changing the way that the health and social sectors provide services. It also means greater reliance on digital technology for surveillance, self-monitoring of vital signs, and real time data for planning and intervention.” THE THIRD WAVE With vaccines still in short supply, the vaccination rollout far from what’s needed to achieve herd immunity anytime this year, and SA bracing for the third wave of Covid-19 infections, it’s anyone’s guess whether the lessons learnt from the first and second waves will make any difference?
