covid: Don’t panic about rising Covid cases. Hospitalisation & deaths are the real metric: Experts

India discovered its first cases of Covid caused by the BA.4 and BA.5 sublines of the Omicron variant late last month, and the country reported a record nearly three-month record of more than 4,000 new infections on Friday. The Omicron subvariants sparked a surge in South Africa in May, although a preprint of a new study shows that more than 87% of the population had been previously infected. However, with a slower increase in the number of cases, fewer hospitalizations and fewer deaths, South Africa is transitioning to a different way of living with Covid, where there is less panic about the number of cases. But boosters are critical because we don’t know when immunity wanes, say Dr Michelle Groome, head of the Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, South Africa, and Professor Sheetal Silal, director, Modeling and Simulation Hub, Africa, University of Cape Town, in an interview with Indulekha Aravind during a Zoom call. Edited excerpts:

How does the latest increase in cases led by BA.4 and BA.5 compare to previous waves?

Michelle Groome (MG): We started to see small increases in the number of cases where we identified the BA.4 and BA.5 sublines. But the rate of increase was not as fast as what we had seen with the first Omicron wave with BA.1 in December. And we saw very low numbers of hospitalizations compared to what we had seen with the first wave of BA.1 and a very small number of deaths. And the resurgence seems to have settled. In addition, there are other differences. For example, our test rates are much lower right now, so direct wave-to-wave comparisons are difficult.

Leaf Silal (SS): In South Africa we have moved away from this terminology of a wave. We have to be careful with the language we use. Different statistics are appropriate at different stages of the pandemic. For example, a wave of cases has previously heralded a wave of serious hospitalizations and deaths from Covid-19. But now we have to consider the levels of previous infection and vaccination in the population. In South Africa, with many previous infections (and likewise in India, with many previous infections and vaccinations), a large number of cases do not necessarily lead to a large number of hospitalizations. So if we just continue to emphasize the increase in the number of cases, we risk causing unnecessary public panic. Thinking about the pandemic and how we characterize and measure it needs to change. Now we need to worry about monitoring statistics to assess when future flare-ups become an acute public health burden.

How important are booster doses – an area where India is lagging?

Michelle Groom: I think we have similar issues to India – our booster shot wasn’t great. That’s partly because people feel that if they’ve had Covid, they’re protected and why they should have a vaccine. There has also been quite a bit of misinformation. We need to get the word out that we don’t know much about waning immunity and so we don’t know how long this protection will last. Certainly, for those at higher risk, booster will give you a longer protection against serious diseases.

Leaf Silal (SS): With high seroprevalence and some vaccine uptake already, we run that risk of the story that okay, well, we already have some protection. Perhaps now more than ever it becomes important to target the vaccines, the boosters.

Based on your experience dealing with sublines, what are the one or two things policy makers should keep in mind?

Leaf Silal: The role of the media is very important in this regard. If the media were to spread information about the slow increase in hospitalizations and deaths despite the increase in the number of cases, it would start to change the story and send a different message than we have become accustomed to over the past two years.



Michelle Groom: The most important thing is not to panic about the increasing number of files. We need to focus on measuring, you know, hospitalization and deaths as the real yardstick for the future.

How important is wastewater monitoring in detecting a future peak?

Michelle Groom: One thing we’re also trying to convey is a shift away from lockdowns and public health responses and more towards individual risk-based responses. So you are abolishing the requirement to wear masks, but if you are an elderly person with an underlying illness, would you choose to wear a mask or perhaps choose not to go to a large public gathering. So something like wastewater monitoring, where you detect the virus in wastewater, might give an indication of where there are higher case numbers. People can go to their district’s dashboard, and if there was an increase in SARS-CoV-2 in their province or district, those at high risk may want to take extra precautions. As we change our view of Covid, I think more and more sentry monitoring will become important as a mechanism to monitor what is happening with these and other viruses.

Leaf Silal:Setting up systems that are relevant to other diseases and not just Covid, but that have a much greater benefit to society, such as wastewater monitoring, is becoming even more important. It is difficult to justify such expenditure, perhaps in a non-pandemic environment, so this is almost expedient, if there is interest in setting up this kind of infrastructure.

What should individuals do in terms of precautions?

Michelle Groom: For the most part people are tired of Covid and any kind of disability. We need to draw attention to those at higher risk, for example the elderly and those with co-morbidities, and tell them that these are the ways you can limit exposure to respiratory viruses in general. The other thing is, with the Omicron wave and even now, we had very few restrictions (in South Africa). So you see a low number of hospital admissions and life is practically back to normal. It is encouraging that we are not seeing an increase in hospitalizations and deaths in light of that.

Leaf Silal:I think it’s important to learn from the East Asian example. After SARS and H1N1, it has become normal to wear a mask if you are symptomatic. The government can participate in social communication and what responsible behavior and hygiene practices are without necessarily obliging them. If we were to change the approach and promote good hygiene, it would be a very big win, not only for Covid, but for all respiratory diseases.

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