Navigating the third wave

by Dr Gareth Kantor

The COVID third wave has ripped terrifyingly through Johannesburg and other communities and is now here.

Hospitals in the Western Cape are reaching capacity, and we’re now in Stage 4 lockdown to avoid a similar catastrophe in our own city and province in the days ahead.

What can we do?
Sixteen months into the pandemic it seems crazy to have to remind ourselves about so many things that we should already know. It’s also tiring to have to keep doing them. But some insights are new or have taken a while to come through to public health messages. And some well-accepted prevention measures and behaviours have still not been understood — or acted upon — by large segments of the community. On the other hand, we still see a lot of ‘hygiene theatre’ — performative gestures like the ‘single hand spritz’, or the ‘chair seat wipe’, which have no value in preventing the spread of COVID-19.

Handling surfaces or items is a low-risk activity. If something is heavily contaminated with virus, and you rub your hand in it and pass it directly to your mouth, nose or eyes, you might get COVID. But each contact with a contaminated surface is estimated to have a less than a one in 10,000 chance of causing infection. Daily sanitising is enough in most situations. It’s not a bad idea to clean your hands with alcohol-based sanitiser after contact with high-touch surfaces and as a general hygiene measure.

COVID does spread through close contact with other people, partly via the large droplets(>100 µm size) that exit people’s mouths or noses in coughs or sneezes. Also through aerosols — smaller particles that are expelled when breathing or talking — which hang in the air for minutes or hours and can be inhaled. Aerosols spread easily across poorly ventilated indoor spaces to infect people at a greater distance. Therefore, avoid crowded indoor spaces, keep your distance (2m or more) and wear a mask.

If you have to be indoors for more than a few minutes — a grocery store, workplace, shopping mall, school, etc — make sure it’s well ventilated and keep your mask on. Windows and doors should be open so that there’s a constant exchange of indoor air for fresh air from the outside. If that’s not possible, ventilation systems that are properly engineered to exchange room air at least six times an hour are needed. This can be measured, for example with carbon dioxide meters which reflect the amount of rebreathed air in the environment. Circulating the air through devices with special filters (‘HEPA”, MERV-13’) can help. Perspex shields prevent droplets splattering on you from someone’s cough or sneeze, but fixed screens can also impede ventilation airflow and possibly make things worse.

Hospitals have strict rules about ventilation in certain clinical areas, but other building owners and managers do not yet seem to have the necessary level of awareness of the implications of ventilation and the airborne spread of COVID. Regulations have not yet caught up with the science. During this rising phase of the epidemic, and until the wave is clearly over, plan your shopping needs in advance, use delivery services, minimise the number of shopping trips, or shop at quiet times such as first thing in the morning.

Mask-wearing limits the spread of COVID in two different ways. If you’re infected, you can reduce the amount of virus you emit into the surroundings by wearing a mask. If you’re sick you should not be out there, but remember that about half of COVID transmission occurs from people who are without symptoms at the time. You can greatly reduce your risk of inhaling enough virus to get sick, by wearing a mask. The mask must cover your mouth and nose.

Invest in the best quality mask you can find, and make sure it fits. This means triple layer, with or without filters. No valves. Easy to breath, but no leaks. A well-fitted mask may be less comfortable than you would like but it’s worth it, and there are various ways (clips, etc) to improve the fit. Double masking — surgical mask underneath, cloth mask on top — is another way to reduce leaks, and also increase filtration.

Crowded spaces
Eating in a crowded restaurant is a high-risk activity which is why they’re closed for the next two weeks. When they reopen, seat yourself well-spaced from other groups, outdoors or in a very well-ventilated indoor space. Accept the temperature check at the restaurant door but understand that it’s a ritual with no proven value for keeping COVID out.

If you feel sick, go home. It might not be COVID, but be a good citizen. If it is COVID, stay home, get in touch with your GP or other health-care provider, community support, friends and family; and stay the course — ten days. Most people recover without much more than Panado, but if your symptoms worsen, get professional help right away. A few people will get really sick, need hospital admission, and we know how the rest of the story can unfold tragically.

Embrace the outdoors; it’s not only good for body and soul, but safe from COVID. Very, very few people have acquired COVID outside, but don’t go overboard by getting too close to people outside your normal family circle at the braai, on the beachfront or at other outdoor events.

Mass vaccination is what we desperately need, as quickly as possible, along with the measures described above. It’s a race against the virus.

How to get vaccinated? Vaccination is available for over-60s, healthcare workers (this job description has a broad definition and you may qualify even if you aren’t a nurse, doctor or other health professional), and from mid-July, over-50s.

Whatever your age, get registered on EVDS. ( If you need help, please ask. Wait for your SMS. More vaccination sites are being set up, but it’s a fluid and uncertain situation. Walk-ins are currently accepted but people with appointments take precedence. If you’re eligible, try your luck, and don’t give up too easily.

While it is still not a 100% guarantee, very few fully vaccinated people have become really sick and even fewer have died. But you can still get COVID and probably even pass it on to others. About two weeks after your second dose of the Pfizer vaccine, or about a month after the J&J, your protection is established. Exactly how high the risk of infection is then is not yet clear, and is variable depending on the individual, the type of vaccine, and the variants of SARS-COV-2 that are circulating.

If you’ve been vaccinated, your risk of getting COVID from another fully vaccinated person is low, but not zero. Still, if you’ve both had the jab, this is probably the threshold for allowing socialisation at close quarters without too much concern, unless you or your companion has a severe health condition which could mean that you should be more cautious.

While the pandemic is on the rise, consider the stress on our health-care system. As hospitals fill up, you may not be able to access care for normal health conditions, or even for urgent and emergent problems. The health-care workforce is at breaking point. This is another reason to be generally cautious.

Good luck out there; be safe and keep your friends, co-workers and loved ones safe too.

Dr Gareth Kantor is an anaesthesiologist based in Cape Town, a health industry consultant and a health system improver. He is also on the expert panel of GreenFlag Association, a new group that aims to give people the peace of mind that they live, work and relax in safe, healthy, well-ventilated spaces.

• Published in the PDF edition of the July 2021 issue.

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