Prof Salim Abdool Karim Weekly COVID-19 UPDATES

16 June 2022
Just to highlight that Covid-19 risk is ever-present, I learnt that I had been SARS-CoV-2 exposed last week in Paris and have been testing myself – fortunately, I was negative throughout the period when I would have developed an infection after the exposure. This reminded me about the differences in dealing with community risk and individual risk. While the current approach to Covid-19 in many countries, including South Africa, is to accept that viral spread may occur following exposures but interventions like quarantine are no longer recommended, principally because most infected people are not identifiable due to large numbers of asymptomatic infections and so quarantining a few people is not likely to make a big impact. However, at an individual level, I would not be able to forgive myself, if I was responsible for infecting anyone else when I could have avoided it, especially an elderly person at higher risk of severe disease – so, I took several precautions to limit that possibility during these last few days when I could have become positive. 
The apparent conflict between public health advice that does not require measures like quarantine to limit spread either when exposed/infected versus the individual advice to do what you can to limit potential spread is not a conflict – they focus on different aspects of the problem – and, one is based on pragmatism while the other is based on individual beliefs and concerns for the welfare of others. This happens all the time and is not unique to Covid-19, to give an extreme opposite example, we have public health measures to reduce smoking exposure (such as no smoking in most public indoor spaces) but a smoker can expose his/her children repeated daily in the privacy of their home. 
Today’s missive comprises 4 points:

1. Should South Africa remove/ease all public health measures now that the 5th wave is over and we likely have about 3 months of low transmission?  There is no simple answer to this – some would say once measures like masks and social distancing are dropped, it would be difficult to toggle them back on when needed in the future. Others argue that getting prevention holidays increases adherence to public measures when they are needed. Regardless of which point of view is most applicable to a population at a given time, there are some simple measures that could be considered during periods of low transmission to help people live smartly with the virus – not going overboard with precautions or conceding defeat to the virus. I found an article in Spotlight / Daily Maverick to be a useful practical approach. Disclosure: The article entitled “COVID-19: What role for masks, sanitising, and ventilation in the new normal?” is written by my daughter, Aisha.

2. Globally, the pandemic has continued to decline and is now at the point of low transmission (around 5 cases per 100,000 population per day) (Slide 12). Good to see that the trend of increasing cases in North America has eased (Slide 13). Indeed, cases have been declining in countries across the spectrum of income (Slide 14). This is consonant with the increasing impression that the pandemic is over.

3. In South Africa, there has been a continuation in the decline of cases (Slide 2), the test positivity rates (Slide 6) and reported and excess deaths (Slide 8). The decline in testing is a phenomenon that needs further investigation – how much of this is due to people with mild symptoms opting not to test and how much is people opting to use rapid tests or just self-diagnosing Covid-19 based on their symptoms without testing? Or it could just be Covid fatigue and people choosing not to engage with Covid-19 any longer. Whatever the reason, it compromises surveillance programmes and decreases the likelihood of finding the next variant of concern timeously. 

4. Talking increases virus in aerosols - In last week’s email, I provided an article from Clinical Infectious Diseases showing that breathing and talking were more risky than singing in relation to spreading the virus to others. In that article, there was a photograph of the equipment used in the study. Certain sounds when speaking may be more likely to result in small aerosols. A British radio skit plays on this possibility by suggesting that certain sounds be restricted and replaced with less risky sounds – the skit is attached - it is quite hilarious. Thanks to Jeff Spieler for sharing this with me.  


Salim S. Abdool Karim, FRS
Director: CAPRISA
CAPRISA Professor of Global Health: Columbia University