Prof Salim Abdool Karim Weekly COVID-19 UPDATES

26 January 2022

This week’s missive covers both my trip to Vietnam and the Covid-19 situation in South Africa

My experiences with Covid-19 in Vietnam

Quarraisha and I have just arrived in South Africa from Vietnam. We went to Vietnam for the Vinfuture awards activities and events.  The Vinfuture Award ceremony was like a Broadway theatre production with the full Hanoi orchestra, a contribution by Vietnam’s top pianist and a special guest appearance by John Legend who sang 3 songs, including my favourite, “All of me”.  The prize certificate we each received has a painted portrait of each of us – we personally met the artist who painted our portraits the next day. We were handed our awards by the Vietnam Minister of Finance and the Minister of Defence in the amazing French-built Hanoi Opera House. Part of the prize was a holiday – we chose to go to Ho Chi Minh City (previously Saigon), which is the bustling economic hub of Vietnam. The War Remnants museum is a must visit in this city – it is a sober reminder of the atrocities of war.  A newspaper article about the Vinfuture award.

What was fascinating to me is how they deal with Covid-19 in Vietnam – their vaccine coverage is >90% and so they don’t bother too much about checking for vaccine cards – we were only ever asked for vaccination cards once – when we went to visit the ancient Pagoda. What you need to go to most indoor function venues is a negative Covid-19 test. So, we were tested everyday in Hanoi!  The nurses come and take swabs for a rapid test and a PCR test – they do both tests each day. This switch from vaccine mandates to vaccine + testing mandates for indoor events makes good sense in a country with very few cases, given that omicron routinely breaks through vaccination. For the award ceremony, everyone had to come early to have a test done and were only allowed to enter once negative – that is how we could go maskless in the Hanoi Opera House.

Many tourist venues in Vietnam are still closed and they have not allowed foreigners into Vietnam for the past 2 years. The international airport looks like a dystopian movie with most of the shops closed, the escalators switched off and a few passengers about in the large halls. For those coming to Vietnam for business, there is a 7-day quarantine. There are also very few flights to Vietnam. It took 4 days to get to Hanoi including stops in Frankfurt, New York and San Francisco - when we landed in Hanoi, we all went straight for our Covid tests and once negative, we were taken straight to our hotel fitted with full PPE including the Hazard suits for our 3 days of quarantine in spoilt comfort. Once our quarantine ended, we were involved in a range of activities relating to the prize – lectures at VinUniversity, Award Ceremony, Opening Art exhibitions, etc.  Vietnam has a strict mask mandates both indoors and outdoors – and it is followed almost 100%! I once counted 86 motorcycles at a traffic light – every rider with a mask!

One of the highlights of this trip was to meet the winners of the grand prize, Katalin Kariko, Drew Weissman and Pieter Cullis for the mRNA vaccine that BioNTech developed with Pfizer, we knew them only slightly before, though Drew has been following our work over many years. Katalin developed the mRNA approach over 3 decades and is now Head of mRNA treatment research at BioNTech. Drew is an immunologist at Penn State and he put the mRNA into the vaccine format while Pieter, who is based in Canada, developed the lysosome packaging for mRNA which Drew and Katalin used when they made the Pfizer mRNA vaccine. The trio truly deserve the main prize.

Covid-19 in South Africa – an update

A little-known fact is that the world has seen record highs in case numbers almost every day in January – we are uncharted territory. The daily case numbers are almost 4 times higher today than they have ever been (slide 4). Part of the reason why this is seldom covered in the media is that we have lost the global focus in dealing with Covid-19. We see Covid-19 as a bunch of country epidemics, rather than a pandemic requiring global solutions that go beyond what individual countries do (or don’t do) in response to the virus. This limited country-focused perspective also drives some of our problems like vaccine nationalism.

In the meantime, the omicron wave is over in South Africa – we have passed the cutoff of 5 cases per 100,000 per day (or the NICD cutoff of 30 cases per 100,000 population per week or the 10% test positivity cutoff). Whew!  Upon reflection, I recall that day in late November when I was so concerned when Prof Tulio de Oliveira called me down to his office to show me the multiple mutations in the sequence of a new variant that he had just seen. Thank goodness, omicron turned out to be less severe. However, being less severe is not grounds to become complacent – omicron is still causing mayhem in several countries (like France this week) – its high transmissibility means that cases increase so rapidly that even small fractions of sick patients translates to large numbers of patients presenting to hospitals.

A key point emerging in today’s slideset is in Slides 10 and 11 on excess deaths – data from Debbie Bradshaw. Excess deaths in South Africa are about 3 times higher than reported Covid-19 deaths. During the waves, they mostly comprise Covid-19 deaths plus some deaths from other causes that are impacted by Covid-19. Excess deaths have usually risen quite rapidly in each wave, except for the omicron wave where SA only had a small bump where a spike would normally have been. The current trend is a firmly on the downswing and is reassuring that we are not going to have a late surge in deaths from the omicron wave – I am pointing this out because SA is a few weeks ahead of the rest of the world in how omicron unfolds. I am so concerned about the unpredictability of this variant that I wanted to be absolutely sure that there is no sting in the tail in the form a late surge in deaths. I am now confident that this concern is not going to occur. So, countries in the downward omicron slope like Canada and USA need not be concerned about this potential problem.

Just a quick note to end with – Angelique of SAMA called me, while I was in Vietnam, to chat about whether we should be relaxing most, if not all, of our restrictions now. I said that it is either a brave or foolhardy scientist who says that (s)he knows that the Covid-19 threat is over. An endemic virus can still be a deadly virus – HIV being a case in point.  I recall a few colleagues telling me that the Covid-19 threat was over after Delta – how could the virus possibly get worse than Delta?  With genetic mutations – it is hard to predict what the phenotype would be. As I explained last week, we can hope that the next variant is more like omicron than delta – but that is just hope as we predict this with any degree of certainty.

Anyway, we are likely to have about a 3-month period of low transmission now in South Africa, based on past trends before we can expect our next wave, likely due to a new yet-to-emerge variant. In preparation for that new variant, we need to ensure we use our tools against SARS-CoV-2 wisely as combination prevention – where vaccines form the essential core of our prevention approach to which we add public health measures like masks, as appropriate.


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