By Dr Sheri Fanaroff  MBBCh FCFP MFamMed, a Family Physician, practicing in Melrose, Johannesburg. Fanaroff is a member of GGPC (Gauteng General Practitioners Collaboration) which has created a platform for doctors to share resources during Covid-19. Look for  #voicesthatcare on the GGPC Facebook page.

New Year, new Covid strain, record numbers, new hope.  Same old rules

2021 has arrived with a tsunami of new cases reaching the highest daily numbers we have seen and a massive percentage of positive results (over 30 percent of tests done).
 
Sadly, while SA ranks high in the number of new COVID cases, we have been unable to procure a meaningful number of vaccines. Hospitals around the country, both public and private are under enormous pressure and there is major concern that there will not be enough ICU and high care facilities to cope with the expected huge demand.
 
Over the holidays, many people have experienced either being infected with Covid-19 or exposure to someone who has had it. I am going to give some guidelines in response to the questions I have most frequently been asked in the last few days.
 
COVID new strain : The FAQ’s

How does the new strain affect us?

The new variant of Covid-19 has mutations on its spike protein and appears to be the dominant strain circulating since at least early December. Coronaviruses naturally mutate, so this is not unexpected, and on the whole, the management of the virus remains the same.

  • It is 40% to 70% more transmissible than the old strain (in other words it can be more easily spread).
  • At this stage it has NOT been proven to be more virulent or to cause more severe illness. 
  • It is spread in exactly the same way, in other words in droplets in the air and from contact with surfaces. 
  • Some countries (eg the UK) have closed their borders to South Africans based on the new variant.
  • It is UNKNOWN at this stage whether someone who has already had COVID-19 can get re-infected with the new COVID variant.
  • NB. Even those who have had COVID in the last few months and/or those who have antibodies, should behave in the same manner as if they have not had it, i.e mask, distance and wash hands. 
  • Someone who has had COVID 19 or who has antibodies, should follow the SAME protocols for quarantine and isolation (10 DAYS) if they have been exposed as a close contact or if they develop new symptoms of COVID-19 infection.
  • The current PCR and antigen tests do also pick up the new strain.
  • It is still unknown whether the new strain will impact the effectiveness of the vaccine – more research is needed, but at this stage it is not thought to be of major concern.

I am returning to Gauteng from Cape Town ? Plett/ Garden Route/ Umhlanga/ other high risk area. Do I need to quarantine?

  •  If you have been diagnosed with COVID-19 or have any symptoms, you should complete 10 days of isolation before traveling home. This is both to:
    a. prevent you from spreading the infection to others and
    b. also because traveling home may be dangerous for you – the patient – due to the increased risk in clotting and the risk of low oxygen levels.
  • If you have been a close contact of someone with COVID-19, you should complete 10 days of quarantine in the place where you are before traveling home. (This is for the same reasons as if you are infected). NB:
    a. A negative swab or antigen test during this period does NOT MEAN THAT YOU DON’T HAVE TO QUARANTINE. Many early and asymptomatic infections may be missed by tests in the first seven days following exposure.
    b. You could be sitting next to someone vulnerable on the plane while you are unknowingly shedding the virus, and would then be responsible for making them sick or even causing their death. Please be responsible and don’t knowingly cross provinces leaving infected people in your wake.
  • If you are coming home from a high risk area but haven’t definitely been a contact, then you don’t strictly need to quarantine. However, I would advise extreme caution in anyone coming from high risk areas , and anyone traveling by plane, as we suspect there are likely to be positive people on the flight. So while you don’t have to stay home in strict quarantine, you at least need to be vigilant.
  • Should you develop any COVID-19 symptoms on your return, you need to immediately go into isolation and be tested.

What about our domestic workers who are returning from high risk areas. 

The same principles apply for domestic workers in your home as for anyone else returning from an area where there is a high number of cases, where they have been in large gatherings or where they may have been exposed to COVID-19. Remember that your family is equally at risk to the worker, and that best practice is for everyone in the home to follow the same protocols.

  • The safest option is to quarantine separately for a ten day period. Particularly if there is anyone vulnerable (elderly/ comorbidities) in the home, this is definitely the safest choice. A test could be done on the 7th day – a negative test at this time gives some reassurance, but does not completely exclude infection; however a positive test would mean that the worker would need to isolate for a ten day period.
  • The PCR (swab) test is more expensive, but is more accurate than the antigen test.
  • If the worker is coming straight back into contact with the family, for a ten day period:
    1. both the worker and the family wear masks,
    2. keep the doors and windows open,
    3. maintain a distance of at least 1.5 metres and practice excellent hand hygiene.
    4. Ideally, avoid being in the same room at the same time.
    5. Frequently touched surfaces should be wiped down often.
    6. Should anyone develop symptoms during this period, they should be tested.

    Is public transport safe?

    Public transport, especially taxis filled to high capacity over long distances, are obviously high risk situations. Look for alternative options if available. If using public transport, workers should:

    1. wear masks covering mouths and noses,
    2. insist on windows being kept open,
    3. not eat or drink in the taxi and
    4. carry their own sanitiser.

    Is it safe to go back to work?

    • If people working together in an office space have travelled around the country, it might be better to work from home for a two week period (if this is feasible), while waiting to see if anyone develops symptoms, rather than spreading the virus throughout a workforce.
    • If you do go back to work immediately, it should be with strict COVID protocols in place.
    • All workers should be screened for any COVID symptoms and importantly for any possible exposures or high risk situations.
    • Temperature screening, strict wearing of masks over mouths and noses, good ventilation and excellent hand sanitising should be observed.
    • Meetings should be conducted in well ventilated spaces where attendees are safely able to social distance. Masks should be kept on during the meetings.
    • Colleagues should not eat and drink together except outside or in very well ventilated areas and at a distance.

    What about sending our children back to school?

    • Public schools are only due to go back later in the month, when it will be clearer what trajectory Gauteng is following.
    • Private schools will need to communicate with parents in the next week what their plans are, and I suspect that each school body will come up with their own protocol.
    • Some schools may elect to start off the year online to prevent students returning from around the country from infecting each other.
    • Others might decide that with COVID protocols in place, school is a safer place to be than many other spaces that students engage in. Having school online doesn’t guarantee that students are not socialising together anyway – at parties, restaurants and the gym.
    • A school observing excellent COVID protocols is a controlled environment where social distancing can be implemented, frequent sanitising can be enforced, and mask wearing can be mandatory. Most schools are now well prepared and experienced in appropriate management, having implemented the protocols since June 2020.
    • Whatever your school decides, it is of utmost importance to NOT send any children to school who have any symptoms, who are still completing ten days isolation or who have been in contact with a COVID patient and who should be in quarantine. If you are uncertain, it is best to keep them home until they have been cleared by a doctor.
    • It is now a criminal offense to knowingly expose others to the virus – ethically jeopardizing an entire class or school by sending infected or infectious children to school is unconscionable.

    BOTTOM LINE

    My best advice for the next few weeks is to treat everyone around you as if both they have COVID and could infect you, AND that you have COVID and could infect them.

    While this seems at best antisocial and at worst psychopathic, the truth is that we are indeed expecting a massive flood of cases in Gauteng over the next few weeks, with a peak predicted anywhere between the end of January and March.

    This threatens to overwhelm the health system and could mean that you or your loved ones don’t have access to a hospital bed if needed.
    • Wear a mask over mouth and nose during ALL interactions and outside your home at all times.
    • Maintain a social distance of 1.5 metres.
    • Wash and sanitise hands often.
    • Avoid large gatherings and avoid eating with anyone outside your family circle.
    • Stay in well ventilated or outside spaces.

    The new year does bring hope of better global management of COVID-19.. We need to stay the course until vaccinations bring the pandemic under control.

Related useful articles:
  • How to fight mild Covid at home, by Dr Lauren Wise. Read more
  • Covid 2, the second wave, a second opportunity, by Analytikal Mama. Read more.
  • Is it safe to visit the gym during the pandemic, by Dr Sheri Fanaroff. Read more.
  • Let’s go on a family outing in Gauteng, Jozikids. Read more
  • Isolation kit: a shopping list to help you get through. Read more.
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