WESTERN CAPE NEWS - "While we know a third wave is likely, we cannot predict the timing, location or magnitude of a resurgence." So says Western Cape Premier Alan Winde who has made public the province's strategies to prepare for a third wave.

The Western Cape has a four-pronged response to Covid-19. "Rolling out vaccines effectively, procuring our own vaccines, preparing for a third wave, and supporting our scientists researching therapeutics, are key in responding to this pandemic in the coming weeks and months," says Winde.

He says Western Cape epidemiologists are part of the MAC (ministerial advisory committee) technical working group who are preparing a response to a possible third wave. 

"The country has just moved to Level 1, allowing for more movement and congregation and in the coming weeks, public holidays, and the Easter weekend will see more people moving around and congregating, increasing the risk of infections. It is imperative that we are all acting more responsibly than ever before."

Key factors that could drive the third wave are:

• Changes in viral transmissibility which could be brought about by changes in the weather and seasonal changes in behaviour such as the Easter weekend and funeral attendance.
• Behavioural changes among the population such as the changes in restrictions and adherence to quarantine and isolation protocols.
• Changes in interactions between connected subpopulations such as movements between provinces and movement between urban and rural areas.
• Changing immunity/reinfection risk, as there is some evidence to show immunity post infection. However, this may wane over time.
• Viral evolution, as new variants like 501Y.V2 could affect viral transmissibility.
• Speed, impact and uptake of vaccinations will also impact severity of third wave.

Containment and mitigation
He says between peaks, the focus must be on containment, and ensuring that clusters of cases, related to a specific place or event, do not result in widespread community transmission. 

"Once community transmission has been established, containment efforts become ineffective and the focus must then shift to mitigation measures, to reduce the numbers of deaths, ensure that our healthcare system does not become overwhelmed and protect our healthcare workers."

He says their containment response will focus on prevention behaviour and increased testing and surveillance, while mitigation measures include retaining a core field hospital capacity and making use of the additional infrastructure put in place during the first two waves.

'Community behaviour is key'

"To contain infections, community behaviour remains key to preventing Covid-19. A surveillance and outbreak response is also important to ensure we are able to closely track and respond appropriately."

The Western Cape's surveillance strategy focuses on three key areas:

• Determining the proportion of and places where previous infections have occurred through seroprevalence testing. The Western Cape has conducted seroprevalence testing among people accessing our services for HIV treatment and antenatal services following the first wave. In February, residual samples from people accessing diabetic, Paediatric and HIV treatment were taken which will, in the next few weeks, be able to give us a picture of infections in communities following the second wave.
• Tracking the rate, areas and the molecular characteristics of new infections. The province's waste-water testing system is an excellent early warning system which it is continuing to use. Scientists across the country and around the world are also constantly working to identify new variants which may have an impact on the third wave.
• Tracking individual new cases allows the tracing of contacts, advising them to isolate or quarantine and contain cluster outbreaks around cases.
  "In the Western Cape, we will be using screening, and PCT or rapid antigen tests for these purposes."

Vaccination

"A vaccination campaign is also an important aspect of a containment strategy. The Western Cape is on track in its rollout of the J&J Sisonke implementation study, to vaccinate healthcare workers. We have completed our first tranche of just over 13 000 vaccines, and the second tranche is currently being rolled out. In this tranche, 64% of vaccines will be allocated to the public sector, with 36% going to the private sector and we have scaled up from four vaccination sites to a total of 8 to be brought online by 15 March."

Vaccines in this study will be rolled out in four tranches over an eight-week period, covering approximately 40% of the province’s healthcare workers.

Phase 2 vaccinations

The general population will begin to receive vaccinations in phase two of the rollout.
"It is important that we urgently vaccinate priority categories within the next three months in order to mitigate the impact of a third wave. 

"As phase 2 includes many of our most vulnerable including those over 60 years old, and with serious co-morbidities, this phase is important in reducing deaths, and protecting our health system from becoming overwhelmed."

He says the province is working to develop an efficient delivery system which will roll out vaccines to as many people, as quickly as possible.

At this stage, the only vaccines currently available in the country are those being used as part of the J&J Sisonke study. "Given this limitation of availability, contingency plans to procure vaccines for the country and the province must be explored urgently."

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