South Africa’s COVID-19 questions answered – Airborne transmission, re-infections, long-term brain damage, and the country’s current plan

The COVID-19 storm is currently sweeping across South Africa with over 250,000 confirmed coronavirus cases and an average daily increase of over 10,000.

Health Minister Zweli Mkhize has also announced 140 new COVID-19 related deaths on Friday, taking the total to 3,860 casualties.

This only tells part of the story. Professor Shabir Mahdi from the University of Witwatersrand said the majority of COVID-19 infections go unnoticed.

Madhi, who is leading South Africa’s first COVID-19 vaccine trial, said only around 10% of all COVID-19 cases are officially reported.

This means the number of COVID-19 cases in South Africa is likely to be well above 2-million – and rising quickly.

This rapid increase in COVID-19 cases and deaths are concerning to many people, especially with new information emerging about damage to the body and how the virus is transmitted.

Professor Salim Abdool Karim, South Africa’s COVID-19 ministerial advisory committee head, said health experts and scientists are learning new things about the virus daily.

Many of these new revelations are alarming, but he highlighted that some of them require more research to be confirmed.

To shed more light on the latest information regarding the COVID-19 pandemic and South Africa’s response, Karim and Mahdi answered questions from South Africans.

Here are a few of the most prominent questions about the pandemic and what the latest research says.

Is COVID-19 an airborne disease?

Karim – We know the coronavirus is present in small droplets which linger in the air for a long time, but it is unclear what role these small droplets play in airborne transmissions. We have seen evidence of aerosol spread in closed spaces, like taxis. More research is, however, needed to answer the question of airborne transmission definitively.

Mahdi – We may have underestimated the role of airborne transmission in COVID-19. New evidence suggests there is a fair amount of airborne transmission taking place through micro-droplets. Airborne transmission is most likely a reality and may explain the rapid rate at which the virus is spreading.

Learn more: Prof Karim interview | Prof Madhi interview | New Scientist article

Can somebody be re-infected by COVID-19 and therefore get it twice?

Karim – We do not know which antibodies are required to protect against COVID-19. We also do not know whether the antibodies which are created with an infection will protect against a re-infection.

Mahdi – Many people who have been infected by COVID-19 lose their antibodies after 2 to 3 months. This, however, does not mean there is no underlying immunity. The durability of this underlying immunity is currently unknown.

Learn more: Prof Karim interview | Can you get COVID-19 twice?

Can you strengthen your immune system to protect against COVID-19?

Karim – If you just eat a balanced diet with all your food groups you do not need anything else. None of the tablets or supplements which companies are trying to sell you work. Your normal immune system is good enough.

Learn more: How to boost your immune system

Is COVID-19 herd immunity achievable and a good strategy?

Karim – From the start we knew the strategy to achieve herd immunity was problematic. This is partly because we don’t know whether a person can be re-infected. Even if we assume you cannot get COVID-19 twice, you still need between 60% to 70% of the population to get infected. This equates to 40 million people in South Africa, which is not a real prospect or strategy.

Learn more: COVID-19 herd immunity article

What is South Africa’s strategy to deal with COVID-19?

Karim – South Africa’s strategy is to deal with the first wave and with enough prevention measures we hope it is not too big. After that we will fight off little outbreaks with localised lockdowns. This is in the hope that there will be a vaccine in the next 18 to 24 months.

Learn more: SA Government COVID-19 info

When will we get a vaccine?

Karim – We hope to get a vaccine by the end of 2021 or early in 2022. There is, however, no guarantee we will get a vaccine. We have never created a vaccine against a coronavirus before.

Madhi – If the clinical trials are successful and the regulatory authorities expedite approval, a vaccine can become available in September or October 2021. The end of the next year is therefore the earliest at which a vaccine which is registered and approved for use will become available.

Learn more: COVID-19 vaccine trial details | Prof Madhi interview

How much contact with a COVID-19 positive person is needed to have to self-isolate?

Karim – There is no scientifically valid number, but as a guideline you should be considered a contact when you have had over 30 minutes exposure to a COVID-19 positive person. Between 15 and 30 minutes is a grey zone, and below 15 minutes is regarded as not adequate exposure.

How long should you self-isolate after contact with a COVID-19 person?

Karim – The guideline is currently to self-isolate for 14 days, but we are looking to change it to 8 days after new evidence emerged. It should be noted that if you do not display any symptoms after 5 days you can resume normal activities. In summary – 5 days in quarantine as a suspect with no symptoms, and 8 days of isolation if you have the infection.

When do you know you have recovered from COVID-19 and can stop to self-isolate?

Karim – From the date of first onset of symptoms – a sore throat, headache or fever – you can count 14 days and you are recovered. You do not need a negative test to come out of quarantine.

There are reports of possible long-term brain damage because of COVID-19. How serious is this concern?

Karim – The virus causes inflammatory changes which result in a swelling in the brain and occasional bleeding, similar to a mini-stroke. This usually reverts in time, but in some cases the damage may be permanent. This is currently only a caution (no need to panic yet), and more research is needed into the issue.

Madhi – COVID-19 causes multi-organ dysfunction because of clotting in the blood vessels. These small clots disperse through the body and cause problems in the microvascular system. The virus also causes an immune response which in some cases can be overzealous and inadvertently result in damage in surrounding tissue. This damages organs and leads to multi-organ dysfunction.

Learn more: Prof Karim interview

Now read: Load-shedding can have devastating effect on work-from-home

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South Africa’s COVID-19 questions answered – Airborne transmission, re-infections, long-term brain damage, and the country’s current plan