As of 22 June 2022, numbers of SARS-CoV-2 infections continue to decrease in South Africa, following the recent resurgence associated with the emergence of the Omicron BA.4 and BA.5 subvariants in South Africa. While numbers of cases and percentage testing positive did increase in this resurgence, the decoupling of numbers of hospitalisations and deaths from cases, first observed in the Omicron BA.1 wave continued.
Substantially lower numbers of hospitalisations and deaths were observed in this resurgence compared to any previous wave including the Omicron BA.1 wave. High levels of population immunity are likely a major contributor to the reduction in the burden of severe illness and death in South Africa, with a recent study by the South African National Blood Service estimating that 98% of South Africans have detectable antibodies to SARS-CoV-2. These antibodies are a result of infection, vaccination or a combination of the two.
In the context of high population immunity and lower disease severity the decision has been made to lift the COVID-19 regulations implemented as part of the National State of Disaster. However, it is important to keep in mind that SARS-CoV-2 will continue to circulate in the community, and therefore the potential for new variants or subvariants to emerge, and in turn cause surges in the number of cases exists. Therefore, continued monitoring of the SARS-CoV-2 trends and changes in early warning system indicators is important.
The National Institute for Communicable Diseases (NICD) will continue to monitor the trends in the number of SARS-CoV-2 tests performed, the positivity rate, and the number of cases. In addition, the trends in COVID- 19-related admissions and deaths will be monitored through the DATCOV hospital surveillance programme. We will also continue to monitor levels of SARS-CoV-2 in wastewater. Should there be any trend in these data suggesting a potential resurgence, the National Department of Health, NICD and others will be alerted to the early warning signals from the above surveillance programmes, and take early action to inform appropriate public health response.
Recommendations for control of COVID-19 following the lifting of COVID-19 regulations
Vaccination is the most effective method for preventing and controlling severe COVID-19, and people eligible for COVID-19 vaccines must get vaccines and boosters as indicated in the national programme. A South African study found that among individuals vaccinated with the Ad26.COV2.S (Johnson & Johnson–Janssen) vaccine, the vaccine effectiveness against hospitalization for COVID-19 was 74% (95% confidence interval [CI], 57 to 84) at 14 to 27 days post vaccination, and 72% (95% CI, 59 to 81) at 1 to 2 months.