Lifting of mask wearing too early dangerous for SA, warns epidemiologist

While calls to scrap masks grow following approved changes to the level 1 lockdown regulations, experts say the mandatory wearing of masks in public should remain in place, as South Africa was not out of the woods yet.

According to epidemiologist Dr Jo Barnes, should another variant appear, it would be even more problematic to get the population to go back to wearing masks.

Lifting control measures too early may leave the country in a worse situation than before and with a population that might be more reluctant to cooperate with the authorities.

“I am concerned about the strong calls to scrap mask-wearing. There is another subvariant of omicron in Denmark, called BA.2, spreading fast,” Barnes said.

“We do not know whether this subvariant is more dangerous than the original omicron variant. Should that be, then all the changes to the rules may have to be reconsidered or repealed.”

Barnes also said another concern was the isolation of cases are now solely managed on the presentation of symptoms.

“We know that a sizeable portion of those who get infected show no symptoms at all, but they are still able to pass on the infection,” she said.

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“We know that breakthrough infections occur with omicron, infecting those who had immunity from earlier variants.

“So, counting those with earlier infections as protected may be problematic,” Barnes said.

“So, looking at the new rule with that in mind, then simply isolating those with symptoms will allow a number of people who are unaware that they have Covid to mix freely with others and pass on the infection.”

National department of health spokesperson Foster Mohale confirmed nonpharmaceutical interventions remained in place such as mask-wearing and hand hygiene or sanitising were still mandatory.

“We can go back to normalcy as long as more people vaccinate in numbers and continue to observe protocols,” he said.

“Where it is possible to maintain social distance, we encourage people to maintain it and reduce the chance of transmission.”

Public health medicine specialist Dr Atiya Mosam said given the way that Covid was transmitted, mask usage should still be in place and social distancing should not be forgone as a way to decrease exposure, especially by someone who was symptomatic and unaware that they were infected.

“This is being signalled in the latest guidelines, which places emphasis on the symptoms and therefore the transmissibility,” Mosam said.

“Given that the aim of vaccinations is to decrease the severity of the disease, therefore it shouldn’t be seen as an alternative to mask-wearing and social distancing; and should be seen as an adjunct measure to protect ourselves.”

Vaccinologist Prof Shabir Madhi said the adjustments were a correct way to proceed in context of where the country was with population immunity against severe Covid and unable to prevent infections.

He said there was little value in wearing masks in outdoor spaces, with the recent adjustments they should still be considered in indoor spaces.

“Especially people at high risk of severe disease even if vaccinated, but then the right type of masks need to be worn,” Madhi
added.

“Only a minority of asymptomatic [people] would be diagnosed. From a public health perspective, having less than 5% of asymptomatic infections being in isolation does not contribute much to limiting spread of the virus.”

University of Pretoria senior lecturer Prof Elize Webb said based on the reported numbers to the National Institute for Communicable Diseases that SA had passed the fourth wave nationally, the cost of contact tracing and the self-isolation of people who have been in contact with a SarsCoV-2 positive person was too costly for the country.

“The pandemic had huge financial implications and also human costs and we have achieved quite a high level of herd immunity – my estimate is that we now have between 60 to 80% population immunity in SA to the coronavirus.

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“We probably do need a large antibody screening study to prove the correct proportion. But the omicron variant is both highly in infectiousness and low in virulence – and not as deadly as previous variants and people are better
within three to five days.”

Prof Mosa Moshabela, deputy vice-chancellor of research and innovation at the University of KwaZulu-Natal, said he had mixed emotions about the adjustments. He was mainly concerned that they were not responding to the general public.

“We have been educating the public in a certain way around how to deal and understand this infectious respiratory viruses and I feel like this is giving the population the impression that being asymptomatic and infected is not a problem,” he added.

“The fact that they do not have to isolate is not a good massage to the public and in that way, the message is very poorly constructed and unfortunately the message is not designed for the general public but for the workforce.”

– reitumetsem@citizen.co.za