Subscribe to our Newsletter


click to dowload our latest edition

In the race against COVID-19, vaccination just the first lap

Published

on

OP-EDS

About 200 years ago, the Torah giant, the Tiferet Yisrael (Rabbi Israel Lifshitz – 1782 to 1860) exhorted his followers to be vaccinated against smallpox. The sage was meticulous in fulfilling the mitzvah aseh (positive commandment) of the obligation to avoid the much greater threat to life posed by the disease even if the vaccine itself was far from harmless. In those years, smallpox vaccination was a rather hazardous procedure coming with a mortality of close to 1:1000.

It has been ascribed to the Tiferet Yisrael that he drew up a list of non-Jews who ought to be credited with olam habah (a future in the world to come). Top of his list he put the chosid, Yenner, (Edward Jenner) who developed the first human vaccine against smallpox at the close of the 18th century which saved millions of lives down the years. About 200 years later, that virus was eradicated from the planet by global vaccination.

So, where are we now with our present pandemic – the COVID-19 pandemic? What could the future light at the end of the tunnel look like?

Our current travails with the COVID-19 pandemic are due to a new virus, SARS-Cov-2, introduced into the human population just less than a couple of years back. This is a new pandemic, against which new vaccines were developed at an unprecedented breakneck speed to prevent the resulting new disease. It was a triumph of advanced modern science to develop new vaccines within a year of discovering the causative virus in order to address this formidable new pandemic with urgency. Technologies were employed which had never previously been used for human vaccines. To add to this bewildering mix came the internet and pervasive social media – valuable tools for disseminating important public-health messages, but an equally sinister vehicle for spewing misinformation, conspiracies, and mistrust and, in no small measure, contributing to confusion, anxiety, and, unfortunately, vaccine hesitancy.

So, where do we stand on the eve of Rosh Hashanah 5782 (2021) in controlling the COVID-19 pandemic? As of 24 August (by the time you read this these figures will be quite a bit higher) more than eleven million doses of vaccine have been administered in South Africa with more than 21% of the adult population being vaccinated. Even now, the effectiveness of the vaccination programme is starting to be felt with a small, yet significant, reduction in serious COVID-19 disease and hospitalisation in the country.

What is our expectation for controlling the pandemic with vaccination? It’s interesting that when we look back at the earlier days of the pandemic last year, the scientific community thought that the SARS-Cov-2 virus was as menacing as any new pandemic was feared to be, but that it would turn out to be no more complicated than measles or polio to combat and conquer. We hoped, as with measles and polio, that it wouldn’t take long to develop an effective vaccine to conquer this newcomer.

But that was before the virus uncannily demonstrated its ability to mutate and generate new variants which could escape the protection afforded by vaccination. In turn, the Beta variant arrived, which was relatively resistant to vaccines, and after that, the highly contagious Delta variant, which is now also flexing its muscles for vaccine escape.

Common wisdom dictates that infectious diseases can be combatted in four phases. Phase one is the phase of containment. In this phase, the main damage caused by the offending infectious agent is brought under control. In the case of COVID-19, this is the phase reached by Western developed countries. High vaccine coverage has drastically reduced severe disease which, in the pre-vaccination era, resulted in wealthy countries being brought to their knees and unable to cope with the overwhelming number of critically ill patients, and mortuaries unable to keep pace with burying the dead. But, in spite of extensive vaccination campaigns, infection and illness still persist to a worrying degree. Fortunately, in the majority of cases, illness is mild. Where preventive measures are relaxed, as prematurely occurred in many countries such as Israel, the United States, and several European countries, there have been significant flare-ups. Most public-health authorities would accept this to be an interim phase, as restrictive measures still need to be in place to prevent epidemic waves of illness flaring up.

Only in a future phase two, the phase of control, may we contemplate returning to a pre-COVID-19 life. To enter into this phase, a second generation of advanced vaccines would have to be developed. They would need to provide more effective and durable immunity, be able to be effective against any new variants, and also be able to reduce transmission markedly from infected vaccinated persons. For the latter, the new vaccines will need to effect good immunity in the upper respiratory tract – mucosal immunity. There is, indeed, intensive research into developing this next generation of vaccines. In this phase, restrictions may be relaxed to the point of returning to our pre-2020 lifestyle. Infection and illness won’t totally disappear, but it will be at a tolerable level – perhaps much like the common cold or flu we all accept every winter season.

Phase three, the elimination phase, has been reached with a number of vaccine-preventable diseases. In this phase, infection and illness no longer occur in many parts of the world because of successful vaccination campaigns, although it remains present in other regions of the globe. Examples are polio, measles, and a number of other childhood infections. This phase cannot yet be contemplated for COVID-19. Our best expectation would be to enter into phase two, the control phase.

The ultimate phase four, the eradication phase, has been achieved only with one infectious disease – smallpox. About two centuries after the chosid, Jenner, invented the smallpox vaccine, and following unprecedented vaccination campaigns in every corner of the world, the disease and the virus were finally eradicated in 1980, and the virus formally declared to have been purged from the planet.

Meanwhile, let’s try make the present phase, phase one of COVID-19, as successful as possible. Get vaccinated, and continue to maintain all infection-prevention measures religiously so that we can safely look forward to phase two – maybe some time next year?

  • Barry Schoub is the chairperson of the Ministerial Advisory Committee on COVID-19 Vaccines. He is professor emeritus of virology at the University of the Witwatersrand, and was the founding director of the National Institute for Communicable Diseases. He writes in his personal capacity.

Continue Reading
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

OP-EDS

Omicron: hoping for a storm in a teacup

Published

on

An avalanche of panic calls, contact questions, and quarantine-bound disappointed families was certainly not what I expected in the last week of November. I have, once again, awoken this morning to a stream of positive COVID-19 test results.

Every day this week has been similar. This after a month of not a single COVID-19-positive result detected through my practice.

COVID-19 has been described as a pandemic of disease, economic challenge, and patient anxiety, and it’s always that anxiety that we, family medical practitioners, have grappled with at the start of a new wave.

This community anxiety is applaudable because it reflects the deep respect that this virus has gained. The trauma our community has experienced over the past 22 months has scarred us. It’s this deep respect that, in fact, propels our community to contain COVID-19 outbreaks and directly act to save lives now.

However, anxiety needs to be transformed into evidence-driven knowledge to be productive. Knowledge empowers patients to make informed choices about socialising, travelling, and even the symptoms to look out for in their bid to keep safe and still live “normally” during a COVID-19 surge.

Imparting this knowledge is the most time-consuming occupation for my GP colleagues and myself at the moment. We have, once again, invested deeply in responding to every question, sharing sound information, and finding innovative ways to educate our community appropriately.

The mental fatigue from the formidable task of caring virtually for dozens of COVID-19-positive patients is balanced by the sense of worth in making a dent in this pandemic.

I recognise that as much as long workdays and being a distracted father may not be the best input I could give my family now, these efforts may truly assist a large number of other families to get through this unexpected twist at the end of this challenging year. Each of the GPs in our community has expressed similar sentiments.

The COVID-19 sky isn’t so dark this time round. We’re familiar with managing COVID-19 at home. I think back to June 2020 with its grocery sterilisations, runs on hydroxychloroquine, debates about whether masks actually matter, and even COVID-19-toe queries, and realise how far we’ve come.

We now know what evidence-based vitamin regimens to give patients early on in the disease. We know how to track their vital metrics at home. We know what signs of deterioration to look out for, and we have a good idea how to prevent the spread of infection.

The Omicron finding has been trying. We are now dealing with an “extra-novel” coronavirus. Virologists have warned that with more than 50 new mutations, more than 30 of which are on the spike protein by which the virus enters the human cell, we can predict serious disease and a resultant escalation in hospitalisations and death.

The thought of once again conducting midnight rushes of hypoxic patients to hospital, running daily blood tests on serious patients at home, and counselling patients after regrettable losses is overwhelming.

However, our experience this week on the ground has been the saving grace so far. Our community is largely vaccinated, unlike the majority of South Africans who unfortunately aren’t.

Amidst all the speculation as to whether vaccines work against the Omicron strain, we are seeing vaccinated patients easily contracting COVID-19, even if they have had a previous infection in the past three months.

Thankfully, though, they aren’t becoming particularly ill.

Although routine COVID-19-positive swabs aren’t undergoing genomic sequencing to establish whether or not they are the Omicron strain, the massive uptick in cases with a concomitant community finding of a new variant suggests they are.

The juxtaposition of these facts implies that either Omicron is, in fact, mild, or that vaccines are, indeed, protective. It’s too early to predict that this surge of Omicron will be mild, but if you are a clinical optimist, the prospects are looking good.

I have experienced a flood of questions this week requiring a recap of the basic facts.

* Exposure to a COVID-19-positive individual still requires a 10-day quarantine. A negative test at five days doesn’t shorten that time;

* Exposure is defined as contact within two metres. Masks are protective, but in closed environments, masks don’t obviate the need to quarantine unless the exposure is both outdoors and distanced;

* There are no new novel treatments for early COVID-19 infection. Vitamins remain the mainstay of early treatment, and steroids are largely contraindicated in the first week. (Regeneron, molnupiravir, and ritonavir are all new effective treatments for early COVID-19, but aren’t yet available in South Africa.);

* Isolation for infected patients remains 10 days;

* Secondary contacts don’t need to quarantine; and

* Vaccinated individuals who are exposed to positive patients need to quarantine as well.

I believe the next two weeks will be the most telling time for our community in this pandemic thus far. We have all worked tirelessly to get ourselves vaccinated, and we are desperate to continue our former lifestyles, even alongside COVID-19.

I’m filled with optimism, and hope that for those of us who have been vaccinated, the worst of this new strain of COVID-19 will be a disruption of our holiday and perhaps the experience of a contagious flu upon some of us.

However, until we know more, and while so many of the South African population is unvaccinated, it’s vital that we pull up our masks, socialise safely, and test appropriately over this peak.

I look forward to the next relaxation of these measures, a population greater vaccinated, and a less daunting situation next year.

Continue Reading

OP-EDS

After all the bad news, the economic outlook is still positive

Published

on

The legendary New York Yankees’ catcher, Yogi Berra, renowned for his paradoxical axioms, was attributed as saying, “It’s like déjà vu all over again.” Just as infections and hospitalisations were falling and we were beginning to delight in the pleasures of our former lives, along comes news of a new COVID-19 variant that has put an abrupt halt to our holiday plans.

At this point very little is known about Omicron – the name given to this new mutation. Apparently, it’s fast spreading, but other than that, we don’t know whether it’s dangerous and if our vaccines are sufficiently effective to fight it off. And as we have witnessed in the past, no one is hanging around to wait for the answers. While countries have slammed shut the doors to travellers from South Africa, in financial markets some investors, fearing a resumption of harsh social and economic measures to contain the spread of this new variant, have abandoned equity and commodity markets, seeking safety in the US dollar and US government bonds.

The past two years have been difficult for us in many respects, from worrying about our physical and mental health to being concerned about our relationships, our jobs, our businesses, and our families. From the outset, medical experts warned that it would take years of effort before the virus was tamed and relegated to nothing more than a commonplace flu. The good news, though, is that while things still seem bad, they’re getting a little less bad each day.

The pandemic caught the world off guard. Healthcare systems were inadequately equipped and organised to handle the load of wide-scale hospitalisations, COVID-19 testing, and vaccine rollouts. It could have proved to be a moment for global cooperation but, instead, each country acted on its own, protecting its borders and looking to develop its own remedies. Developed countries did little to safeguard less developed countries or share vaccines with them. Yet again, the latest outbreak demonstrates that until the whole world is vaccinated, no one is safe.

In response to these failings, vast amounts of money are being invested in global healthcare. Several new vaccines and drugs to treat chronic diseases will be released next year. Innovative genetic therapies – aimed at curing diseases by modifying or removing human genetic information – are finding their way to market, together with pioneering robotic surgical devices and groundbreaking diagnostic tools.

While domestic politics uncaringly controlled how countries chose to fight the pandemic, encouragingly, central bankers and governments took appropriate action to address the negative impact of an economic shutdown, pumping liquidity into the market, slashing interest rates and providing financial support to businesses and individuals. Also, recognising that the recent crisis was a health crisis and not a financial one, the world economy is favourably positioned to work its way back to prosperity. Corporate earnings are above their pre-pandemic levels and individuals, flush with savings hoarded during lockdown, are eager to splurge.

The pandemic has changed our behavioural patterns, and even when we return to normality, the way we go about our lives, jobs, and relationships will never be the same. The pandemic brought forward the future. It accelerated our use of technology, from video conferencing to online shopping. It fast-tracked our adoption of technology to levels that had not been expected for years. In a matter of a few weeks, we were propelled five years forward. Yet more than anything, the pandemic burned our consciousness about the world in which we live, stirring us to build a new order rather than trying to return to or repair yesterday’s ways.

You can sense this in political calls for wealth redistribution and environmental action, and in society’s push to embrace gender and race equality at home, in schools, and in the workplace. Governments, eager to achieve net-zero carbon transition, are fast introducing legislation to penalise consumers and businesses that breach accepted pollution and emission standards. The path to clean air has become one of the most significant investment trends at present, opening appealing opportunities in renewable energy and carbon reduction solutions.

The drive to fight climate change has engulfed the motor industry that’s now riding a wave of exciting electric car strategies. Mainstream manufacturers cannot abandon petrol and diesel production altogether, but almost all are targeting all-electric output by 2030.

Electrification is not only the dominion of the motor firms but a big theme for the producers of semi-conductors and batteries too. It’s estimated that between $2 500 (R40 354) and $3 000 (R48 425) worth of computer chips will be embedded in each new-generation motor vehicle, while the challenge facing the battery industry is to reduce the size and weight of batteries and, at the same time, double its output and power. The need to secure metals essential for the manufacturing of batteries is a further demand. Apparently, a passenger vehicle battery requires 20kg of nickel, 20kg of cobalt, and 60kg of lithium compounds.

Besides possibilities arising out of the need to control our environment, the transition to automate business processes, boost efficiencies, and improve the quality of strategic decision-making will continue to spur investment spend. Disruptive technologies such as artificial intelligence, the use of big data, cyber security, and the rollout of 5G will remain dominant themes for at least the next decade. The downside to these enabling technologies is that with the number of connected devices growing rapidly, the hazard of online attacks has increased significantly.

Despite the odd setback, conditions in the world economy are improving. The success of the vaccine rollout backed by huge stimulus has enabled economies to open up. People are returning to work, socialising, spending, and getting their lives back. The erratic nature of the recovery has caused imbalances that will need to work their way through the system. These imbalances have manifested themselves in higher prices, especially in energy and labour, and until these are ironed out, interest rates will remain lower for longer. The economy that emerges from the pandemic will not be like the one we left behind, but that opens the way for attractive investment opportunities. The outlook for 2022 and beyond is encouraging.

  • David Shapiro is a veteran stockbroker, market commentator, and deputy chairman at Sasfin Securities.

Continue Reading

OP-EDS

The Stockdale Paradox has lessons for locked-out South Africans

Published

on

By

*Trigger warning: This opinion piece references domestic abuse.

What do you call it when you’re dependent on someone and feel you can’t escape them? What is it when you’re being controlled and beaten down daily and locked up, having done nothing wrong? When your only crime was to simply be in the wrong place at the wrong time, and yet you feel like you’re being punished in inconceivable ways.

Ongoing isolation from those you love and being made to feel like nobody wants you has become a part of daily life. Locked away, you obsess over ways to escape. When you do, you find another gate is there to keep you ‘secured’. You try everything. Resources are all but consumed by your battle for escape. Your family are begging for you to get to them, but you’re cut off with what feels like no hope.

Every day you look through the bars at others who somehow made their escape and yearn for your day to come. Gradually more and more break free.

Your anger diminishes as you focus on the freedom that lies ahead as your day seems to be approaching. Excitement builds.

You try to suppress that nagging warning at the back of your head reminding you that this isn’t the first time you’ve felt this close and that you need to step cautiously. And just as you’re ready to step out, the door slams loudly in your face. You run to another door, but it was double locked before you got there. Even the back door clangs shut as you speed towards it. You’re desperate.

You beg and plead, but no one seems to hear you. As the lights grow dim, you sit in the corner depleted – deathly afraid to try again. What’s the point?

This is what it feels like for many stranded in South Africa at the moment. This is what they have been and are again being subjected to.

When I was made aware on Wednesday morning of a new variant of the COVID-19 virus sequenced by South African scientists, I immediately called a few volunteers to warn them of the possibility that South Africa was about to feel the backlash. But never in my wildest imagination did I expect it to be within a matter of hours and with such intense escalation.

Since the first news of a country closing its doors to South Africa came that evening, my phone has not been quiet. The speed at which countries jumped on the banning bandwagon is unprecedented, even since the pandemic began. All sense of logic seemed to vanish instantaneously and what was put into action is what I refer to as the ‘vicious 3-Ps cycle’.

I have to believe that South Africa’s scientists had good intentions. Perhaps they didn’t realise the power of sharing their discovery. But when the 3Ps take over, there’s no stopping them.

The PRESS

The PANIC

The POLITICIANS

Each dangerously feeds the next. The press uses this news to grow their readership, exercising their global online reach to create, eagerly selling more advertising space.

The now anxious global citizens implore their governments to keep them safe from the ‘scary variant’ they actually know little about.

Enter the politicians, many previously feeling the backlash from their voters blaming them for not having dealt rapidly enough with the Delta variant. They spring into banning action. There’s no time to reason and little to no logical consideration.

The press grabs hold of the fast-acting bans and race to cover them, creating more fear. The more experts try to engage with world leaders and reason with them over the fact that this isn’t exclusive to our country and is already found around the world, the more political heels are dug in for fear of losing face and votes.

Panic builds within South Africa. The press eat it up.

Everyone needs to step back, calm down, and take a strategic pause. There is a solution to navigate all this.

The best approach for most is to heed the Stockdale Paradox, so termed by Jim Collins, which highlights the incredible benefit of maintaining unwavering faith that, in the end, you will prevail in spite of the current struggles, but simultaneously remain cognisant of the harshest reality.

When Admiral James Stockdale was asked how he survived the torture of the ‘Hanoi Hilton’ war camps during the Vietnam War, not knowing when it would end, he answered, “I never lost faith in the end of the story … I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I wouldn’t trade.”

He noted that the men who didn’t make it were the optimists’. They were the ones optimistically setting deadlines for when they felt it would end. Deadlines that continued to be made and missed. “And they died of a broken heart.” Stockdale’s approach was, “We’re not getting out by Christmas. Deal with it.”

Unfortunately for many, deadlines are an obvious requirement when it comes to booking tickets and planning our travel abroad. But if we learn from Stockdale and his paradox, we would plan our journeys in pencil for now, keeping our eye on the inked, highlighted, and underlined goal of the destination and reunions. The time will come. It did before. And we will prevail. It’s just a matter of when and how.

Community Circle Home SA has been incredible throughout the pandemic but even more so in recent days, holding space for each other and providing updates and compassion. As I proudly watched the Facebook group grow by thousands this week, I wish it was for better reasons, but overwhelmingly grateful that we have a space that can guide those stranded and support them within the circle. We will help you navigate this. We will guide you to your goal and help make reunions a reality.

Kim Kur is the founder and lead volunteer of Community Circle Home SA.

Continue Reading

HOLD Real Estate: Here is what you need to know about getting a mortgage in Israel. Read the full article here:

Trending