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South Africa – or why I think the pandemic is not over

Sunrise over the savanna and grass fields in central Kruger National Park in South Africa

South Africa seems to be entering their fifth COVID-19 wave, driven by the new Omicron variants, BA.4 and BA.5, compared to the “original” variant BA.2.


Worth comparing where South Africa is with the UK. Here are the reported cases:

It is worth keeping in mind that these are reported cases, so liable to be highly dependent on testing. So, it does not mean South Africa has been so much less affected by COVID-19 than the UK – simply they test less.

It also does not mean there so few COVID cases in the UK in 2020 than in 2021 and 2022 – testing has changed remarkably over these two years. A better – but still not ideal – measure of epidemic intensity is the share of positive tests:

This looks very different – and shows the recent SA growth in perspective. But it also shows that the UK is now pursuing a very different pattern to SA – instead of “boom and bust”, we have had an almost constant – even slightly increasing – levels of COVID-19 since June 2021.

Interestingly, excess deaths show the power of vaccination (and possibly also Omicron being inherently less damaging), as the waves of deaths are getting smaller and smaller in comparison to the earlier, 2020 and early 2021, ones, whereas the number of cases – in both SA and UK are of similar amplitude.

Two lessons from the graphs above. Firstly, SA was supposed to reach herd immunity by the “natural” (as opposed to “vaccine”) way several times over the last 2 years. It might have been a case at some point, but the new variants quickly made this route unrealistic.

The vaccination levels in SA are low compared to the UK which might explain why we see the “boom and bust” rather than the “endemic” route:

Secondly, the pandemic is still not over. As mentioned at the beginning of the Omicron wave, the connectivity in the world is such that what spreads in South Africa, spreads in the world. Indeed, BA.4 and BA.5 are already everywhere.

In a sense, both SA and UK are now in an “endemic” phase, as we “learn to live with the virus”:

but the “endemic” can mean different things (although I am not sure why Dr Fauci’s assessment is called “upbeat”).

For some countries – perhaps those with high vaccination levels and low stringency – it will mean a constant stream of cases with relatively low deaths. For others – those with low vaccination levels or continuing stringency – it will mean “epidemic” i.e. large-scale outbreaks separated by relatively low periods.

However we call it, “pandemic”, “epidemic” or “endemic” – COVID-19 will be with us for quite a long time.


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