South Africa is up to number 15 in total case numbers. During the holidays, many people may have experienced either being infected with Covid-19 or exposure to someone who may have it. Here are some facts to be aware of as we navigate through 2021.
How does the new variant affect us in SA?
The new variant of Covid-19 has mutations on its spike protein and appears to be the dominant strain circulating since at least early December. It is reported to be up to 40% to 70% more transmissible than the old strain (in other words it can be more easily spread), but at this stage, it has not been proven to be more dangerous or to cause more severe illness. Coronaviruses naturally mutate and the management of the virus remains the same.
What is the new SARS-CoV-2 variant?
This new variant of the virus was discovered through routine genomic surveillance of SARSCoV-2 performed by a network of laboratories around the country (Network for Genomic Surveillance South Africa, NGS-SA). Work is being done to understand what effect these mutations have on the behaviour of the virus and our body’s response to it – particularly whether it makes the virus spread more easily, whether it might lead to more severe COVID-19, and whether the virus can evade our immune response.
Is the new variant associated with an increase in the severity of the disease?
At this stage, there is no clear evidence of the new variant being associated with more severe disease or worse outcomes, but clinicians are undertaking more studies to establish if this new variant does change the course of the disease.
Where did this new variant come from?
SARS-CoV-2, like all other viruses, mutates as a natural process. The new variant will have evolved naturally.
Will the PCR tests be able to detect the new variant?
The current PCR tests employed by South African testing laboratories will detect the mutated SARS-CoV-2 lineage.
Will the antibody test be able to detect it?
Antibody tests detect response to the virus, not the virus itself. It is likely that the antibody test will perform in same way. Note antibody tests are not used for diagnosis of patient with suspected COVID-19 infection.
Do these changes in the virus change the way the virus is spread from person to person?
No, they do not. The virus still has the same proteins and the same way of entering the body and causing illness. The virus will still be spread by droplets and by contact with surfaces where the virus has been.
What do these changes in the virus mean for prevention measures like social distancing, mask wearing and sanitising?
Prevention measures like social distancing, mask wearing, handwashing and sanitising remain the best ways of preventing infection. There is no change to these messages and to the actions that we need to take. Rather than relaxing our guard, we need to do all we can to prevent transmission.
Will the new variant have an impact on the effectiveness of vaccines?
It is not currently known whether or not this mutation will impact on the effectiveness of vaccines. More research is needed to see whether or not this is the case, and if the mutation significantly reduces vaccine efficacy further vaccine development will be required.
Some effects that are important to note:
- The mutation allows it to enter cells more easily, making it 40% to 70% more transmissible than the older strain.
- It is spread in the same way by droplets in the air and from contact with contaminated surfaces. Thus, it remains crucial to practicing mask wearing, social distancing of 1.5 metres as a minimum and frequent hand washing with soap and water or sanitising.
- It is still unknown whether the new strain will impact the effectiveness of the vaccine.
National Institute for Communicable Diseases (NICD) has answered some FAQs for those who need to go back to work after testing positive for Covid.
My manager has asked me to re-test before I can return to work even though I have been in self-isolation for 10 days.
At present, re-testing people who have experienced mild illness, and have recovered from Covid-19, is not recommended. A person is considered safe to return to the workplace and discontinue self-isolation if they are no longer infectious. This means they developed their first symptoms more than 10 days prior and have not experienced any symptoms for at least three days (72 hours). However, returning to work is dependent on the patient’s clinical state of health.
Is it a fact that after 10 days you cannot transfer the virus anymore?
The most infectious period is thought to be one to three days before symptoms start, and in the first seven days after symptoms begin. But some people may remain infectious for longer and this is because typically with viruses, the higher the viral load (the more virus circulating in the body), the higher the risk of transmission through known transmission pathways. So, the more severe the illness and the higher the viral load, the longer you continue to shed the virus and are infectious.
If someone with mild disease has been symptom-free for 3 days and they developed their first symptoms more than 10 days prior, they are no longer considered to be infectious.
Do I need a documented negative result to return to work?
If a worker has been diagnosed with Covid-19 and isolated in accordance with the guidelines, an employer may only allow a worker to return to work on the following conditions:
- The worker has completed the mandatory 10 days of self-isolation.
- The worker may need to undergo a medical evaluation confirming fitness to work.
- The worker on returning to work then needs to wear a surgical mask for 21 days from the positive test result while at work and practise social distancing and good respiratory and hand hygiene.
Will the mandatory 10 days of self-isolation be taken from employees’ annual leave or sick leave?
The employee’s entitlement to sick leave is outlined in section 22 of the Basic Conditions of Employment Act. Further guidance on this around Covid-19 is found on page 8 of http://www.nioh.ac.za/wp-content/uploads/2020/06/C19-OHS-Directives-June-2020.pdf.
Should I not be tested negative first before returning to work?
People who have been self-quarantining because they had contact with a confirmed case of Covid-19 and have completed their 10-day quarantine period without developing symptoms, can return to work on day 11. There is no requirement to be tested prior to returning to the work. It is, however, recommended they continue to practise social distancing and good hygiene as a precaution and wear a surgical mask.
Currently, re-testing people who have experienced mild illness, and have recovered from Covid-19 is not recommended. A person is considered safe to return to the work and discontinue self-isolation if they are no longer infectious. This means they developed their first symptoms more than 10 days prior and have not experienced any symptoms for at least 72 hours. There should be a workplace with precautions in place that include social distancing, employing good and hand respiratory hygiene and wearing a surgical mask for 21 days from the date of the test. Medical evaluation may be necessary to determine fitness to do their job.
I have tested negative, but the symptoms are still there … what now?
A patient can have a false negative if they have little virus or perhaps the specimen was taken inappropriately. The test swab did not get up high enough to get to the place where the virus was located. If a patient presents with symptoms of Covid-19 — cough, fever, shortness of breath — but they test negative, they should consult their health practitioner for further assessment.
What if I am still testing positive after four weeks without symptoms?
Patients can remain test-positive even after they are no longer infectious. A positive PCR test does not equate to an infectious, viable virus. Patients may be de-isolated without the need for repeat PCR tests, provided the patient’s fever has resolved and their symptoms have improved. Those with mild disease may be de-isolated 10 days after symptom onset, while those with severe disease may be de-isolated 10 days after achieving clinical stability (for example, once supplemental oxygen is discontinued).
What if I am still showing symptoms after the 10 days? Am I not putting co-workers at risk?
It is common for patients to continue to have symptoms for longer than the above time periods (10 days). Full recovery may take several weeks. Patients who are still symptomatic at the end of their isolation period can be de-isolated provided their fever has resolved (without the use of antipyretics – medicines that reduce fever) and their symptoms have improved. If symptoms are persisting, the worker should seek medical assessment from their practitioner.
I was tested over two weeks ago, and I haven’t received my results yet. Can I return to work?
Suspected Covid-19 cases who have mild disease may be managed at home while awaiting testing, isolated from the workplace. These workers should communicate with their manager and not be at work until they have results. Constant communication with their employer is essential during this time so that the workplace can take steps to manage and clean as appropriate.
Remember: Small actions x many people = BIG CHANGES
Wear a face mask properly over your mouth and nose, frequent hand washing with soap and water, sanitising often and maintaining a minimum of 1.5 meter for social distancing done by all of us = we can beat this pandemic together.
DISCLAIMER: LUTIEK HEALTH DOES NOT PROVIDE MEDICAL ADVICE TO THE PUBLIC. FOR MEDICAL ADVICE, PLEASE CONSULT YOUR HEALTHCARE PROVIDER.