Shabir Madhi
@ShabirMadh
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Professor of Vaccinology @WitsUniversity . Passionate about healthier lives by prevention of diseases through vaccination. Posts are in my personal capacity
Randburg, South Africa
Joined September 2018
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Reflecting on SA experience with Omricon thus far in Gauteng - the epicentre in SA. 1. Rate of increase per capita much quicker than any of previous three waves. Strongly suggestive of more transmissible than even delta. 2. Positivity rate 30-40% in some settings.
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Much awaited excess mortality data for Gauteng. The Omicron wave is at its tail end and excess mortality already on downward trend, and was a blip compared with experienced in the past waves. This is GOOD news and IS a turning point in the pandemic.
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Remember this desperate call for help to save life’s of children. Upholding the Hippocratic Oath and living by a code of ethics sadly lacking in Gvt. In return Dr Tim de Maayer has been suspended by GDoH for speaking out for the benefit of the vulnerable.!
@WitsHealthFac
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One week later and heading into week 5 of Omicron wave in Gauteng SA and outlook remains positive for what matters most - relatively low rates of severe disease and death. Many other provinces now also showing rapid rate of increase, however in Gauteng:
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After much scepticism of SA data, indicative of “unless we say so”, appears that scientists and Governments from high income countries have come around that Omicron causes less severe illness, despite being the most antibody evasive variant. Experience seems to be tracking SA.
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A desperate cry for help from frontline health worker dedicated to the public sector in a neglected facility bearing the name of a struggle icon. A disgrace of how little is being done to address a lingering problem for which there is a quick fix if meaningful governance.
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9. IF downturn in infection rate and no massive surge in hospitalisation and death in the next 2-3 weeks, may well mark turning point in pandemic, particularly since SA not boosting to prevent infection and mild illness like HIC are doing (at cost exacerbating vaccine inequity)
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10. Gvt response correctly remains measured by not increasing restrictions and not panicking with increase in cases, but seem to rather focussing on COVID ( excluding coincidental Ix) hospitalisation and health facility capacity. 11. Lastly, vaccine coverage still lagging.
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Decision to extend SoD in SA indicative of NCCC being devoid of any understanding of the pandemic and flight of fantasy of what needs to be done without any clear goal in mind. Somehow foolishly still believes in being able to prevent infections. Predictable given it’s record
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@paimadhu
@SouthAfricanASP
@MoshabelaMosa
@Tuliodna
@TheLancet
And if you think the travel ban is “Stupid”, even more lost for words in how to describe the Canadian advisory on not accepting PCR test done in SA
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3. Three weeks into resurgence, many adults and children testing SARS-CoV-2 pos in hospital , but COVID hospitalisation remains low relative to community case rate. High % (30%) women in labour coincidentally testing positive. Also,most children testing pos are coincidental Ix.
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4. Death rate very low compared to period of same case rate in previous waves. Trend over next week will be informative, but optimistic unlikely to surge. 5. Study in SA and elsewhere confirm omicron 5 fold more antibody evasive than beta., hence many breakthrough and re-Ix.
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6. Attenuation of clinical course of illness. Likely explanation is the 73% of population in Gauteng with previous infection and/or vaccine induced underpinning T cell immunity, since omicron largely antibody evasive. Hospitalisation for severe Covid mainly in unvacccinated
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8. Health facilities under pressure due to infections in staff, needing to go into isolation for 10’days- despite the isolation (and quarantine) recommendations being outdated and probably obsolete in context of underpinning immunity and widespread infection.
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7. Unfortunate still delay rollout of 3rd Pfizer dose to older than 60yrs and immuncompromised. Little value doing so after the wave has already peaked probably in next 2 weeks. Likewise no 2nd dose for ALL single dose JJ recipients inexcusable with 15 million vaccines in depot.
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NO political party willing to come out with clear stance of mandatory vaccination but want to be elected to “Govern”. Governing entails showing leadership- vaccination only sustainable way to get back to normalcy without adding to the 250,000 lives already lost from Covid in SA!
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At long last coming to grips with the reality. Effective end of Covid restrictions. Now to work on the collateral economic and other damage of what was self inflicted due to stubbornness of not following the science.
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Gauteng Premier announcement of walk-in for COVID vaccine without prior EVDS registration for older than 60yrs to be lauded. Removes obstacles to expedite vaccination, including facilitating greater equity of access. 👏🏽
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Well done to the Medical graduates of 2023 at Wits. Wits for GOOD. Once a Witsie, always a Witsie. Wishing you well in your future endeavours and seeing you contribute to the upliftment of Society as a whole, irrespective of borders.
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@PresidencyZA
@HealthZA
@SouthAfricanASP
Apologies long post -suggest do’s and don’t for resurgence Don’t: 1. Indiscriminately impose further restrictions, except on indoor gatherings. If it has NOT reduced infections in past 3 waves, considering 60%-80% people were infected.
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No better way to start 2022 than revel in earlier optimism of being in a new phase of pandemic. Further variants always a likelihood, however, Omicron in SA hopefully a prelude to what to expect moving ahead- death rate only 13% compared to delta wave.
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NDoH extends regulations on masking, gathering and travel- none of which is fit for purpose and regulations full of internal contradictions. Simply stated, regulations that are still focussed on the pretence of preventing infections - which in the SA context have failed dismally
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Forgot to add SOS t
@HealthZA
- there is no time to hold back on boosting people above 65yr, immuncompromised individuals , all adults who only received a single dose of JJ - and do so without creating obstacles . Much more sensible than keeping 17 million doses in the depot!
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Absolutely shocking- Gauteng hospitals running beyond 100% occupancy but the Covid ABT facilities that cost millions are not being fully used due to ??? Is there anyone in the office at GDoH. Things are about to get worse! Below from Jonny Meyers
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1/2 Worse decision SA GVt can make is lockdown re B1.1.529. Would be indicative living pipe dream that lockdowns achieved much in preventing infections in SA. Only prolongs the period of time over which same number infected, as evident with >2/3 population who been infected
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South Africa on cusp of resurgence, after the high infection rate with Omicron- albeit massive decoupling of infections and severe disease materialising. Current resurgence likely due to sub-lineage of Omicron- BA4. What can we expect, now that >80% population have some immunity
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A dignified response by the Palestinian UN representative that cuts to the heart of the deception and lies of the Israeli Gvt and its genocidal actions , as well
as the complicity of many Western Gvt.
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@DrZweliMkhize
@ferialhaffajee
Covid vaccines are actually the much sought after silver bullet to bring the pandemic to an end unless we willing to go through multiple waves of outbreaks . NPIs are important to manage the spread of the virus- but does not deal with the route cause of susceptibility.
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@ProfTimNoakes
Thanks for sharing the insight Tim. Unfortunately I’ve been doing it for 27 years and didn’t get the memo. Now I can become and an overnight expert in Sports physiology and start dispensing reckless advise on nutrition and everything else I’m able to suck from my thumb
@UCT
🆘
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The CHBAH ABT Covid facility has 500 beds ready but only 100 commissioned due to staffing ( unbelievable). Why build something if you can’t staff it! In the meantime there are Covid cases that will spend up to 2-3 days on O2 in chairs at HJH waiting for a bed. Inhumane!
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South Africa’s MAC vaccine strategy summed up in a nutshell
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Want to get back to normalcy- encourage everyone to get vaccinated. and expose irrationality and lies of anti- vaxxers l. Below the tales of UK and SA demonstrating power of vaccines in reducing death to a fraction. PS! UK does 14x more testing than SA. Courtesy J Myers.
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the ongoing unmasking of the genocide by Israel . There are many issues and challenges to deal with in SA, but being on the right side of history in relation to not being silent and complicit in the genocide ain’t one of them.
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Health Care Workers and Wits joint staff at Helen Joseph Hospital voicing plight on behalf of patients and others dependent on public health sector in Gauteng. Gauteng health system is in serious need of intensive care. Let’s not pretend there isn’t a crisis, but rather fix it.
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The political theatre of the UK's travel ban on South Africa - The Lancet
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Only
@Zapiro
is able to encapsulate the reason for level of debate on Twitter from some quarters . Thank you!
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So as SA heads toward tailend of the Omicron wave, recalibration of response to the pandemic and clarity of goal should inform the urgently required recovery plan. Variants likely to continue arising, and ongoing vigilance on severe disease required. Wishing 2022 is a new dawn🙏🏿
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Hated the sound when I worked in ICU for 10 years - difficult to comprehend how nurses and doctors have coped with this ongoing beeping of death for the past 18 months . We can make a difference by getting vaccinated - simple 1,2,3…
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How is it that what was so common under apartheid rears it’s ugly head again- at a time when SA is considered to be a middle income country. An indictment of inequity fuelled by incompetence of Government. Not white monopoly capital- but simply incompetence to deal with basics
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SA vaccine rollout - unfortunately this graph says it all. And to be clear , it’s not only about vaccine nationalism, but poor decisions that we’re made. There should be consequences as thousands more life’s will be lost from Covid in the next few weeks.
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Results from PHE in UK on Pfizer and AZ against alpha and delta. After 1st and 2nd dose vaccine effectiveness against delta Covid hospitalisation 94% and 96% for Pfizer and 71% and 92% for AZ.
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1. Wave of Covid cases has peaked and on a downward trajectory already. Peaked 4 weeks after onset , compared with peaking at 8 weeks after onset in previous 2 waves. Has peaked at same positivity rate of 38%, but at lower case rate per 100000 than delta.
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In summary, outlook still optimistic for uncoupling of case and severe disease rate in setting such as Gauteng with high force of past infection (70% in older than 18 yrs), and 45% older than 50yrs ( group with 80% previous deaths in SA) with 2 Covid vaccine doses.
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Sign in support for the immediate reversal of a frankly idiotic decision.
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Thanks
@zapiro
probably a blindfold over his eyes to demonstrate blindness to science also merited? Don’t think he actually read any memo, certainly not the G20 minutes based on CR comment.
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Despite delta being more transmissible than previous dominant variants in UK, 3rd wave was lower magnitude even with relaxing restrictions. Notable was unhinging of death rate and case rates. Why? Vaccination of >85% adults. In contrast SA(WC)- Courtesy J Meyers
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@alanwinde
Thanks for showing some responsible leadership. How wonderful if the same could be said for the rest of the DA “leadership” Any plans to hold the Chair and party “leader” to account? Being open minded is different to entertaining lies and deceit.
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PLEASE consider doing the following. 1. Ensure health care facilities are prepared , not only on paper- but actually resourced with staff, PPE and oxygen!. There are 2000 interns and community service doctors waiting for their 2022 placement confirmation. It’s one month away!
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8. Do learn to live with the virus, and take a holistic view on the direct and indirect effects of the pandemic on livelihoods. 9. Do follow the science and not distort it for political expediency. 10. Do learn from mistakes of the past, and be bold in the next steps.
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@DrZweliMkhize
To be clear- vaccines are the only option to bring the pandemic to an end within 2021. But certainly not if the plan is only to get enough vaccine for 10% of the population! Hopefully the above is an out of context quote - because If not - SA is in much deep trouble.
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would be wise to use these and provide all single dose JJ adult recipients a JJ or Pfizer boost, and those > 65 or immunosuppressive conditions an additional Pfizer dose if received 2 doses >5 months ago . Let those who willing to be vaccinated benefit.
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So MAC sensibly advises lifting of restrictions on size of indoor and outdoor gatherings, and confirms that physical distancing useless- yet somehow “we guided by the science” ignores MAC recommendation from mid-Feb 2022
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Data from SA and U.K. confirm antibody evasiveness with VE for Pfizer 30-34% against Omicron infection. Pfizer x 2 report 70% VE against Omicron hospitalisation. Probably could have higher VE if boosted older than 50yrs and immuncompromised. Pity bureaucratic delays in SA.
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The inability of rational thought for this shambolic turn of events is simply ludicrous. The next step needs to be dissolution of the NCCC, so that parliament can start exercising oversight on such matters. Current state of Covid does not merit ongoing state of disaster in SA
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Latest excess mortality, with 1 week delay relative recorded deaths. Both on downward trajectory . Since start of pandemic, approx 50% Covid deaths occurred during delta wave and under 5% during omicron wave . Decoupling has taken place, with -73% population immunity
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@CyrilRamaphosa
To help with the decisions- type of 😷 used in SA have NOT protected against infection. Physical distancing does not protect against virus mainly spread by airborne route. Restrictions on outdoor gathering size non-sensical. The SA regulations have failed to prevent infections
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Gauteng, original omicron epicentre on steep downward trend, as rapid as was the increase. Recorded death rate crept marginally up and probably for another week, but less than 10th of peak of previous variants and at interweave rate. Image credit Jonny Myers
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2 Hospitalisation rate in Gauteng seemingly plateaued at one third of where delta peaked, although cases in hospital include coincidental infection. May explain shorter stay ( 3.5 d) than before (8d). Unclear if mainly causing bronchitis vs LRTI ( re lab experiment)
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2. Do provide booster dose of JJ or Pfizer to ALL adults who received a single dose JJ- it’s needed to increase protection against severe Covid. 3. Do implement vaccine passports for entry into any indoor space where others gather, including places of worship and taxis!
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@pieterstreicher
@MRCza
There is NO need for children to still be wearing masks in schools. Besides them usually not wearing it correctly( which is very uncomfortable for prolonged period) most of the time, the type of masks they use provide little protection in preventing or acquiring infections.
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Simply stated, SA remains on its unique mission of rehashing regulations which have unsurprisingly failed to prevent spread of the virus in SA context. All this at the cost of further undermining economic recovery , further harming livelihoods, disrupting sporting events …SOS
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Vaccines ( and past Ix) still likely to protect against severe B1.1.529 Covid even if have breakthrough cases. This was the case for AZ and Beta ( and for other vaccines). Mutations will have less impact on polyepitope T cell responses - mediator protection against severe Covid
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Reflecting on where we are and basis as to the State of Disaster needs to be lifted. Also, what exactly did we achieve with lockdowns. Saves me time to do another tread of why we can get back to normal ASAP. via
@YouTube
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South Africans marching on the right side of history, in support of the freedom of Palestine and against the genocide an ethic cleansing underway by the fascist state of Israel
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Reason for less severe disease probably underlying cell mediated immunity induced by vaccines and more diversely so by natural infection. Despite greater infectiousness and transmissibility, Omicron more adapt in replicating in upper airway could contribute to milder illness
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@mailandguardian
If this is what M&G considers to be “ethical leadership”, time to close shop. No wonder that M&G bordering on verge of closure . A far cry from the M&G I read back in the 1990s. What utter crap.
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3. Although death rate increasing , coming off an extremely low base rate, as dropped close to zero after Delta wave. Current excess death rate 1 per 100,000 (11Dec) lower than the previous inter-wave period prev. Excess Death rate at peak of Delta as 25 per 100,000. Next 2 wks?
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2. Don’t have domestic (or International) travel ban - the virus will disseminate irrespective of this - as has been case in the past.
3. Don’t announce and pretend that people adhere to regulations that are not implementable or enforceable in the local context;
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@AkSafs
@DrZweliMkhize
@ferialhaffajee
Ability of vaccines to impact on the pandemic is directly related to how soon you can get approx 50-60% of the population vaccinated. The narrative should not be the false notion that vaccines are not a silver bullet or won’t bring the pandemic to an end.
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Missed the boat for Omicron despite having ~15 million doses in the depot, and still seemingly no plan to open up a 3rd dose to everyone older than 50yrs in SA.
@HealthZA
rather than vaccine expiring, start the 3rd dose now
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May not hurt the marketing cause, nevertheless, well done to Game on this pro vaccine initiative. In the interest of everyone for private sector to support vaccination.
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4.Don’t delay and create hurdles to boosting high risk individuals - those above 65 yrs and underlying immune suppression. 5. Don’t try selling the herd immunity concept- it’s not going to materialise and paradoxically undermines vaccine confidence.
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Protest today at CMJAH demanding action on the incompetence and corruption that has bedevilled the renovation of the hospital at the cost of lost of 100s of lives. Listening to Mark Heywood describing the manifest corruption in the Province - truly shameless and nauseating.
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SA Gvt correctly advised to abandon contact tracing and quarantine, and not test asymptomatic. Such practices in SA context where testing capacity is limited, with only 1/10th cases identified in 1st place achieves little, more so with underlying protection against severe Covid
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Key issue, accept that we in phase where Covid continues to cause death albeit at much lower rates and start work on a recovery plan from numerous health, economic and livelihoods detrimental indirect effects, more so in LMIC where no spare bandwidth unlike in HIC
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The only reason for higher levels of restriction in SA health faculties are coming under pressure. Even then, needs to be a regional approach, as the resurgence will differ in timing and severity across province, as was the case with the 3rd wave
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Or continue with HIC posturing of need to minimise infections with ongoing boosting and restrictions, neither of which are feasible or pragmatic in LMIC. Deciding on a clear goal as we head into 2022 is key. HIC don’t face same burden of other infectious disease deaths as LMIC.
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Glad that the suspension has been rescinded. Important lessons to be learnt about not shooting the messenger and addressing the root cause of the problem. We need our public hospitals to work for patient care and training of health care workers
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@HealthZA
Why is it so difficult not to confuse the public! You cannot report 500 deaths without explaining that it is correcting for data cleaning, when the NICD on the same day reports 45 deaths. Here is an idea- leave it to the NICD to report on, instead of sowing confusion!
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@DrNeilStone
The naivety of believing that you can avoid importing a Covid variant by red listing a handful of countries, whilst allowing travellers from other nations who directly or indirectly still have travel with the handful of countries on the red list. Go figure !
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South African Population Immunity and Severe Covid-19 with Omicron Variant | medRxiv.
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4. Do continue efforts at reaching out to unvaccInated - including through pop up facilities where people likely to gather. 5. Immediately boost high risk groups older than 65 and other immunosuppressive conditions.
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@SAHPRA1
Allowing politics (and corruption) to distort science has been disastrous in SA response to COVID, contributing to >150,000 deaths. SA needs COVID vaccines urgently, but not by short circuiting the process. SAHPRA needs to continue maintaining its integrity. Well done!
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Upward trend for Covid in 6 of 9 provinces already (source Jonny Myers)- worrisome .
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@ferialhaffajee
@mphophalatse1
Truly disappointing that grab for power comes at cost of excellent leadership. She has done more in a year than I can recall previous Local Gvt doing in past two decades - during which time Jhb deteriorated from a world class African city to a slum of deteriorating infrastructure
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@WitsVIDA
proudly involved in first study to show 82% efficacy (reduced risk) against severe Respiratory Syncytial Virus (RSV) lower respiratory tract infection (LRTI) by vaccinating their mothers during pregnancy with a RSV protein vaccine. Published in NEJM today.
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6. Do encourage responsible behaviour, to avoid re-imposing alcohol and other restrictions to punish all due to irresponsibility on part of a minority. 7. Do monitor bed availability at regional level to help decide on regional action to avoid overwhelming of faculties .
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@HealthZA
an astounding U turning doing away with quarantine and contact tracing, Can only marvel how NDoH once again clutches defeat from the jaws of victory! The reasons why contact tracing and quarantine are futile in the SA context has been detailed
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@Jay_Naidoo
@MarikaSboros
@DrAseemMalhotra
@TheSecretSarah
@SouthAfricanASP
Avoided responding to your misguided “personal truth” about Covid vaccines- premised on misinformation and wilful misguided data interpretation. Calling for debate on misinformation is analogous to a debate whether apartheid was evil or good. Remain in your lane of expertise
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Eagerly awaiting to see how
@Our_DA
pays the price at the polls in the WC for not speaking out against the genocide in Gaza. Well done on your endless effort at self destruction and keeping SA devoid of any meaningful opposition in 2024.
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Seemingly “herd immunity” has been achieved in SA. Embarrassingly so.
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@rid1tweets
Only good thing about the graph is what goes up has to come down- unfortunately at huge cost. Analogous to India ( Courtesy J Myers). Sadly won’t be able to benefit form the AZ vaccine that works well against delta - courtesy of poor decision making.
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Let it be clear, this is a noble cause- which simply should not have arisen. The incompetence and uncaring attitude of Gauteng Gvt defies believe. Needing doctors to buy ingredients to bake bread for patients who otherwise would not be fed in our public hospital!
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A view from the trenches- heartbreaking where we have landed.
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