As Covid-19 cases increase, Dr. Sheri Fanaroff answers questions

By virtue of his work, Dr. Sheri Fanaroff – A self-employed Wits-educated GP with a family office in Johannesburg – has had extensive experience with Covid-19 for more than two years now. Recently, the number of infections has increased slightly and some say that we are on the verge of the fifth wave. Although many people are simply sick and tired of Covid-19 and all the restrictive measures associated with it, Dr Fanaroff warns South Africans to be themselves. In this article, she thoroughly answers questions that may concern citizens when we go this winter. – Nadya Swart

A practical guide to the 5th wave in South Africa

by Dr. Sheri Fanaroff

I have not written an update for some time. Nobody really wants to read about Covid-19 anymore. Covid-19 was a problem in 2020 and 2021. Life needs to go on and we all want to get back to normal. Masks are a fashion item last year, fist pumps have been replaced with kisses and social distance is out of fashion. Parties are happening, theaters have spectators, sporting events have spectators and travel is once again a possibility.

The mild Omicron variant, the population’s resistance to vaccines and previous infections, and the low number of cases following the fourth wave, as well as the “disconnection” of infections and mortality, have rocked us with complacency.

So what happens when South Africa enters the fifth wave, winter weather forces us indoors, the number of infections increases and hospitalizations increase? How do we live our lives but avoid getting sick?

In order to try to optimize what best practices should be and what risks people are willing to take, we need to assess what the current situation is.

1. What is happening in South Africa?

  • In the last two or three weeks, GPs have noticed a large increase in the number of patients with respiratory symptoms (sore throat, cough, headache and congestion). Some of this is positive for Covid-19; some have the flu, some have RSV (respiratory syncytial virus) and some have other respiratory viruses or bacteria. Many people with respiratory symptoms do not test at all because they do not know (or do not want to know) that throat or sinus symptoms or cough may be Covid-19.
  • Despite limited testing, the NICD reports a sharp increase in the number of cases over the past two weeks, and the test’s positivity has exceeded 20%.
  • Genetic monitoring has shown that Omicron BA.4 and BA.5 variants are predominant in most provinces. These are more contagious than previous Omicron strains and have replaced them.

2. What are the characteristics of this strain?

  • Common symptoms we see are sore throat, cough, wheezing, congestion and headache.
  • Fever, body aches and odorlessness are also common.
  • GPs have seen some patients with worse breasts than we experienced in December / January with the fourth wave of Omicron. We also see more patients with elevated inflammation and coagulation signs.
  • There have been more hospital admissions for Covid-19 patients in the last two weeks.
  • However, although hospital admissions to Covid-19 are rising slightly, it is still too early to begin this wave and it is too early to say whether the strain we are experiencing is causing more severe symptoms.
  • We are also awaiting updated data on results in vaccinated versus unvaccinated patients.

3. What is the purpose of testing?

  • Tests are important as they affect treatment, monitoring and behavior.
  • A positive early symptom test means that the infected person can isolate themselves and prevent it from spreading. This could save others from becoming very ill.
  • Knowing that it is Covid-19 as opposed to other viruses or bacteria means that one should monitor closely (especially oxygen levels), rest and treat symptoms appropriately, eg no need to take antibiotics for sore throat as it is likely direct symptoms of the virus but not bacteria.
  • Probably enough to test the index in a family; in other words, if mom has a cough and tests positive, you can assume that when dad and kids have a sore throat and cough two days later, so does their Covid-19.

4. Can I get Omicron back?

  • It is still uncertain how much protection a previous infection provides, but the Sigal laboratory in KZN reported an immune flight with a new BA.4 and Tullio de Oliviera said that “Previous infections with Omicron BA.1 are not enough to prevent another infection with BA . .4 and BA.5. “
  • I and other GPs have seen patients with symptoms and test positive for antibody tests, who had registered Covid-19 as recently as February 2022.
  • The Sigal study showed that immunodeficiency with Omicron BA.4 and .5 is much more pronounced in unvaccinated people; in other words, the resistance of vaccine antibodies was higher than the resistance to a previous infection.

5. Do I need stimulation?

  • Vaccine immunity decreases over time, so it is highly recommended that if you are eligible for the stimulant and the last vaccination was more than 12 weeks ago, that you receive the activation.
  • Vaccination plan reminder: First Pfizer – 21 day intervals to second Pfizer – 90 day intervals to stimulation (either Pfizer or J&J) OR First J&J – 60-day intervals for first activation (either J&J or Pfizer) – 90-day intervals for second stimulation (either J&J or Pfizer).
  • The fourth “extra” dose is currently only prescribed for immunocompromised patients and can be given 28 days to three months after the second or third dose.
  • Adolescents between the ages of 12 and 17 are only eligible for two doses of Pfizer, at 21-day intervals or more, and no stimulation.
  • Children under the age of 12 are not yet eligible for vaccines in South Africa, although vaccines in this age group have shown benefits in the United Kingdom, the United States and Israel.

6. Should I get the flu vaccine?

  • Yes!
  • Influenza is a virus other than SARS-CoV-2 and Covid-19 vaccines only offer protection against Covid-19 and not against the flu.
  • Vaccination against the flu should be done annually. The last two years have seen a very small amount of influenza in the country, but this year we are again seeing the flu and could potentially have a significant epidemic.
  • Influenza can cause significant symptoms of fever, body aches and respiratory symptoms with possible complications. Having a flu vaccine significantly reduces the symptoms and risk of complications, although it may not prevent you from becoming fully infected (similar to the Covid-19 vaccine).

7. What treatment do I need if I receive Covid-19?

  • Treatment is continued with symptoms.
  • Rest is important.
  • Most people just need Panado, throat lozenges, antifungals and cough syrup to relieve respiratory symptoms.
  • Vitamins such as vitamin D, C and zinc can be helpful in boosting the immune system.
  • Many patients ask their GPs and pharmacists for medicines such as antibiotics, Ivermectin, antivirals such as Tamiflu and other medicines; this has not been shown to be effective against the SARS-COV-2 virus and should not be used.
  • Cortisone should only be used when prescribed by a doctor. Your doctor should only prescribe cortisone if the signs of inflammation are elevated and the patient is hypoxic (oxygen saturation is low).
  • Similarly, anticoagulants can be dangerous and should only be used if your doctor prescribes it (usually if a CT scan shows clotting). The AD Dimer blood test may be helpful for at-risk patients to screen for clotting, but is not conclusive as it may also increase due to inflammation.
  • Paxlovid (nirmatrelvir and ritonavir) is an antiviral drug that has been shown to be effective in preventing severe Covid-19 when administered to at-risk patients in the first five days after the onset of symptoms. It is unfortunately not available in South Africa. (There is a study in Johannesburg where Paxlovid is used but patients who have received a Covid-19 vaccine in the last 12 months are not eligible to participate – patients are blindly randomized so that they can receive either Paxlovid or placebo and do not know what they are getting .)

8. How do I monitor myself?

  • Monitoring of Covid-19 symptoms is still important, especially in the elderly and those with underlying diseases.
  • The following symptoms should prevent you from contacting a doctor or going to the hospital:

– Temperatures stay above 39 degrees for more than five days

– Heart rate after more than 125 beats per minute

– Chest pain

– Cough up blood

– Breathing difficulties, rapid breathing, inability to speak whole sentences, difficulty walking

– Rugl

– Children who appear very ill

9. Do I still need to isolate myself?

  • Current guidelines in South Africa are that people who are infected with Covid-19 and have mild symptoms should isolate themselves for seven days from the onset of symptoms.
  • Asymptomatic individuals who test positive (eg pre-travel or pre-surgery tests) do not need to isolate themselves, but should wear good masks and avoid close contact, especially with sensitive people.
  • Positive people do not need to isolate themselves but should be careful; wear a mask, avoid large gatherings and if symptoms occur, you should isolate yourself for seven days.

10. Does isolation still mean staying in my room and leaving my food outside the door?

  • We have learned a lot since early 2020 when shopping bags and shoes were disinfected. The virus spreads in the air and although cleansing is important, I do not believe that it is necessary to lock infected patients inside their rooms.
  • Families need to be practical and do what suits them. If someone in the house has Covid-19, there is a good chance that the rest of the family has already been exposed. Everyone with symptoms should assume that they also have Covid-19 and preferably stay at home, even if they do not test or if they test negative.
  • In the house, the person should wear a mask and keep their distance. Anyone who is vulnerable in the house (elderly / unvaccinated / immunocompromised) should also wear masks and stay away. Rooms should be ventilated; leave windows and doors open and the infected person should not eat with those who are not bent (except outside and at great distances). Everyone in the house should wash and disinfect their hands regularly. If possible, the infected person should sleep in a separate room.

11. What can we do to protect ourselves?

  • Being fully vaccinated and stimulated is the best protection against serious illness, hospitalization and death from Covid-19.
  • While numbers are rising again, each individual needs to assess their risk and do their best to minimize their risk in each position. This can be done by considering ventilation and spacing, wearing masks indoors and cleaning your hands regularly.
  • The quality of the mask is important; The N95 mask for public travel and indoor gatherings is affordable.
  • Anyone who is ill with respiratory symptoms should preferably stay at home and avoid endangering others.

12. Why not just get infected?

  • It is still unpredictable who will be severely affected by the virus.
  • Although most people have mild illnesses, even young healthy people sometimes suffer from serious complications.
  • Long covid is an uncomfortable complication of even mild infections and fatigue, heart and lung disorders and brain fog can last for many months.


We have learned a lot about the virus since March 2020 and now we need to continue living our lives while being careful. Mental health and social life are vital for well-being and although it is important to try to avoid infection, vaccinations and immunity have reduced the threat that has kept us in our homes for the past two years. However, although numbers are rising and there is still some uncertainty about the severity and dangers of new strains, I would still advise caution. In particular, individuals in a risk group need to carefully assess their risks when considering whether to participate in group events, and if they choose to participate, they should do so with a certain amount of vigilance.

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As Covid-19 cases increase, Dr. Sheri Fanaroff answers questions

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