On Monday, the Presidential COVID-19 Task Force announced that the entire country had ‘gone green’, representing the first time this year that COVID-19 cases have fallen below 10 per 100,000 this year.
For Batswana who endured the harshest winter in memory, with cases in June and July peaking at a collective 69,711, the latest downtrend is a Godsend. July was the worst month in terms of COVID-19 mortalities, with deaths rising to 573, from 219 in June and from an average of 184 in the five months before that.
During that period, funeral notices became a daily occurrence for many, as both public and private hospitals overflowed and the limited health human resources were stretched to breaking point. Reports emerged of stricken patients waiting for hours in the parking lots of health facilities, while the major hospitals issued notices essentially asking patients to stay away as they were filled up.
The uptick in cases was driven by the delta variant of COVID-19, which is more aggressive in terms of transmission and tends to have worse outcomes in terms of the disease burden. As with other waves, the variant peaked and waned, a situation helped in part by higher vaccination rates and measures to boost healthcare capacity.
The numbers revealed by the Task Force on Monday continue a slowdown in cases seen from mid-August and confirmed by the lifting of the State of Emergency (SoE) on September 30, 2021.
This week, however, authorities warned that even as Batswana reacquaint themselves with ‘normal’ life, the pandemic is not dead and buried.
“We cannot say with certainty that the worst of this disease is behind us,” Health and Wellness chief public relations officer, Christopher Nyanga says.
“We can only wish so.
“Despite the falling infection figures in our country, we have seen surges in other countries in recent weeks, raising fears that a fourth wave may be lurking.
“The Ministry urges the nation to continue observing COVID-19 protocols because COVID-19 remains a threat to humanity in general.”
Locally, several threats to the low cases loom in the short term. The first involves the by-elections to be held on December 18 in 11 wards countrywide. By their nature, elections and the prior campaigning period, involve the gathering of large numbers of people as part of the political process.
Health authorities call such gatherings ‘super-spreaders’ meaning they involve the risk of high and fast infections of people at a single moment. This fact is the reason why by-elections were suspended under the SoE, as protocols such as sanitising and social distancing weaken when large, excited crowds congregate.
In South Africa, similar fears were raised ahead of that country’s recent municipal elections.
“Election day is going to be possibly the most intense with regard to how many people are going to be getting out,” Gauteng Premier, David Makhura was quoted as saying last month.
The fears have largely gone unfulfilled as South Africa’s COVID-19 cases remain generally at the same levels they were after the Delta-driven third wave. On Tuesday, however, the country did record a spike of 566 cases and authorities are keenly monitoring whether an uptrend is kicking off.
In the fight against COVID-19 in Botswana, South Africa has become a good predictor of the next trend of the disease locally. Each of the previous waves, from the original Alphavirus to the Beta and the Delta variants, have hit South Africa first before engulfing Botswana.
Besides the municipal elections, Makhura also cited another threat to the low cases.
“From the elections, we know that we are going into the festive season and people are going to be travelling,” he said.
The same concerns are echoed locally, where the last Christmas and New Year festive season led to an explosion in cases and deaths.
Task Force data indicates that from monthly cases of 3,897 in December last year, Botswana’s cases jumped to 9,145 in January, then to 11,716 by March. The jump in deaths was even more dramatic, rising from 21 in December to 121 in January and 243 deaths for March.
The festive season will be a testing period for the country, particularly as it comes in a year in which Batswana spent most of the time under inter-zonal restrictions.
In South Africa, a few weeks ago, scientists had even gone as far as predicting the very day they expect the fourth wave to begin in that country.
The difference, however, between the previous waves and the expected fourth wave is higher vaccinations as well as more robust healthcare resources and infrastructure. By Tuesday, 54.7% of the eligible population had received their first dose while 27.3% were fully vaccinated. The lull in cases has also allowed critical infrastructure to be added to both public and private health care, which improves the preparedness for the next wave.
“Like all health systems across the world, especially those in developing countries, Botswana’s health care system has been highly strained by this pandemic,” Nyanga says.
“Despite this, the ministry has made great strides in augmenting both the requisite medical equipment and personnel, in order to respond to this public health emergency.
“More medical equipment like oxygen plants and concentrators, are being procured, together with other relevant Personal Protective Equipment.
“The ministry has also engaged more staff, some on a temporary basis, to respond to this emergency with more might and vigour.
“Although this may still not be enough, the ministry believes that with these resources and the experience of its past efforts, it is better prepared now than it was when this pandemic first struck.”
In addition to this, nearly 200,000 people have already had COVID-19 in Botswana and retain a level of antibody response to new infection.
Across the border, the South African COVID-19 Modelling Consortium this week said new data suggested the fourth wave in that country would not be as severe as previous surges.
On Tuesday, Bloomberg quoted the consortium as saying with between 60% and 70% of the population having contracted the disease and vaccinations on the rise, the fourth wave would result in ‘substantially lower’ hospitalisations and deaths than previous waves.
But how imminent is a fourth wave? Unlike the previous waves, which were driven mainly by the emergence of more powerful variants, no new variant of global concern has arisen since the delta variant. The World Health Organisation, which classifies the variants, is monitoring some strains peculiar to certain countries and regions but these have yet to rise to global concerns.
“Both research and experience have shown that the coming of the fourth wave can be determined by many factors, including a surge in infections globally and locally, the number of vaccinated people vis-a-viz those not vaccinated and the emergence of new and more infectious variants,” Nyanga explains.
The health ministry believes pharmaceutical and non-pharmaceutical approaches will delay any new wave and reduce its impact once it lands in-country.
“The pharmaceutical approach involves getting people vaccinated for COVID-19 and the non-pharmaceutical approach involves always strictly following COVID-19 protocols.
“These two approaches have helped reduce surges in COVID-19 infections, including severe cases of the pandemic, both in Botswana and globally.
“The ministry, therefore, urges all Batswana and residents of this country who are eligible for vaccination but are not yet vaccinated, to visit any nearest vaccination site for COVID-19 vaccination.
“The ministry further, urges all Batswana and residents, to always strictly observe COVID-19 protocols, regardless of whether they have been vaccinated or not.”
