The early months of the COVID-19 pandemic were marked by uncertainties over the behaviour of the novel coronavirus, delays in decision making by governments, and the management of a global pandemic along strictly national lines. As we approach the second anniversary of the pandemic, a new variant of SARS-CoV-2 has just been identified in South Africa and many of the past uncertainties have resurfaced yet again, generating responses we are by now all too familiar with.
It is natural for viruses to mutate, as this is the only way they can ensure survival in an increasingly hostile environment. B.1.1.529 was accordingly first recognised by genomic (gene sequence) analysis on a specimen obtained on 9 November in South Africa’s Gauteng Province, which includes the major cities of Johannesburg and Pretoria. The variant was subsequently identified in 77 samples collected in Gauteng between 12 and 20 November, and analysed at the University of KwaZulu Natal, before being reported to the WHO on 24 November. The first cases outside South Africa were reported from Botswana (on 11 November) and Hong Kong (in travellers from South Africa), and also from Belgium (in a traveller from Egypt via Turkey) and Israel (in a traveller from Malawi), and it is likely that others are waiting to be discovered elsewhere.
The newly recognised variant is reported to carry more than fifty mutations in all, with at least 32 of these involving the virus’s all-important spike protein, including ten on the receptor-binding domain where the virus attaches itself to human cells. The immediate implications of this major genetic transformation in the virus are the possibilities that this particular variant is more likely to be transmissible, to predispose to reinfection and possibly more severe illness, and to reduce the efficacy of available coronavirus vaccines (immune evasion) and anti-viral drugs. Before long, in keeping with more recent tradition and to avoid labelling it by nation of origin, the variant was renamed “Omicron” (fifteenth letter of the Greek alphabet) and simultaneously declared ‘a variant of concern’ by the WHO.
Governments had to be seen to act swiftly, in part to counter previous accusations of delayed action or even inaction in the face of a public health crisis. In what was claimed to be a “precautionary measure”, the EU, UK, US, Canada, Australia, Brazil, and Russia soon banned all flights to and from South Africa and seven other southern African nations (Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, Zimbabwe), with others expected to follow imminently. The flight ban was to come into effect in most places by 29 November, although the UK “red list” restrictions kicked in at midday on 26 November, shortly after a Virgin Atlantic flight from Johannesburg had just landed at London’s Heathrow Airport. This travel ban was immediately criticised by the South African Health Ministry as “draconian” and “unjustified”, while the WHO advised a “risk-based and scientific approach”. The points were made that initial detection of variant in a particularly location does not automatically imply it is also the place of origin, and that the reimposition of a travel ban would further damage South Africa’s already struggling economy.
South Africa has been here before. An earlier variant, subsequently named the Beta variant (B.1.351), was first identified in the Nelson Mandela Bay Municipality in the Eastern Cape Province on 15 October 2020, driving a second wave of COVID-19 and inflicting serious damage on the national economy. Like Omicron, the Beta variant was also declared a ‘variant of concern’ by the WHO at the time. Beta faded away over time, with only 6,700 cases reported in the country by the end of October 2021, and its impact on health turned out to be less severe than initially predicted. Naturally there are concerns in South Africa over a repetition of the economic shock from last year.
One particular feature of the coronavirus pandemic is an accompanying viral proliferation of experts, all equally willing to speak in public, to be interviewed, or to share their expertise in many other ways, ostensibly to inform but often more likely to further confuse and increase anxiety within their respective audiences. Some have been warning of impending disaster, claiming vaccines are likely to be ineffective, while others are being more restrained, saying not enough is known to be able to comment. Some support a travel ban while others consider it a disproportionate response. And there is more of the same yet to come. What seems clear is that not enough is known on which to base authoritative comments on. In these circumstances, confusing speculation is likely to be unhelpful in the days to come.
A sensible course of action would be to trust our public health authorities and to be guided by their recommendations. Whenever decisions have to be taken rapidly on the basis of incomplete, and sometimes imperfect, information, less than perfect choices may be taken, as is well known from the fields of economics and medicine, but we can only recognise these with the benefit of hindsight. It is important, however, that national authorities engage with one another constructively as they coordinate their efforts to control the spread of the new variant in what may possibly turn out to be yet another setback in the continuing fight against COVID-19.
Ashis Banerjee.