‘It could be COVID-22’: SA expert explains ‘worst outcome’ for next variant

With the emergency phase of COVID over, SA is heading into its first wave of the virus with no lockdown measures in place. Countries like the UK have seen coronavirus numbers rise and decrease in cycles since lifting their restrictions, and health systems have not been overwhelmed. But could a ‘COVID-22 variant’ change that?

Why are cases rising in South Africa?

The name sounds a little dramatic, and given the context of Shabir Madhi’s comments, it’s easy to understand why. The leading vaccinologist at Wits University has been discussing what a ‘worst-case scenario’ for South Africa would look like, if a new, non-Omicron-related variant emerges.

South Africa has seen its COVID cases rise significantly in the last week. A combination of seasonality and new Omicron ‘sub-variants’ are to blame – but Madhi believes the fifth wave won’t ‘max out’ our medical facilities.

“South Africa on cusp of resurgence, after the high infection rate with Omicron – albeit with massive decoupling of infections and severe disease materialising. Current resurgence likely due to sub-lineage of Omicron, BA.4.”

Shabir Madhi

Immunity levels in South Africa ‘very encouraging’

He’s right to say there is no need to panic. South Africa has a high coverage of population immunity, through either natural infection, vaccination, or hybrids of both. While these surges are being driven by sub-variants and strains with familiar lineages, society will continue to function by treating the virus as endemic.

Need to be cautious, but no need to panic as we live with the virus. Any pretence that we achieve much with regulations aimed at preventing infections is dismissive of what transpired in SA, and agnostic to the detrimental impact on SA which disproportionately affected the poor

— Shabir Madhi (@ShabirMadh) April 23, 2022

Only a ‘COVID-22 strain’ could break SA’s immunity wall

Madhi, however, says there is one ‘very unlikely scenario’ that can take us back to square one. If a new variant was able to bypass our T cell response, that’s when existing immunity would be rendered ‘largely obsolete’.

It sounds scary, but in all honestly, our T cells are an incredible line of defence against infections. They are the body’s strongest wall against severe disease, and for a mutation to find a way past it, it would have to essentially evolve into something so radically different, the strain could be renamed as ‘COVID-22’.

• Thankfully, however, the chances of this actually happening remain extremely slim…

“It’s very unlikely, but the worst thing would be if a new variant could evade T cell immunity, which protects against severe COVID. In the unlikelihood of that occurring, we’d be back at square one – as would make current immunity largely obsolete, taking us back to March 2020. We could therefore rename the virus COVID-22.”

Shabir Madhi