A fifth COVID wave is likely to erupt in South Africa much sooner than previously thought. The number of infections has steadily increased over the last 14 days. According to virologists and scientists, these infections are most likely caused by the BA.4 and BA.5 subvariants of Omicron. Public health officials are on high alert and closely monitoring the situation. There is a need to understand what is causing the recent increase in COVID cases, as well as the global implications.

Early evidence suggests that BA.4 and BA.5 can avoid the antibodies produced by a prior BA.1 infection in unvaccinated people. Because only about 30% of South Africans are fully vaccinated, the country is experiencing this surge.

In South Africa, the number of cases per day has been decreasing since February. However, the number of infected people began to rise last week and has continued to rise at a rapid pace since then. South Africa is now recording thousands of cases per day, up from a few hundred just a few weeks ago.

The rate of positivity has increased from 4% in mid-April to 19% last Thursday. Water-quality monitoring has also revealed an increase in the spread of coronavirus.

South Africa was the hardest hit of all African countries, with the highest number of coronavirus cases and deaths.

The fourth wave, as it was known, passed in January. Scientists predicted that the fifth wave would arrive in the United States as early as May or June. These two months are winter months in the Southern Hemisphere, when transmission is expected to be lower than during the summer season.

The number of COVID cases decreased after the pandemic caused by Omicron reached its peak in December. However, the caseload has tripled in the last week. Positive attitudes among the general public have risen in tandem with an increase in the number of hospitalized people. This has health officials concerned that the country is on the verge of a fifth COVID wave.

However, South Africa’s Minister of Health, Joe Phaahla, recently told reporters that while the number of hospitalizations had increased, there had been no significant increase in deaths or ICU admissions. He also stated that, with the exception of Omicron variants, health officials had not been notified of any new variants circulating in the population. This is significant.

The BA.4 and BA.5 Effects

This recent increase in cases has been directly linked to BA.4 and BA.5, two different sub-variants of the Omicron strain of Coronavirus. At a briefing, Richard Lessells, an infectious disease specialist, suggested that the previous four waves’ reduced immunity may have contributed to the latest resurgence of cases. According to him, the increasing number of cases attributed to the BA.4 and BA.5 sub-variants of Omicron suggests that they have a growth advantage over other sub-variants of Omicron such as BA.2.

The director of South Africa’s KwaZulu-Natal Research and Innovation Sequencing Platform, Tulio de Oliveira said that the BA.4 and BA.5 sub-variants are an example of the evolution of the virus in different ways in response to an increase in immunity on a global scale. According to him, the recent outbreak in South Africa is the result of sub-lineages of the current variants rather than completely new variants.

It is important to note that since its discovery in Botswana and South Africa, Omicron has produced several different sub-variants, but there is no evidence that sub-variants BA.4 and BA.5 cause a severe disease over Delta. Despite an increase in COVID cases in the country, Omicron’s virulence has remained low in comparison to Delta.

During the pandemic, South Africa reported over 3.7 million COVID cases and over 100,000 deaths. Last Thursday, WHO’s office in South Africa attributed the rise in the number of infections in the country as the primary cause of the uptick in cases all over Africa.

The growth advantage of Omicron BA.4 and BA.5 over BA.2 and BA.1 is 0.08 and 0.12 per da.

The BA.4 and BA.5 spike in the country is concentrated in the Western Cape, Gauteng, and KwaZulu-Natal provinces. Scientists are trying hard to understand what this spike means about immunity from previous cases of Omicron infection. The highly contagious Omicron variant first appeared in South Africa last year, and it quickly spread to the other continents.

Nicholas Crisp, a senior health official, stated on Friday that South Africa has enough vaccine doses and has no plans to obtain more, and that the country does not intend to purchase Pfizer’s Paxlovid (COVID treatment tablet) for public-sector patients due to the high cost.

According to some experts, approximately 90% of South Africans may have some form of immunity. This is because of the immunization and, to a lesser extent, the previous infection. Immunity from COVID infection begins to wane after about three months, according to Dr. Ali Mokdad, an epidemiologist at the University of Washington. At this point, reinfection is a distinct possibility because people in the country and around the world are wearing masks less frequently and traveling to different regions more frequently.

According to emerging data, BA.4 and BA.5 easily evades the body’s natural defense mechanism developed in response to previous Omicron infection in unvaccinated populations. The Omicron variant, also known as BA.1, was responsible for the country’s massive increase in COVID cases last winter. As a result, the new sub-variants infect humans and cause symptomatic infections which is why BA.4 and BA.5 are fueling the new surge in cases in South Africa.

Scientists in the country are attempting to determine whether this fifth wave causes severe or mild illness. It’s also unclear whether the BA.4 and BA.5 sub-variants will appear in other parts of the world. According to Dr. Kavita Patel, who worked with the Obama administration to combat the H1N1 virus, this is an awkward time for people all over the world because past trends cannot predict future ones.

Patterns that were once familiar, such as a wave in one country synchronizing with a wave in another, no longer apply. To stay on top of the situation, however, it is necessary to monitor situations as well as data coming from countries such as South Africa. This will provide consistent signals for understanding the virus’s evolution in the future.

BA 2.12.1 Emergence in the U.S.

BA.2 is currently the dominant strain in the United States. The sub-lineage of BA.2.12 has also accelerated. BA.4 and BA.5 were also discovered to be present in the population, albeit at low levels. Omicron BA.2.12.1, according to virologists, has a mutation similar to Delta in that it carries the L452R mutation, which is not found in the original BA.2. In terms of weekly growth, it outperforms BA.2 by 30 to 90 percent.

BA.2.12 and BA.2.12.1 are rapidly spreading throughout New York and the rest of the United States. In New York City, infection rates have risen to nearly 2,500 per day, up from 600 in early March. This was enough to reclassify the city as COVID risk “medium.” BA.2 accounted for 88 percent of the nearly 3,600 analyzed cases in California in April, while ascendant BA.2.12.1 and its relative, BA.2.12, accounted for 9 percent. BA.2.12.1 is thought to be 25% more transmissible than BA.2.

Some health experts say South Africa’s BA.4/BA.5 wave could repeat in the U.S. — but probably not immediately. Experts warn that the true number of infections could be even higher because many New Yorkers test at home, and positive results aren’t included in the city’s official tally. Although hospitalizations have remained low thus far, the increase in cases may spark a debate about the return of masking and other health restrictions.

According to Dr. Eric Feigl-Ding, the takeaway from all of this is that transmission must be stopped at all levels, which can only be accomplished if people follow COVID-specific behavior. This is not the time to be complacent; rather, we must ensure that the spread is largely contained, resulting in fewer infections and fatalities. And, as evidenced by the data presented above, we can all agree that #COVIDISNOTOVER.

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