For most of the world, COVID came out of nowhere, like a big smack in the face. Two years and more than 6 million deaths later (100 000 of these officially in SA), it’s still hurting. The economic recovery is slow and people are still being infected. The good news, however, is that SA is nearing the end of the pandemic – at least in terms of deaths during 2022 relative to the number of deaths that will occur from other preventable causes, according to Shabir Madhi, the Wits University vaccinologist who led the local vaccine trials for AstraZeneca and Novavax.

‘The Omicron wave is at its tail end and excess mortality is already on a downward trend and was a blip compared with that experienced in past waves,’ the professor tweeted in January 2022, calling it ‘a turning point in the pandemic’. In a more recent tweet he said that ‘better COVID vaccines are required, but we are no longer at “code red” and it’s time to rebuild livelihoods, economies and all other facets of life that [were] impacted over the past two years; especially in fragile low- and middle-income countries’.

For Madhi and other leading health experts, the goal is no longer preventing infections at all costs – through lockdowns, state of disaster, contact tracing and quarantine – but learning to live with COVID, just as SA is living with other infectious diseases such as TB, HIV/Aids and hepatitis. This means using the lessons from the past two years to prepare the economy against the risk of another COVID-19 variant or an entirely different virus emerging in the near to medium-term future. The pandemic has shown what business, regulators and science can achieve in an emergency, notably by developing, funding and fast-tracking COVID-19 vaccines in record time.

‘We have learnt that we can come together as all sectors of society to address a crisis if we focus on the crisis and the national interest,’ says Cas Coovadia, CEO of Business Unity South Africa (BUSA). ‘We’ve also learnt that there are non-traditional ways of working and a hybrid model will probably be used.’

In this new model, only a few employees will have to go into the office every day while the majority will work remotely from home for some of the time. ‘Our office will become our creative, collaborative workspace where we connect,’ says Desiré Pauw, human capital executive for Momentum Investments. ‘Hybrid requires a completely different way of doing things. Leadership and how we lead our teams in this new way of work and into the future has also changed forever. I believe EQ [emotional intelligence] will be a non-negotiable skill to lead successful hybrid teams.

‘Moving away from managing but rather coaching our employees in order to empower and equip them will be essential. Leaders will be our change ambassadors and, as the drivers of culture for an organisation, will set your business up for either success or failure.’

SA companies were blindsided by the outbreak of COVID-19, although Christopher Palm, chief risk adviser at the Institute of Risk Managers South Africa (IRMSA), says it should have already been on our risk radar. ‘SA considered COVID a “black swan” event – something unpredictable, never seen or heard of before,’ he says. ‘Yet a pandemic is not a black swan. There was enough evidence available from previous pandemics such as the plague, the Spanish flu and Ebola. Or think of the Hollywood movie Contagion, which provides a roadmap on how to respond to a pandemic such as COVID. It identifies very relevant post-pandemic issues. For example, who will make the vaccines? How will we distribute the vaccines? What will the uptake be?’

2020 marked a significant shift in SA’s risk landscape, according to the IRMSA. Many businesses were hard hit by the pandemic (yes, a few thrived, particularly those in the online environment), but the majority could have survived the crisis better had it not been for either a lack of organisational readiness and agility, lack of effective business continuity plans or the absence of visionary and decisive leadership.

Therefore the major lesson for SA boardrooms is that conversations about pandemics, droughts, floods, famine or riots are not too far-fetched and futuristic but necessary, according to Palm. ‘We need to build an emerging risk capability,’ he says. ‘COVID-19 is no longer a risk, because it has already materialised. By definition, risk is the effect of uncertainty on objectives. So we need to talk about our four most pressing “pandemic-like” risks, namely economic collapse, social unrest, failed state and climate change.’

He says the crisis has underlined the need for properly benchmarked risk-management processes, which must include stakeholder analysis; external environmental scan and context; and integrated strategic- and systems-thinking to make sense of uncertainty and to understand the interconnectedness of strategy, risk and resilience. ‘The “learning”, if we did, would have rendered us more resilient,’ says Palm. ‘Learning, adopting and adapting being the operative words in becoming more resilient.’

Despite being surprised by COVID, SA business responded immediately and with full force, displaying the agility required as the scientific understanding of the virus evolved. For instance, there now seems limited value in measuring people’s temperature for building access control; or deep-cleansing shops and offices after an occupant has tested positive. The current recommendations against the airborne virus focus on improving ventilation, wearing masks inside buildings and improving air quality.

Airlines and hospitals already routinely use HEPA (high-efficiency particulate air) filters to eliminate the virus causing COVID-19 from the air, and now a 100% black-owned and controlled company, 3Sixty Biopharmaceuticals, has started distributing a NASA-developed air-purifying technology in Africa. Originally invented to purify the air for astronauts on the International Space Station, the technology uses a patented combination of UVC light and a proprietary, titanium dioxide-based photocatalyst to kill airborne pathogens and allergens. The system, called Airocide, has been clinically proven to eradicate volatile organic compounds, viruses, bacteria, fungi and mould. Importantly, it eliminates 99.9% of SARS-CoV-2, which could contribute to pandemic-proofing a variety of local industries, ranging from healthcare and hospitality, grocery chains, wineries and commercial real estate, to schools and private homes.

However, the most effective weapon against the virus remains vaccination. ‘The science is clear that vaccinated people will not get seriously ill if they contract the virus,’ says Coovadia, who reiterates BUSA’s mantra of vaccination being the responsible thing to do, from a health and economic point of view. He explains that many corporates have, under guidance of the Occupational Health and Safety Act directives, implemented forms of mandatory staff vaccination.

‘Given the recent partial relaxation of some protocols and the intention to lift the state of disaster, employers are responding accordingly. Information we have says vaccinations have gone up from around 60% of staff to 98% after an announcement that mandatory vaccination will be implemented,’ he says.

Most businesses felt they had appropriately responded to COVID-19, according to the IRMSA’s 2022 risk report, yet many were surprised at the enormous impacts of the pandemic. One of these is, without doubt, long COVID – the lingering, often debilitating long-term disease that is set to become a massive challenge for businesses and the healthcare system. ‘It is globally estimated that long COVID could affect approximately 10% of those infected with COVID-19. While we do not know for certain what the burden of long COVID is in SA, it is likely to be similar,’ says Shahieda Adams, associate professor at the UCT and head of the Occupational Medicine clinic at Groote Schuur Hospital.

‘Long COVID is recognised as a disorder in SA and defined as patients diagnosed by means of a positive COVID-19 test who have ongoing symptoms for more than four weeks after the acute illness that cannot be explained by another diagnosis.’ Even young and otherwise healthy people are affected, suffering a long list of symptoms that include fatigue, ‘brain fog’, muscle weakness, breathlessness, sleep difficulties, anxiety and depression. This can go on for months, without indication of relief.

‘From a legal perspective, it may be possible for certain instances of long COVID to be considered a disability,’ says Pareen Rogers, employment lawyer and partner at ENSafrica. ‘This depends on whether the condition results in employees having a physical or mental impairment that is long term or recurring, and which substantially limits their prospects of entry into, or advancement in, employment.’ She explains that employers need to carefully consider the ‘reasonable accommodation’ of staff with long COVID, and that remote working and employee-wellness programmes will become increasingly important.

Diagnosis is key to finding a treatment for long COVID, and a local scientist is making global headlines as her team leads the race to solve the mystery. ‘We found high levels of various inflammatory molecules trapped in microclots present in the blood of individuals with long COVID,’ says Resia Pretorius, head of physiological sciences at Stellenbosch University, who made the microclots visible by using fluorescence microscopy. Currently it’s difficult to diagnose long COVID because it mimics other diseases and there is no general pathology test available. Pretorius believes a blood test to detect microclots as biomarkers for long COVID could be the answer. ‘Even those without long COVID could benefit from such research, as symptoms noted in long COVID patients show many similarities to those seen in chronic and viral-related illnesses including chronic fatigue syndrome – another disease that has been dismissed as “psychological” for decades,’ she says.

The pandemic has been ‘a giant catalyst’ for different technologies, data and research that offer insights into other diseases, according to the Guardian. This includes the rise of digital health and home COVID test kits. But most of the potential breakthroughs are linked to the growing research into high-tech vaccines. The article suggests that this will benefit patients with cancer and a whole raft of infectious diseases, and gives the example of Moderna trialling an HIV vaccine that relies on the same technology as its COVID jab.

SA might still licking its wounds, but the lessons from COVID-19 will ease the burden from other diseases while the country has a real chance to prepare for future risks – be it the next pandemic or another event that seems unimaginable at the moment.

By Silke Colquhoun
Image: Rafe Burchell