In a significant step against the global trend of strict quarantine and contact tracing for COVID-19, South Africa’s Director-General of Health has announced that effective immediately, all quarantine of contacts of confirmed cases will cease and most contact tracing will stop, except in congregate settings and cluster outbreak situations or self-contained settings. The public announcement was made on Christmas Eve and all Provincial Health Departments were notified the day before.

Henceforth, contacts of known cases are to continue with normal activities but with heightened monitoring, such as daily temperature testing and symptom screening, for early detection. If symptoms develop, then individuals will be “tested and be managed according to the severity of the symptoms.” People will not be tested unless they are symptomatic.

There will be no further quarantine of contacts of known cases, regardless of vaccination status. Individuals who are known cases will no longer need to be isolated if asymptomatic. Self-observation for 5-7 days for symptom development and avoidance of contagious settings is instructed.

For covid-positive people with mild symptoms, defined as those “who do not require hospitalization, do not have shortness of breath, dyspnoea or abnormal chest imaging“, isolation is required for 8 days and mask-wearing is mandatory. For covid-positive people with severe symptoms, isolation and mask-wearing is required for 10 days after clinical stability is achieved. No testing (either PCR or rapid antigen) is required prior to returning to work after the 8 or 10-day periods. The announcement further states that “no further testing is required after either 8 or 10 days of isolation.”

Dr SSS Buthelezi made the announcement following advice received from the South African Ministry of Health COVID-19 Ministerial Advisory Committee on 16th December. Copies of the memo were widely circulated on social media and are reproduced here.

Key factors behind the Ministerial Advisory Committee’s recommendation are:

• The proportion of people with immunity to COVID-19 (from infection and/or vaccination) exceeds 60-80% in several serosurveys of the population;
• The emergence of variants such as Omicron are likely to render efforts to eliminate and/or contain the virus unsuccessful;
• The vast majority of cases are not diagnosed, as only an estimated 16% of all cases are symptomatic and testing is skewed toward symptomatic cases;
• The testing sensitivity itself is suboptimal;
• The definition of a “high risk contact” is based on droplet spread while ignoring aerosol spread, and is not appropriate with the increased transmissibility of the new variants and pre-existing levels of immunity.

The Committee advised that “quarantining and contact tracing are of negligible public health benefit”. Further, their advice states that “On an individual level, the consequences of prolonged quarantining include loss of income, loss of employment, and loss of schooling time.”

On the same day that the decision was announced to Provincial Health Departments, South Africa announced it had identified 21,157 new cases and 75 deaths related to covid. It appears however that the peak of cases from Omicron has already passed.

A journal article preprint published on 2nd December 2021 entitled “Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa” concluded that the Omicron variant evades immunity from prior infection and postulated that the variant may evade vaccine-induced immunity. Another paper published subsequently concluded Omicron evades the 4 most commonly distributed covid vaccine products.

Omicron is a game-changer for public health responses to COVID-19 to date. It has become the dominant variant globally, already outstripping Delta, yet is resulting in fewer severe cases. The US has announced it will be reopening its border to South Africa on New Year’s Eve. It is clear that efforts to eliminate or contain this natural tide have been in vain.