COVID-19 wave 4 in Western Cape Province, South Africa: Fewer hospitalisations, but new challenges for a depleted workforce

With the announcement of a new SARS-CoV-2 variant of concern containing 32 mutations to the spike protein, South Africa (SA) braced for another December of high rates of hospitalisations, oxygen utilisation and mortality.[1] Omicron has lived up to expectations for high transmission and immune escape, with a reproduction number just over 2.5 recorded in Western Cape Province by December 2021. [2] However, the public breathed a sigh of relief when early Gauteng data hinted at less severe disease. As of 20 December 2021, wave 4 in the Western Cape has fit a similar pattern, with high case rates and growing reinfections but much lower rates of hospitalisation, oxygen and high-care utilisation, and mortality in comparison with prior COVID-19 waves (Fig. 1).[2] Despite the number of daily new diagnoses nearly reaching the wave 3 peak, hospitalisation rates remain a third of prior waves (6% of all cases in wave 4 v. 18% in wave 1), while deaths and oxygen utilisation have not risen above inter-wave troughs (Fig. 1).[2]