Question NW230 to the Minister of Health

Reply:

The decision that asymptomatic persons who test positive for COVID-19 infection do not need to isolate was based on advice from the COVID-19 Ministerially Advisory Committee. This is a committee of scientists that have been advising the Minister and the country on Covid-19 throughout the duration of the pandemic. The evidence underlying this decision can be summarised as follows:

From a public health perspective, the utility of isolation is dependent on rapidly identifying individuals with COVID-19. There is good evidence that the rate of case ascertainment in South Africa during the fourth wave (Omicron variant) is low and this due to a number of reasons including:

• There has been a small percentage of cases (perhaps 16%) that are symptomatic.
• Only a limited proportion of symptomatic cases access testing, and even when testing is performed, they come out with false negative results, leading to only a small proportion of positive cases are identified.
• By the time that the cases are correctly identified and timeously isolated, the onward transmission has likely already occurred between the person testing and the release of the results. This is due to SARS-CoV-2’s high transmissibility around the time of symptom onset, including substantial pre-symptomatic transmission.

At the same time, isolation has a substantial economic and social burden in the current climate, including significantly reducing economic and other activities especially amongst health care workers. On an individual level, extended periods of isolation can result in loss of income, loss of employment, and loss of schooling time.

The period of isolation should therefore be seen as a trade-off between its (limited) benefits and its costs, rather than as an effort to reduce the chances of onward transmission to zero for the small proportion of cases that are identified.

Asymptomatic persons are less likely to transmit the virus, and it is difficult to know when the period for which they are infectious starts and ends. As a result, the costs of isolating asymptomatic cases are considered to outweigh the benefits thereof. It should be noted that though people with asymptomatic infection do not have to isolate, such people should be advised to engage in COVID avoidance practises such as observing strict mask wearing, avoiding social gatherings and avoiding socially meeting with others in indoor spaces.

END.