Health workers in Alexandra test people for Covid-19. Picture: THULANI MBELE
Health workers in Alexandra test people for Covid-19. Picture: THULANI MBELE

It was tempting for a moment to believe that a 21-day lockdown would save SA from being decimated by Covid-19. From a public health perspective it was undoubtedly the right decision. Taking decisive action just nine days after the first locally transmitted case was a heroic effort to flatten the curve.

However, not unexpectedly, the lockdown brought into sharp focus the economic consequences, trading one sort of human suffering for another. Our economy is a fragile house of cards, easily collapsed with plummeting global markets, currency weakness, spiking unemployment and particularly vulnerable informal and immigrant sub-economies. But the choice between economic and public health disasters is a false dichotomy — financial, social and physical wellbeing are tightly woven together in a way that can’t easily be traded off.

The illusion of being saved by the lockdown was shattered with the realisation of the impossibility of social distancing in poor communities. Close living quarters, communal bathrooms, poor access to running water, a lack of freezer space, reliance on public transport combined with a low trust of the government and the police — a powerful cocktail of impediments to social control. Does this mean the lockdown was a mistake? If it was intended to completely stamp out the spread of the coronavirus, then yes. But if its purpose was to slow the spread and buy us time to get our health system organised, then no.

As we roll out more testing capability, reorganise hospital wards and put in place measures for patients to not have to come into primary care clinics, we are readying ourselves for the worst-case scenario. Good leadership means going in with your eyes open — seeing things as they are. Foolish are the governments that don’t understand exponential curves. Yes, our health system is vulnerable. Compared to developed countries, we don’t have enough health workers, hospital beds or ventilators. But South Africans are nothing if not resourceful. With our limited resources we’ve waged one helluva fight against HIV and TB, and I don’t see us backing down this time round.

The past week has brought one remarkable story after another. Our participation in a global trial to find an effective treatment. Our rollout of drive-through testing facilities. The National Health Laboratory Service stepping up testing capacity and rolling out GeneXpert machines for rapid testing. A wide-ranging community of health-care providers and funders pushing back against the Health Professions Council of SA’s archaic stance on telemedicine. The launch of a world-leading WhatsApp hotline. The software development community coming together to voluntarily work out a range of tech solutions.

Zero-rated data for online learning resources. The remarkable decongestion of public primary care clinics. Intense collaboration between epidemiologists. The rapid rollout of tax and social security benefits. The coming to the table of private money. Is there more we can do? Undoubtable! Pulling the brakes on an economy is a gargantuan task with a myriad unintended consequences. So yes, there will be U-turns and it will feel at times like being in a game of whack-a-mole. There is no perfect way to do this, but we all have a role to play in getting behind the collective effort.

Much has been made of South Korea’s successes with Covid-19: their swift action, widespread testing and contact tracing. We’ve followed closely by also acting quickly and doing our best to deepen access to testing and screening. There is one critical cultural aspect we do need to take note of, something every individual can take responsibility for: a co-operative citizenry. We need to be doing our best to deepen social solidarity, holding on to our empathy and humanity, remembering that we are all in this together.

There is no doubt that global society will be reshaped by the crisis. The way we think about the right to health care, how humbled we are by our interconnectedness, the mind-boggling degree of scientific collaboration to hurtle us towards a vaccine and treatment. Many of the decisions we take now will be with us for a long time: how we reshape our educational institutions, the crumbling of resistance to digital technologies, the degree to which we permit human rights to be overridden in the name of state control. All of these decisions require clarity of thought, looking our collective fear in the eye and then choosing wisely.

• Dr Ranchod is with the University of Cape Town’s actuarial sciences department, specialising in the health-care sector.